Collaborative action to improve health care in developing countries
Most developing countries suffer from a severe shortage of health care professionals, especially in remote and rural areas. They need improved communications to link remote clinics and hospitals with urban hospitals and medical specialists outside the country. They need improvements in administration of their health care sector (e.g., in management of patient records). Health care professionals need access to up-to-date medical literature, both local and international. They need improvements in the provisioning of rural clinics and hospitals with pharmaceuticals and other medical supplies. They need to minimise the number of patients referred to distant hospitals who may already be overwhelmed. They need to raise the level of awareness about health care practices. They need rapid help in the event of a disaster or emergency, such as the break-out of Ebola disease in the Congo (ex-Zaire).
Telemedicine techniques can help. Telemedicine is the use of telecommunications to provide medical and health care at a distance. Telemedicine is usually taken to mean curative practices while telehealth includes preventative measures, but in this leaflet the term is intended to cover both aspects.
Telemedicine services
Examples of the different types of telemedicine and telehealth services include the following:
Access to data bases
A pressing need for health care professionals in developing countries is access to data bases which might be a source of information needed to identify a problem or simply keep up to date with new developments in the field. There are many types of databases. Some are specialised such as the MEDLINE and MEDLARS which are based in the United States. There are many telemedicine sites on the Internet's World Wide Web. Health-on-the-Net is a non-profit foundation based in Geneva which has the mission of extending Internet access to hospitals, including those in developing countries, around the world. While the Internet can be a rich source of information, it is not yet commonly available in developing countries and there can be long delays in finding and downloading information. Delays can be somewhat minimised by switching off the colour graphics and other fancy capabilities and downloading just text.
Equipment needed:
- personal computer
- modem
- subscription with an Internet service provider
- telephone line
Tele-consultation, tele-education and emergency relief
Telemedicine also includes a simple consultation between two health care professionals. This consultation can be as simple as a paramedic in a remote area making telephone or e-mail contact with a doctor in an urban hospital or telemedicine institute. Telemedicine also includes the on-going medical education of health care professionals as well as the public.
Equipment could include:
- laptop computer with modem
- facsimile
- mobile phone (e.g., Inmarsat phone)
- e-mail subscription (e.g., Internet)
Vital signs monitoring
The vital signs of a patient can be monitored and transmitted for diagnosis by distant doctors, at communications speeds as low as 2400 baud. Simple devices attached to the patient can monitor and record ECG, pulse rate, oximetry, blood pressure, and a number of respiratory parameters. Some products come packed in a lightweight briefcase which can be connected with any available means of communications.
Equipment required includes:
- vital signs monitoring equipment
- telephone line
Image transfer and videoconferencing
Another application of telemedicine could be either a videoconference between doctors and/or the transfer of a medical image by a health care professional in a rural area to a specialist in an urban hospital. Videoconferencing equipment includes a video camera, microphones and monitors. Some Windows-based software products enable a portion of the video screen to be used for a live videoconference while another portion of the screen is used for display of medical data.
For higher resolution imaging, a snapshot can be taken of any of the video inputs at any time during the telemedicine session. Such snapshots give considerably higher resolution than live video. Snapshots can be saved as Bitmaps, transmitted from a rural hospital or remote site via a satellite link to consulting physicians who can have the images displayed on a computer screen using any commercially available Bitmap viewer (e.g., Adobe Photoshop, Corel Draw, Paintbrush) or printed out in full colour for further examination.
In addition to software, the equipment needed could include:
- high resolution camera
- microphone
- speaker
- scanner
- personal computer and video monitor
- modem
- telephone line (e.g., via Inmarsat-B or ISDN)
- video cassette recorder
Benefits of telemedicine
- Fewer patients need to be referred to urban hospitals which saves time and money spent on travel and which reduces the stress when family members are separated.
- Health care professionals in rural areas can consult specialists in urban hospitals.
- Health care professionals can keep up to date through access to the latest information in their fields contained in medical data bases.
- Remote clinics and rural hospitals can order drugs and other medical supplies when they are needed.
