Initial Experience with Telemedicine
in
Eastern Hills of Nepal
Saroj Dhital M.D., D.Med.(Surg)
Kathmandu Model Hospital
Public Health Concern Trust - NEPAL
When a visitor from the developed
world goes to poor countries like Nepal
Some of the most
common questions
that come to her
mind could be :
Why is this country so
poor?
Why is this country so
much behind others?
Perhaps the right questions to
ask would be:
What can and should
be done
so that the gap
between the rich and
the poor of the world
is reduced?
so that the
utilization of
available
resources in the
‘poor’ countries
are optimized?
What can and should be done
so that the poor countries can gain higher
speed and catch up with the rich ones?
so that globalization becomes a real
opportunity for the poor countries and no
more a curse?
so that the fruits of science and
technological advances are shared by all
citizens of the world?
There ARE answers to these questions
And there are individuals
and organizations that
have already started
providing these answers
Kathmandu Model
Hospital of PHECT has
been working with them
In countries like Nepal,
Socially responsible health care
providers
sensitive to the needs and realities of
people
are
torn between two extremes of reality
In one hand, the
unfinished agenda of
basic health care is
holding them on the
ground
On the other hand,
they have to stretch
their hands to reach
the sky to access
advances in science
and technology
BUT
How can this be made possible?
Especially when not everything is favorable
in the present day world
When everything is getting
more and more costly
and
less and less accessible
When the gap between the rich and poor
citizens of the world has not yet stopped
widening
When the expectations of people are rising
higher and higher
When these expectations are very much
technology dependent
And when the cost of technology is
decided by international market while the
buying capacity is limited by local realities
How can we make it possible
for the hands to reach the sky
with legs standing firmly on the
ground?
Perhaps we know better
what we should not do rather than what to
do
And one of the things that we in less
privileged countries like Nepalshould not
do is:
simply copying what the more privileged
countries are doing
So far, science and technology has been
of more use to the already rich countries
Now, we should appropriately and
innovatively use that very science and
technology for speeding the growth of
poorer countries like ours
And that can be done
The fruits of Information Technology are
some of those rare things in the present
day world that are getting more and more
efficient and more and more affordable at
the same time
Its use for health and education in
countries with difficult terrain should be
promoted and speeded up without any
hesitation
One should not be ridiculed for predicting
that remote controlled robotic surgery in
future may be more feasible, faster, and
more affordable than building and
manning traditional hospitals in the remote
hills of Nepal
But then
the first step needs to be taken
We had been trying to take that step for long
Long back in early 90s when internet and
e-mail were still a luxury for few elites,
We at phect had already started musing
over the possibility of using wireless sets
for providing instructions to paramedics in
remote areas
And starting ‘Doko Ambulance Service’
But then having radio-transmitters was
illegal
And to get the license for one was
impossible
Non-government institutions were not
allowed even to run FM stations
Actually we did approach the then
information minister and asked for allowing
us to do what we wanted to do
But his diplomatic smile brutally translated
our plea to something cheaper at the level
practical joke!
Then we started a surgical out reach
training-cum service program the SCALPEL
Scalpel
Surgeons and surgically oriented medical
doctors from Kathmandu Model Hospital
and other hospitals would go to hospitals
in remote areas
Spent 2 weeks in those remote hospitals
training the local primary care doctors to
do primary surgery
Things moved well before the full scale
civil war started in the country.
Then, SCALPEL program came into a halt
Not ready to give up, we started consulting
some technicians about the possibility of
starting telemedicine
But again, the ‘security’ came in the way.
Even under such circumstances, however,
our friend Mahabir Pun had been engaged
in using the cyber-space for education and
health
And he had already started showing
results
And Finally,
When the Royal control over people’s lives
started weakening,
contact with Mahabir revived all the
aborted dreams
and
PHECT jumped into the task of making
telemedicine a reality
It has not been easy for an organization like
phect-NEPAL
that has the goal of
creating a non-government model of health
care delivery system
providing
better service to
larger number of
less fortunate section of people
For organizations like this, with lots of
commitments, the lack of resources is a
rule rather than an exception : especially
when you are not bowing down to
irrational demands from the ‘donors’
Thanks to the organizational commitment,
and to the cooperation of like-minded
friends that are mentioned earlier, phectNEPAL has been able to start the
telemedicine program with minimum
expenditure of slightly above twelve
thousand US dollars
Dolakha, a relatively remote district in the
eastern hills, did not have regular services
from doctors in the local hospital for long
One of the reasons behind this was
difficulty in getting doctors to work in the
area, and to retain them
Those few who
offer themselves
to a place like
Dolakha have to
be responsible 7
days a week and
24 hours a day
Life becomes
even harder if
they don’t get
advices from
higher centers or
authorities in
difficult situations
All this
discourages
these doctors to
stay long in the
area
In the first phase of
the telemedicine
program, we
established the realtime linkage between
Kathmandu Model
Hospital and
Gaurishankar General
Hospital in Dolkha.
Besides the technical
issues, extensive
communication had to
be done with people
even to erect the
‘towers’ which were
actually no more than
simple poles for the
radio device
Wherever the trees
blocked the waves,
they needed to be cut
down and that was
quite exhausting
politically and
otherwise
But finally, regular
contact was made
possible
And that had a visible
impact on every thing.
Daily ‘telerounds’ by
doctors in
Kathmandu
model hospital
has become a
routine
Academic discussions
and presentations in
Kathmandu Model
Hospital is telecasted
to Dolakha and
participants from both
ends discuss
efectively and
efficiently
‘Tele-Consultations’
on patient’s
condition have
become frequent
As a result
Health workers in Dolkha have stopped
feeling detached from Kathmandu
They have gained confidence
Consultations from specialists have
become possible for difficult situations
Where there were no doctors, now 7
doctors are working with a total of nearly
30 staff
And their growth process has been highly
facilitated
Very soon
Virtual class rooms are expected to start
for more organized continued education
for health professionals in Dolkha Hospital
When it gains maturity, we hope to start a
network of virtual schools in more remote
hills producing paramedics of different
category
And we hope
This will contribute in building a new Nepal
with healthy and educated citizen
Friends,
We extend our invitation to all of you to
visit that new Nepal
But, in order to bring that day closer, we
need to have you as our partners
With your efforts in equipping us with more
efficient devices, we can make great
changes possible
And that will help to create a better world
to live in – for you, for me, for all of us …
Initial Experience with