The boy’s father pulls away the red blanket, hesitantly exposing the child’s upper body. A huge bright spot extends from the abdomen to the right wrist. Shamsa Yahya's face remains passive. In a calm voice, the pediatrician asks a nurse to turn the screen a little further. Now, the camera is focused entirely on the patient’s upper body. "An extensive burn, a pot of boiling water was dumped on him a few days ago," says a nurse, who is sitting next to the father and son. Some areas are already healing well, but his wrist remains a cause for concern.

Yahya, the doctor, takes some notes. She’d like to take a closer look at that area of skin, but the tele-consultation camera, which usually sends high-resolution close-ups live to the doctor’s office in Nairobi, isn’t working right now. Yahya is actually 400 kilometers (248 miles) away from her patient, in a small office at Gertrude’s Children’s Hospital. The boy, meanwhile, lives in Homa Bay, a town in western Kenya where there are no pediatricians far and wide.

The nurse on the other side of the remote connection links the doctor to her patients. He has several simple devices at hand: a stethoscope with a USB connection for transmitting the sounds of hearts and lungs to Dr. Yahya’s headphones in real time; a small, white ultrasound machine; and the tele-consultation camera, even if it isn't currently working.

Yahya asks the nurse to slowly reduce the boy’s medication, but adds that the child urgently needs to see a surgeon to restore the burned areas of the skin to the extent possible. The father nods reluctantly and then stands up. His telemedicine session is over, and the next patient, who has an ear infection with discharge, is already waiting. The pediatrician treats more than 20 children a day remotely, switching within minutes between Homa Bay, Lamu Island and Garissa, located not far from Somali border.

She has only been working in the telemedicine department at Gertrude’s Hospital for a week, but she’s already slowly getting used to the screen that connects her with her patients. "Of course, it’s not the same if I can’t touch the children, but it still works amazingly well. And they never would have seen a pediatrician otherwise."

"COVID has really advanced telemedicine," says Robert Nyarango, CEO at Gertrude’s Children’s Hospital. He’s a man of numbers, and he can recite them by heart as he spins back and forth in his black office chair: Some 300 patients a day are now receiving treatment through telemedicine, and that number is steadily increasing. Most can be immediately helped, while 15 percent are referred to other experts. Recently, they even managed to discover a heart defect using a USB stethoscope. The child was immediately flown to Nairobi for surgery and is now rapidly improving.

The Children’s Hospital CEO had been thinking of introducing telemedicine solutions for some time, but there was widespread skepticism and funding had been difficult to obtain. "The pandemic has completely changed that, and the acceptance of digital solutions is much higher now," says Nyarango. A major sponsor from the digital economy stepped in to pay for the equipment and set up internet connections in remote health clinics. The number of children treated digitally is growing almost daily, and word of the concept is spreading. What likely would have taken years prior to 2020 is now taking only a few months.

Much has been reported about how the pandemic overwhelmed health care systems around the world and how countries in the Global South, in particular, quickly reached their limits, with the pandemic magnifying shortcomings that already existed. But little attention has been paid to what this disruption might produce in the long term. African politicians who were used to jetting off to India, the United States or Europe for excellent medical care suddenly found themselves stuck in their own countries and had to rely on their own health care systems for treatment. Many of them ended up in the COVID wards of Kenya, Malawi, Zimbabwe and Nigeria. And they inevitably started asking the same question: Shouldn't we be focusing on making immediate improvements?

Thierno Balde coordinated COVID measures for the World Health Organization (WHO) in Africa, a role he still occupies. But the focus as shifted as the pandemic has waned. "We need to look now at how we can make a difference in the long term, how we can keep attention focused on the health sector," he says. During the pandemic, almost all African countries significantly increased their public spending in the area of telemedicine – about time, experts say. Prior to COVID, many heads of government preferred to focus on fancy road projects, new government buildings or airports. "We’re seeing the trend falling back into this old pattern, and we can’t allow that happen," Balde argues.

Yet the benefits of a well-prepared health care system have made themselves apparent since the pandemic, says the WHO expert. When the Marburg virus recently broke out in Tanzania, it was quickly detected and combated, thanks to mobile laboratory capacities from the corona period. Authorities in Malawi were able to bring a cholera outbreak under control because the authorities could draw on infrastructure put in place during the measures to contain the spread of the coronavirus. And when Ebola spread in Uganda last year, teams of nurses promptly assembled to spread familiar messages over loudspeakers: Keep your distance. Wash your hands. Remain in quarantine if you've had contact with infected individuals.

At Metropolitan Hospital in eastern Nairobi, surgeons are just finishing a complicated spinal operation. Swabs full of blood lie on the floor, and the surgeon is still wearing his green scrubs from the operation as he fills out the patient’s chart. They have four state-of-the-art operating rooms here, with a digitally adjustable temperature, huge monitors built into the wall and a special air conditioning system that provides permanent negative pressure, ensuring that viruses can’t spread. And this in a district in the Kenyan capital that more prosperous people generally try to avoid.

The hospital also managed to generate record profits during the pandemic. The medical facility quickly converted its pediatric ward into a COVID unit, which was then completely occupied for months on end. The treatment cost thousands of euros, including ventilation and medication. The lucky ones had medical insurance that picked up at least part of the costs. At the same time, the machines in the laboratory ran day and night evaluating PCR tests, another extremely lucrative source of income.

CEO Kanyenje Gakombe is sitting on the top floor of Metropolitan Hospital. He is well-connected in Kenyan politics and has worked as an adviser to past presidents and now heads the Kenya Healthcare Federation. "During the pandemic, the number of patients and our revenue increased significantly, and we decided to invest the money," he says.

One of his employees leads the way to a modern plant that produces medical oxygen, 300 liters per minute using technology made in Germany. It is located directly opposite the CEO’s office. The tour continues to the intensive care unit, which is relatively empty on this Thursday in March. One patient is on a ventilator; another is already on the road to recovery. But Metropolitan Hospital could provide care for many more critically ill patients. Some 13 ventilators have been operational at the hospital since the pandemic. The machines have been purchased throughout the country, even in rural public hospitals. Maintaining and protecting them from theft has turned out to be the biggest challenge. Or, as hospital CEO Gakombe puts it, "Devices like this can grow legs pretty quickly."

Nurse Emily Chepn’geno checks the patient’s breathing tube. Everything seems fine. She’s just pleased that the pandemic is over and normality has returned. But she says there are some remnants from the pandemic. Like the WhatsApp group that Nairobi’s critical care nurses used to join forces in July 2020. "We still use it to exchange ideas about all kinds of things when we get stuck," says Chepn’geno. Or an informal system for referring patients to other hospitals using quick dial lists on mobile phones. What sometimes took hours before COVID is now done in seconds and is well rehearsed. In addition, all nursing staff are now trained in resuscitation, both in theory and, due to experience in the pandemic, in practice.

Hospital boss Gakombe has big plans – he wants to make full use of the new operating theaters, which have become money makers for his hospital. Joint operations, brain surgery, minimally invasive procedures – it should now be possible to get any of these done in Kenya. He’s also pinning his hopes on politics. "When I was a presidential advisor, it was always about the economy. Health played virtually no role. That’s different now. The issue is at the top of the agenda," says Gakombe. In fact, there have been ceremonious openings of numerous health centers in Kenya in recent months. But it remains to be seen how sustainable the whole development will be.

WHO coordinator Thierno Balde is cautiously optimistic. "The pandemic was a tough wake-up call," he says. "Now, it is up to us to do something about it."