- Reliable communications can help hospitals and health ministry officials improve public health management and supervision of epidemics as well as the delivery of health care to all parts of their country.
- Rescue workers are better able to coordinate their response to disasters and emergencies and thereby mitigate the effects.
The Midjan Group
The Midjan Group was formed to help promote health care and telemedicine in developing countries. It is an Association under French law, comprising commercial, governmental, industrial and academic organisations based in Europe, whose expertise covers both telecommunications and health care.
The Group was formed as a result of an initiative by the French Ministère des Affaires Sociales, the Telecommunication Development Bureau of the International Telecommunication Union (ITU) and Inmarsat who were also collaborating in the preparation of a Telemedicine Report under the auspices of Study Group 2 in the ITU's Development Sector.
The first meeting of the Group members was held at Inmarsat headquarters in March 1996, at which time Guy Rossignol from the Direction des hôpitaux of the Ministère des Affaires Sociales was elected as chairman of the Group.
Originally called the European Telemedicine Collaboration Group (ETCG), the Midjan Group took its name from Abidjan and Midrand, which were the venues respectively for the African Regional Telecommunication Development Conference and the G-7 Information Society and Development (ISAD) Conference, both of which took place in May 1996. The Midjan Group successfully demonstrated telemedicine services to delegates. Using an Inmarsat-B satellite phone, doctors in Abidjan and Midrand were able to exchange views and discuss cases with their counterparts at the European Institute of Telemedicine in Toulouse (France) and the Politecnico di Milano (Italy).
The Abidjan Conference also adopted Resolution 7 calling for the European Commission and other G-7 institutions to support telemedicine trials in Africa. The Resolution was brought to the attention of the G-7 Ministers the following week in Midrand.
Subsequently, the ITU's Telecommunication Development Bureau sent telemedicine experts (one of whom was a Midjan Group member) to several African and Asian countries, which provided a deeper understanding of the needs of developing countries. Members of the Group have collaborated in putting together applications for small pilot projects to be funded in part by the European Commission. The Midjan Group is also undertaking a project called "From Estoril to Valetta", the aim of which is to build pilot projects as the outcome of the first World Telemedicine Symposium held in Portugal in July 1997 and demonstrate those pilots at the World Telecommunication Development Conference to be convened by the ITU in Malta in March 1998.
Objectives and plans
All members of the Midjan group are convinced that health telematics can be useful and efficient in the developing world, but only co-operation between public and private sectors can make projects possible. The Midjan Group believes that successful implementation of telemedicine in developing countries will require participation by diverse players, bringing together different and complementary capabilities, skills, expertises.
The following diagram depicts the Midjan Group objectives.
The Midjan group aims
- to initiate and coordinate telemedicine actions in developing countries with other international development programmes in the area of telematics for healthcare, such as those of the WHO, ITU-BTD, G-7, European Union and major telemedicine institutes;
- to initiate and facilitate new, high quality project proposals starting from identified needs in the developing world;
- to make available European expertise to the developing world, and to identify the best practice, using the lowest cost, most appropriate equipment, software and services
- to organise telemedicine demonstrations to show the possibilities and practicality of telemedicine applications.
The Midjan Group will deal with medical, technical and regulatory aspects of telemedicine projects, but will also address the impact on public health policies and cost effectiveness of telemedicine applications in developing countries.
Recognising the need for local commitment and involvement, members of the Midjan Group work with local health care professionals in the developing countries. The Group advocates a partnership approach. Even if assistance is still necessary in many developing countries, only partnership with local industry and local health care professionals can lead to sustainability. The Midjan Group aims to ensure any projects with which it associates will include education and training as well as a business plan involving public bodies (international, regional or national) and the private sector.
Interested?
Midjan Group members welcome contacts from developing countries interested in sustainable projects or joint ventures. The Midjan Group also welcomes contacts from other European-based companies, telemedicine institutes, telecom operators, equipment suppliers, Ministries of Health, etc, who may have developed low-cost, user-friendly software, technology or services which might be appropriate for developing countries and which could benefit from collaboration with others.