There are two kinds of people in med school: those for whom the final year is intensive enough to keep them busy and those who can combine final-year exams with other things like starting a capital-intensive and time-consuming venture.
Shamim Nabuuma is one of the latter.
Nabuuma was born and raised in Uganda. From a young age, she decided to become a doctor because her parents encouraged her to follow that path. Hence, it was no surprise when she went on to study medicine at Makerere University.
In 2017, while in her final year and having spent a lot of time working with patients in the cancer institute, Nabuuma decided to solve a pertinent problem in Uganda. Realising that people in rural Uganda could not access many of the vital services available in urban areas, particularly in cancer care, she set out to bridge this gap and transform healthcare with Chil Femtech Center, initially called Chil AI Lab.
“After seeing what was happening in the community and working in hospitals, my ideas changed. I thought, ‘it’s not just about myself, it’s about impacting other people out there,’” Nabuuma tells Techpoint Africa.
With 73.23% of Uganda's populace living in rural areas in 2023, over half of the country's residents were cut off from proper healthcare access.
The dearth of healthcare professionals in rural areas is not isolated to Uganda; it is an African problem. About 55% of the African population lives in rural areas, and they are being served by 20% of the constantly dwindling healthcare professionals on the continent.
In many extreme cases, as in Kenya, where 80% of the population resides in rural areas and only have access to 16% of the doctors in the country, adequate healthcare is a luxury.
“We realised that when you move to rural areas, in most villages, there is usually a local clinic that does not have a doctor to treat people.”
Creating a mobile cancer screening clinic
Chil Femtech Center was built on the foundation of a mobile cancer screening clinic. Motivated by her work with cancer patients in hospitals and her experience in the community, Nabuuma decided to take a more direct approach to fighting cancer. Instead of waiting for women diagnosed with cancer to come to the hospital for care — usually when it is too late — she set up a team of healthcare professionals, some of whom were paid and others who volunteered, and created a mobile cancer screening clinic. The clinic would visit rural areas in Uganda and screen women for breast and cervical cancer.
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Breast cancer is the most common cancer and the leading cause of cancer-related suffering and death among women globally. In sub-Saharan Africa, it is the leading diagnosed cancer. Cervical cancer is the fourth most common cancer in women, resulting in 350,000 deaths globally in 2022.
While both forms of cancer are highly treatable, the lack of awareness among African women continues to lead to high mortality rates. Most women affected by breast cancer in Uganda are diagnosed at stage III or stage IV, when treatment is more difficult and survival is significantly lower. Due to this, one in two Ugandan women diagnosed with breast cancer will die.
To tackle this, Nabuuma began visiting rural communities with her team of healthcare professionals, informing them about the cancer screening clinic and educating them on the advantages of the screening.
Instead of dealing with individual women, the clinic interacted directly with women’s groups, which would often contribute money to be screened as a group.
Nabuuma recalls, “The women would contribute $1 (USh 3,000) to pay for the screening, and sometimes, it would take three months to come up with the money because you know, they are farmers and have to wait for the farming season. Sometimes, we would allow them to pay in installments.”
After the women had put the money together, they contacted the clinic to come for the screening of their members. So Nabuuma and her small team of doctors and nurses would go to the community with their lab equipment, set up tents, and screen the women.
“We did it the first time, and another region saw it and asked us to come. So, we had to also look at that group. Over time, it gained so much visibility that the numbers were so many, and the doctors we had were not enough. We were overwhelmed by the numbers.”
Technology saves the day
The first introduction of technology to the mobile screening clinic was as a website for educating women about breast and cervical cancer and setting up telemedicine consultations. After realising the overwhelming number of questions they were receiving at the cancer screenings, Nabuuma decided that it was best to create an online platform where women could get educated on breast and cervical cancer.
A striking feature of the website was a chatbot, through which people could ask questions and get answers immediately. It became an excellent resource for health education for women. Because improving access to healthcare can often hinge on bridging the digital divide, Nabuuma created the dial version of the chatbot. This allowed people without an Internet connection or smartphones to call in, ask their questions, get answers, and request a doctor.
The clinic received initial funding from the Tony Elumelu Foundation, which allowed it to scale further and gave Nabuuma a bit of respite from maintaining the venture with her personal funds. However, sustaining the mobile cancer screening clinic proved to be difficult, and it had to be shut down due to slim margins and the capital intensity of the equipment and logistics required. But, the technology stayed at Chil.
“The problem came when the numbers increased, and I could not fund it because people wanted the services, people were dying, but I did not have the money, and they also did not have the money.”
Birthing KETI: Transforming healthcare accessibility with AI
Nabuuma's journey eventually led to the creation of the Knowledgeable Expert Technology for Innovation (KETI). An artificial intelligence chatbot that interprets medical reports, predicts healthcare possibilities, and recommends pathways to treatment.
Despite having to shut the cancer screening clinic, Nabuuma was still focused on finding solutions to improve healthcare accessibility in rural Africa.
"People lack access to healthcare services because they lack access to healthcare professionals. Most of the doctors concentrate in the town/urban areas. The doctors are rarely in the rural areas. Local clinics cannot employ a doctor to be stationed there full-time because they don’t have that capacity," Nabuuma tells Techpoint Africa.
Chil could solve this problem by connecting them with professionals over the Internet through KETI, its telemedicine platform, using a hub-and-spoke model.
