by James Kline
By James B Kline
All I said was, “Unsweetened tea, please” and it was obvious to the waiter that I was a Yankee in the Deep South. It was obvious that iced tea had to be sweet, like really, really sweet. I should have known better for at that point I had been married to a southerner for nearly 11 years. For us, coffee-black and bold was our beverage of choice and as a result we never argued about the ‘right way to drink iced tea.’
Now imagine your first day in a hospital or clinic in a remote village nearly anywhere in Sub-Sahara Africa. Your patient is a young child presenting with fever, headache, and nausea. Your North American ‘go to’ diagnosis is the flu. Fortunately for the patient, a local healthcare worker is nearby and essentially says to you, “You’re not from around these parts.”
He’s worked here for years and knows the local disease patterns, so he offers the more plausible diagnosis…malaria. He is aware that it is the rainy season. He knows that the population is generally poor so he assumes that the child has been sick at home for several days because the parents couldn’t justify the cost until they were certain that their child needed medical care. He’s also aware that the local population generally does not use mosquito nets. Furthermore, he’s seen more than ten patients within the past week the same symptoms that have all tested positive for malaria.
Understanding local epidemiology is one of the important reasons for the establishment of regional telemedicine centers. Local practitioners can aid you in realizing that your bread and butter diagnoses might not be the most accurate given the local setting. There are many other reasons for these centers…culture, language, time zone, capacity, and ownership, to name a few. Each is significant and deserving of its own blog. One or any combination of these is the rationale for the organization and support of a regional telemedicine center. While much of telemedicine can be effectively delivered using asynchronous communication (communication featuring email or text resulting in non-real-time responses), an additional advantage of the regional center is its potential to offer real-time medical consultation in the event of a medical emergency. Even seasoned physicians value access to medical specialists (intensivist, traumatologist, cardiologist or pulmonologist) in real/near real-time when they need help with a case. Every effort should be made to offer the same capability to healthcare providers in remote access medical facilities around the world. Establishing regional telemedicine centers makes this a viable option for these providers when they wouldn’t otherwise have this access.
If we agree on the many important roles that telemedicine can and will play in the future of healthcare delivery, we must build towards the establishment of regional telemedicine systems so the system is effective on an individual basis. Building regional capacity is part of a sustainable program. These centers are arguably the most efficient way to implement telemedicine. Western based doctors and administrative personnel can serve as trainers providing the backstopping needed during the development stage. We might identify a hospital that has good infrastructure and medical capacity located in Cote d’Ivoire, for example, that can serve as a telemedicine resource for that region’s remote and under-served French speaking healthcare facilities. Lessons learned from this pilot program will serve as the foundation from which similar regional centers are created to impact healthcare needs throughout Africa and beyond.
The world is changing. As telemedicine plays an ever more important role in the developed world, so it will in remote and under-served parts of the world. We dare not let this opportunity pass us by.
Telemedicine Blog 3 of 4
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