The Human Face of Telecommunication Development

INTERNET AND HEALTH: is there a doctor online?

Geneva, 7 March 2002 — Picture this. A young child in a poor, rural town, playing football by the side of a busy road, runs out on the street to chase the ball and is hit by a car. The frightened parents take the unconscious child to the nearest medical centre for emergency aid. The doctor, a young, eager but inexperienced practitioner fresh out of medical school, takes an X-ray of the child’s skull to determine the extent of the injuries. Although the child is stable, the doctor faces the difficult dilemma of either providing treatment locally, based on his or her own diagnosis or sending the child on a long, arduous and perhaps dangerous journey to the capital for treatment at the country’s better-equipped hospital. It is a choice, which could have life or death consequences.

Now picture the same scenario, but with a different ending. The injured child is brought to the rural doctor. The doctor takes an X-ray of the skull, but instead of making the diagnosis, he or she sends the image via the Internet to the hospital in the capital so that more experienced doctors can make the call. The image is sent via low-cost teleradiology equipment, which not only allows X-rays to be sent in a digital format clear enough for experts to identify the extent of injury, but also allows the experts to send advice back to the doctor for treatment. The doctor successfully treats the child, who soon returns home and continues to play football with friends, well away from the busy road.

A vision of the future? No! A snapshot of reality in countries such as Mozambique shows that "telemedicine" is making a real impact on the availability of health care and health care information in the developing world. Telemedicine is a term, which describes the provision of medical services and health care via telecommunications-based systems such as the Internet, either by terrestrial, wireless or satellite links. Mozambique is viewed as one of the most successful examples of telemedicine in action.

The Government of Mozambique, in cooperation with the International Telecommunication Union, has established a telemedicine link between the central hospitals of Maputo, the capital, and Beira, the country’s second largest city some 1000 km away from the capital. The link allows the hospitals to exchange messages regarding laboratory results and treatments as well as radiographs. As a result, doctors in Beira can refer cases to the central hospital in Maputo for primary or secondary opinions and send medical records to the capital so that experts there can determine whether patients facing more serious problems can be treated locally or transferred to Maputo. The project was especially important for the hospital in Beira since it had no radiologist when the telemedicine link was established. "They were handling roughly ten thousand X-ray films per year," noted Leonid Androuchko, a Geneva-based professor of telecommunications. "On simpler cases it was easy to interpret the image locally, but for more complex cases they had to refer to the capital. That was not only frustrating but very costly."

For developing countries, such telemedicine projects tend to be relatively inexpensive to implement. Mr. Androuchko said the approximate cost in hooking up Maputo and Beira was USD 50 000, with the main cost being the digitalization of the X-ray images. Mozambique’s Government is so satisfied with the results that its Prime Minister wrote to the ITU to ask for its help in establishing additional telemedicine links with a hospital in Nampula, the country’s third-largest city, with part of the cost to be covered by the government. The hospital goes live in March 2002.

In Senegal, a telemedicine link has been established between the country’s main hospital in Dakar Fann and regional hospitals in the towns of St Louis, Djourbel and beyond. The link not only allows for the transmission of medical images and medical information, but will also allow doctors to discuss cases in detail via videoconferencing. As in Mozambique, the telemedicine connection is especially important for the regional hospitals in interpreting X-ray images since neither hospital has a staff radiologist.

Additional telemedicine projects have been set up with ITU assistance in countries such as Bhutan, Georgia, Malta, Nicaragua, Uganda and Ukraine. In Georgia, the project is relatively simple and involves trans-telephonic electro-cardiogram (ECG) monitoring systems. With this simple system, a cardiovascular patient holds a small, box-shaped ECG device that transmits information to a hospital-based cardiologist. The remote monitoring allows cardiologists to monitor their patients’ progress after they are discharged from the hospital without the time and expense of frequent return visits.

Advocates of telemedicine are quick to note that it is not a panacea for a nation’s health care woes. "To make it work, you need a good wired or wireless line, a good ISDN connection or a VSAT (very small aperture terminal) link," notes Petko Kantchev, the coordinator of ITU’s telemedicine projects. "You also need good local leadership to ensure proper implementation and follow-up." Many developing countries are setting up national committees or task forces comprising representatives from both the telecommunication and health care sectors. These groups play a very important role in enlisting support from all stakeholders in the country and in formulating viable telemedicine projects.

Most telemedicine projects call upon a mix of delivery paths. High-precision remote surgical interventions, for example, or remote access to very complex imagery such as brain scans, dictate the use of high-speed broadband telecommunication links. However, in many cases, the public Internet offers huge possibilities. It provides fast access to medical data, patient symptoms and expertise nationally, regionally or globally, thus bringing medical care to those who would otherwise go unattended. The improved quality of videoconference and audio tools on the Internet is also providing a valuable resource for live, remote consultation and diagnosis.

The continuing decline in the cost of telecommunications and information technology, as well as great leaps in digital imaging and compression techniques have spurred a new wave of enthusiasm for telemedicine, particularly in developing countries. It is in these countries where telemedicine’s greatest asset — allowing specialist medical expertise to be delivered to regions and locations where doctors are few on the ground — shows the best prospects for success.

For governments struggling with limited health care budgets, a shortage of doctors and other health care professionals, dispersed rural hospitals and poor transportation infrastructure, telemedicine may help them overcome these difficult challenges in meeting the health care needs of their citizens.