The hub is Chil’s network of healthcare professionals and partner hospitals, pharmacies, and laboratories; the spokes are local clinics and schools that require these professionals' services. With KETI, patients in remote areas can receive medical attention and consultations from the hub through a spoke network of local facilities in their proximity.
“So, we go to look for these local clinics, assess them, and see how many patients they get and what services they require. That helps us know what kind of healthcare professionals they need,” Nabuuma tells Techpoint Africa.
Local facilities register on the platform, and when they receive patients who require extensive care they are not equipped to provide, with KETI, the facility connects the patient with a qualified professional from Chil's hub for a telemedicine consultation and, if necessary, extended care.
For example, if a pregnant woman in rural Uganda walks into the local clinic in her community in need of a gynaecologist, the local clinic logs into the KETI app and connects the patient with one of Chil's partner gynaecologists. The gynaecologist consults with the patient and can request tests to be taken at a laboratory within the network. When the results are uploaded on the app, KETI alerts the gynaecologist, who can review and recommend the next steps in the patient's care.
If the situation is out of hand and the local facility cannot handle it, KETI can recommend hospitals within the network that are better equipped for that patient. They can be referred there for further assistance.
“We have about 75+ doctors registered on our platform. So, most of the time, it is unlikely for someone to come on KETI, and they don’t get a doctor to work on them.
“We just want to ensure that even someone in the village can get the same services as someone in the city. Just democratising access to healthcare services so someone doesn’t feel that some services are made for only those in urban areas,” Nabuuma tells Techpoint Africa.
Furthermore, KETI helps patients understand their health better. It offers medical interpretation services to help patients understand what their medical reports say about their health.
Health illiteracy is more pronounced in rural communities, with residents often unable to understand important information about their health, usually leading to reduced prevention participation and terrible health management.
To tackle this, KETI breaks down medical reports into layman's language. By uploading a picture of their report to the chatbot, patients get immediate insight into their health status.
“If you are being treated by a doctor, they’ve given you a report, and you want to know more about what the doctor said, you upload it to the chatbot or the phone number, and it will interpret it for you.”
It interprets in four languages: English, French, Arabic, and Swahili, with plans to add additional African languages.
“It helps people to know what to ask their doctors because they now know a bit about their health,” Nabuuma tells Techpoint Africa.
AI-driven predictive healthcare for maternal and cancer care
Maternal and cancer care are two core services that Chil Femtech Center offers. With KETI, Chil uses artificial intelligence to analyse data and make predictive analyses on the best path for care and medication recommendation for pregnant women and cancer patients.
Sub-Saharan Africa accounts for 70% of maternal mortalities in the world. But with technology, cases of maternal mortality have become easier to manage. With early intervention, issues leading to maternal mortality can be caught and addressed early.
KETI collects and tracks data on pregnant women, such as blood pressure, test results, and foetal positioning, over several months and uses this to monitor maternal care, predict high-risk pregnancies, and recommend specialised care.
KETI identifies warning signs for conditions like pre-eclampsia and alerts doctors for early intervention, assesses foetal position and forecasts the possibility of pre-term births.
This gives medical professionals in charge of women’s health a holistic view of their challenges and the best ways to address them.
On the mothers' side, KETI provides adequate antenatal and postnatal education. Many rural women lack knowledge about their pregnancies and potential complications, and access to KETI offers them a repository of resources where mothers can learn what to do during and after pregnancy, including personal care, breastfeeding, and general child care. They can also ask the chatbot questions and get immediate answers.
“KETI has all these resources so that people can know exactly what is happening with their bodies,” Nabuuma says.
For cancer patients, KETI is crucial in recommending effective treatment options and drug combinations. Cancer treatments often involve trial-and-error approaches when medications become ineffective.
Hence, KETI studies cancer data from patients at different treatment stages in various geographical areas and analyses which drug combinations have worked for similar cases.
“For cancer, it guides doctors on the best combination of drugs to give at any stage. KETI can capture how each patient at any given cancer stage will respond to a combination of drugs that has been given to them. It analyses the data, and it comes up with case studies on how different stages of cancer have responded to different combinations of drugs,” Nabuuma explains.
Doctors using KETI can upload a patient’s medical history and request treatment guidance. The platform processes the data and provides evidence-based recommendations, allowing doctors to have more varied options and make more informed decisions. Moreover, cancer patients can be connected with registered oncologists worldwide for consultations that can transform their care.
“If a doctor gets a patient with any type of cancer and they are not responding to treatment, and the cancer levels keep increasing, what they need to do is go to KETI, click on advise me, upload the medical results and reports. It uses high-level AI to analyse the combinations that have been successful for similar patients,” Nabuuma tells Techpoint Africa.
The future of Chil Femtech Center
From a screening clinic in Uganda, Chil has expanded to Ethiopia, Kenya, Tanzania, Europe, and the Middle East. Nabuuma envisions scaling Chil across other African regions and offering KETI’s services in more languages.
“We want to see all rural areas get services similar to urban areas,” Nabuuma tells Techpoint Africa.
She believes that increased healthcare accessibility is crucial for Africans.
“We want to democratise access to healthcare in the different healthcare sectors. We want to bridge the gap so that people will not die because they are not informed. We also want to make people understand that AI has not come to take away their jobs. It has come to make their jobs easier.”
Chil Femtech Center is revolutionising healthcare access in East Africa, Europe, and the Middle East and offering innovative technological solutions to health issues.
Artificial intelligence is rapidly transforming all areas of life, including healthcare. Healthtech solutions are becoming more common in Africa's tech ecosystem and have been well-received by investors.
