Telemedicine

Editorial

We all remember stories by our grandparents and elders in the community, referring to things to come or the future. Most often these tales foretold of great advancements in the use of technology. One that stays in my memory is my grandmother talking of the greater use of the television in the future, as a means of communication to others, for the purposes of work, social interaction or education. And I am equally sure that most of us laughed off these stories as too space age. But, there have been great strides in technological developments. The early 1900s saw strides in the development of the radio. Then followed developments in television between 1930s and 1950s. The early 1940s saw the advent of computers, with the use of personal computers becoming popular in the last few decades. We have indeed developed into a global village. This is no more evident than in the fields of trade, industry and economics. However, what about health?

The Health Sector has always sought to make use of new technology in delivering better health services. The telephone, and much later, the use of facsimile, supplemented the use of face-to-face consultations with the additional use of the spoken and written word. The computer came into use over the last decade, mainly in the form of email (electronic messaging), electronic discussion lists and the Internet.

With the rapid advancements made by technology over the last few decades, and as a result of globalisation, surely health can benefit from international support to address the challenges it faces? Almost all countries have been facing health care reforms recently, with the most pressing issue being how to balance increasing health care costs, with scarce resources and increasing population demands.

Good quality and well-distributed telecommunication services can have a tremendous impact on the health services. Increasingly, countries are beginning to use telecommunications to deliver health care. The most recent health care initiative, called Telemedicine, is being experimented with.

According to Dr. Salah H. Mandil, of the World Health Organisation, Telemedicine is the practice of medical care using audio, visual and data communications: this includes medical care delivery, consultation, diagnosis, treatment, education and the transfer of medical data. Education covers both the education of the patient and the continuing education of the health-care staff.

Telemedicine is not meant to replace strategies implemented to overcome poverty, access to water, nutrition promotion and sanitation. It is merely a means of optimising the uses of scarce resources (health staff, health facilities and money) that are available to deal with health problems. However, the additional challenge to Africa as a whole is the lack of vital infrastructure. This is by no means mission impossible, though.

The best example of the use of telecommunications in health and its success is the river blindness or Onchocerciasis Control Programme (OCP) involving 11 African countries. The programme relied on teams walking, cycling, driving, and flying in helicopters and the use of face-to-face communication together with the use of old-fashioned but reliable radio transmitters/receivers for reporting between teams and the 5 centres. Data were collected by sensors placed along river streams taking real-time readings and automatically transmitting to a satellite that bounced data to the main collecting station in Ouagadougou, Burkina Faso. This station was linked to a desktop computer for storage, processing and computing the optimal spraying by the team in the helicopter.

Telemedicine has also led to links being established between developing countries and the industrialised countries. One of the earliest examples in Africa was in 1986, with Tanzania and Uganda linking up with Canada.

However, communication infrastructure remains the greatest challenge to implementation of Telemedicine initiatives in Africa. South Africa had embarked on its telemedicine project in April 1999, and one of the objectives of the project is to determine the cost-effective means of ascertaining the necessary communications infrastructures.

There are other aspects that would need to be considered before telemedicine would be able to be implemented nationally:

• Is telemedicine likely to provide increased revenue for urban and specialist centres, rather than rural and remote centres?
• Do standards exist for medical equipment used in telemedicine services?
• What are the costs associated with these services?
• Are tariffs for services going to be imposed?
• What are the ethical and legal implications of this form of health care delivery?

The message here is to advance with caution and deliberation. In the famous words of Captain Kirk, to boldly go where no man has gone before, and to add to this, put one foot in front of the other.