|International Telecommunication Union
For immediate release
|Telephone: +41 22 730 6039
Fax: +41 22 730 5939
The Human Face of Telecommunication Development
The International Telecommunication Union (ITU) will convene the World
Telecommunication Development Conference in Istanbul from 18 to 27 March 2002. 1,500 top-ranking
delegates from government, the private sector, international and regional organizations will
attend. Together they will set priorities to address the inequity between developed and
developing nations created by the uneven expansion of information and communication
This series of background stories is intended to highlight how
telecommunication development can bridge the ‘Digital Divide’ by making a genuine difference
in the lives of those most removed from the information revolution.
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
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.