RNA Diagnostics

PJAMA. 1998;280:1295-1296HYSICIANS in rural America know isolation challenges their ability to keep up with the latest in medical information, techniques, and peer-to-peer consultations. But imagine how tough it is for physicians in developing countries such as Nigeria, Tanzania, and Senegal. “One of the major impediments to the development and delivery of better health care in Africa is the inability, or at least the limited ability, of health professionals to share and collaborate on research, to participate in patient tracking through databases, to consult with colleagues and medical experts, and to track infectious and emerging diseases,” said Nigeria-born Patrick Nta, MS, of Harvard Medical School in an unpublished paper he wrote earlier this year.

Nta advocates using high-tech tools such as the Internet, e-mail, telemedicine, and teleradiology to connect African physicians with each other and with colleagues around the globe.

The advent of modern communication technology has unleashed a new wave of opportunities and threats to the delivery of health services.¹ Telemedicine, a broad umbrella term for delivery of medical care at a distance, has reached around the world, and now health professionals can communicate faster, more widely, and more directly with clients and colleagues, no matter where they are.² Telemedicine may in fact have a more profound impact on developing countries than on developed ones.

Satellite stations in Uzbekistan, wireless connections in Cambodia, and microwave transmission in Kosova have shown that the low bandwidth internet can reach into remote areas, some of them with troubled political situations and uncertain economic environments. It has been more difficult and costly to implement broad bandwidth applications in these locations. Nevertheless, with the internet come email, websites, chatlines, multimedia presentations, and occasional opportunities for synchronous communication via internet phones and videoconferencing. Each of these communication vehicles provides an opportunity for medical education and medical care, not to mention collegial support.³ Of course, they also provide the threat of mischief occurring within the health community, with breaches of security, inappropriate use of equipment, and engagement of terrorist tactics to reach political ends. For example, malicious hackers have been known to electronically deface websites. Threatening messages have been sent to health providers by opposing forces in some conflicts. Lack of systems support may lead to higher levels of virus and worm infections of electronic patient data.

Three important initiatives straddling technology and medicine and building an interface between the two were launched at the Indian Institute of Technology here on Saturday.

NeuroDbase, a unique customised electronic medical record system for Indian Neurologists, Neuropsychiatry Online, a joint effort by the Neurosciences India Group and IIT Madras to provide internet-based counselling to people living in rural areas and Pubmedinfo.com, a unique public portal for health related information were released by Baskara Narayana, Director, Satellite Communication, Indian Space Research Organisation. The occasion was the M.V. Arunachalam Endowment Lecture on Space Technology for Bridging the Health Divide.

Introducing NeuroDbase, E.S. Krishnamoorthy, vice-chairman and director (Neurosciences) Voluntary Health Services, said it was an EMR customised to Indian setting, enabling the collection and categorisation of neuro-psychological data. The history and physical examination of the patient, details about the investigations conducted on him/her, the neuro-ability assessment can all be recorded online.

The publicly funded health infrastructure in India is in a bad shape. However, the private corporate hospitals and super speciality centres catering to the urban rich are having a field day literally. ‘The rural health care sector in India, which has a ratio of one hospital bed for every 1333 citizens has become “nobody’s child”. With most of the medical specialists working in urban areas, villages have virtually no access to super speciality treatment close to their homes.

A recent study conducted by the Indian Institute of Public Opinion reveals that 88.8% of the rural patients in India have to travel 8 kms to access medical treatment of some sort. The remaining 11.1 percent have to travel further. Similarly, a World Bank study indicates that more than 40 percent of the Indians are forced to borrow money or sell assets when they are hospitalised. Strongly advocating the need to strengthen and expand the public health care centres, the World Bank study has recommended allocation of more resources and stepped up activities in the areas of supervisor, monitoring results and increased public accountability. It has also urged a vastly improved investment on disease surveillance, public health monitoring and information system.

The joint effort of Anna University and Apollo Hospitals to set up a telemedicine network shows the way in reaching specialised medicare to rural communities.

The teleconference on telemedicine, which was inaugurated by Prime Minister A.B. Vajpayee in New Delhi. Seen here is the picture of a link between Port Blair, Delhi and Chennai, taken at Sri Ramachandra Medical College and Hospital, Chennai.

WHEN Alexander Graham Bell said, “Watson, come here I want you,” on March 20, 1876, he was not only making the first telephone call but holding the first telemedical consultation, without realising it though. Bell had spilt acid on himself accidentally and wanted assistance. Since this unwitting beginning, telemedicine has come a long way, with developments in communication and information technologies making healthcare accessible across distances. Yet in a paradox typical of India, most of the 620-million-strong rural population has barely any access to basic medicare.

Celebrating its silver jubilee in a novel way, the Chennai-based Anna University, with 240 engineering colleges under its fold, set up a telemedicine network linking, to begin with, 35 of its constituent colleges in Tamil Nadu to provide high-quality healthcare to their students and, more important, to the rural communities situated in the vicinity of the colleges. The project plans to use the infrastructure base of the engineering colleges to extend hi-tech medicare to people in remote areas.

A joint effort by Anna University and Apollo Hospitals (a pioneer in telemedicine), the project also has the blessings of the Tamil Nadu government. Inaugurating the programme, Chief Minister Jayalalithaa said that this facility, the first of its kind in the country, would bring secondary and tertiary medicare to over 95 per cent of the State’s population when all the 240 affiliated colleges were networked. She said: “The world’s largest technical university, Anna University, is to show the way to reach specialised medical care to the needy in the remote areas.”

WEST LAFAYETTE, Ind. — Improving a person’s health in India, or in any country, needs to start with an understanding of culture, says a Purdue University health communication expert.

“India is certainly growing as a global center for economics, education and business, but parallel to this growth is an increasing gap in health care for India’s rural residents,” says Mohan Dutta, associate professor of health communication who is studying the health beliefs of low-income rural Indians. “Today’s health-care technology that is used to communicate and to treat people is amazing, but there are many cultural barriers that prevent some rural groups from accessing these benefits.”