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Telemedicine in Western Africa (RAFT project)

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  • 1. Telemedicine in Western Africa (RAFT) Medical Imaging and Telemedicine (MIT 2005) Cheikh Oumar Bagayoko, Henning Müller, Antoine Geissbuhler Medical Informatics Service
  • 2. 2©2005 Hôpitaux Universitaires de Genève Outline • TelemedicineTelemedicine • Goals and challengesGoals and challenges • Technical needsTechnical needs • Development of the RAFT networkDevelopment of the RAFT network • ResultsResults • DiscussionDiscussion • ConclusionsConclusions
  • 3. 3©2005 Hôpitaux Universitaires de Genève Telemedicine • Communication and sharing of medical informationCommunication and sharing of medical information and knowledge over distancesand knowledge over distances • TeleTeleconsultationsconsultations • TeleTeleteachingteaching • Knowledge creationKnowledge creation • Online and offline communicationOnline and offline communication • Most often: TeleradiologyMost often: Teleradiology • Reduced film cost and transport problemsReduced film cost and transport problems • Possibility to obtain an expert opinionPossibility to obtain an expert opinion • In remote areas, at night, …In remote areas, at night, … • Influence strong where experts are rare, distancesInfluence strong where experts are rare, distances large, and infrastructure is limitedlarge, and infrastructure is limited
  • 4. 4©2005 Hôpitaux Universitaires de Genève Goals of RAFT • Develop aDevelop a South-SouthSouth-South network for distancenetwork for distance continuing medical education and teleconsultationscontinuing medical education and teleconsultations • Between teaching centers and regional hospitals inBetween teaching centers and regional hospitals in French-speaking AfricaFrench-speaking Africa • Integrate first-line healthcare in the telemedicineIntegrate first-line healthcare in the telemedicine networknetwork • DevelopDevelop capacitiescapacities for local, high-quality, medicalfor local, high-quality, medical on-line contenton-line content • Develop tools for local needsDevelop tools for local needs
  • 5. 5©2005 Hôpitaux Universitaires de Genève Challenges • LowLow bandwidthbandwidth • Neither telephone lines nor electricity in rural areasNeither telephone lines nor electricity in rural areas • International bandwidth of RAFT countries is very limitedInternational bandwidth of RAFT countries is very limited • End 2004: 18 Mbps for the entire country, 1,34 bps/capita (Mali)End 2004: 18 Mbps for the entire country, 1,34 bps/capita (Mali) • Switzerland 2002: 66.000 Mbps, 9.040 bps per capitaSwitzerland 2002: 66.000 Mbps, 9.040 bps per capita • Source: ITU World Telecommunication Indicators DatabaseSource: ITU World Telecommunication Indicators Database • Satellite transmission can help but is priceySatellite transmission can help but is pricey • Mobile communication is gaining groundMobile communication is gaining ground • UnstableUnstable electricityelectricity supplysupply • Solar panelsSolar panels • Batteries (car)Batteries (car)
  • 6. 6©2005 Hôpitaux Universitaires de Genève Rural telemedicine : Dimmbal
  • 7. 7©2005 Hôpitaux Universitaires de Genève
  • 8. 8©2005 Hôpitaux Universitaires de Genève Technical needs • Low requirementsLow requirements for servers and clients to befor servers and clients to be able to use old hardwareable to use old hardware Requirements client Operating system: Windows 95, 98 ,2000, Mac OS, Linux, Solaris, or Irix; PC 166 MHz, 64Mb RAM; Sound card; Screen 1024x768 preferred, 800x600 possible; Netscape 4.0 or Internet Explorer 4.0 or later, Java enabled; 28 kbits/s Internet connection (56 kbits/s bandwidth necessary for video images); Real Player and Acrobat reader plugins Requirements server PC 500Mhz, Windows 98, 128 Mb RAM, sound card; Webcam server AXIS 2400; Microphone; Document video camera WolfVision or equivalent; Ethernet hub or switch, 10 or 100 Mbits/s.
  • 9. 9©2005 Hôpitaux Universitaires de Genève Development • 2001:2001: MaliMali: 4 sites in Bamako, 3 regional hospitals,: 4 sites in Bamako, 3 regional hospitals, 1 rural hospital1 rural hospital • 2002:2002: MauritaniaMauritania: 7 sites in Nouakchott, 8 regional: 7 sites in Nouakchott, 8 regional hospitals, 1 rural telecentrehospitals, 1 rural telecentre • 2003:2003: MoroccoMorocco (Marrakech)(Marrakech) • 2004:2004: Burkina-FasoBurkina-Faso,, SenegalSenegal,, TunisiaTunisia • 2005:2005: CameroonCameroon,, Ivory CoastIvory Coast,, MadagascarMadagascar,, DjiboutiDjibouti,, NigerNiger
  • 10. 10©2005 Hôpitaux Universitaires de Genève Results: Teleteaching • 50 teachings from Geneva hospitals50 teachings from Geneva hospitals to Raftto Raft countriescountries with important subjects e.g: HIV ,with important subjects e.g: HIV , obstetrical surgery, fistulas in urology …obstetrical surgery, fistulas in urology … • 4848 from Bamakofrom Bamako to Geneva physicians andto Geneva physicians and medical students and others RAFT counties onmedical students and others RAFT counties on e.g: malaria , leprosy , dermatologye.g: malaria , leprosy , dermatology • In October 2005, every RAFT country will have aIn October 2005, every RAFT country will have a system for teleteaching diffusionsystem for teleteaching diffusion • Thanks to this system an MD agreed to go 875 kmThanks to this system an MD agreed to go 875 km from Bamako because otherwise he saw himselffrom Bamako because otherwise he saw himself cut from the rest of the worldcut from the rest of the world
  • 11. 11©2005 Hôpitaux Universitaires de Genève Teleteaching from Bamako
  • 12. 12©2005 Hôpitaux Universitaires de Genève South - North Collaboration
  • 13. 13©2005 Hôpitaux Universitaires de Genève Results: Teleconsultations • 10 teleconsultations10 teleconsultations to Genevato Geneva in neurosurgeryin neurosurgery for 15 children in Malifor 15 children in Mali • 2 teleconsultations2 teleconsultations to Bamakoto Bamako in leprosy andin leprosy and dermatology for Geneva University hospitals anddermatology for Geneva University hospitals and another clinic in Geneva (de la Tour)another clinic in Geneva (de la Tour) • 4 teleconsultations in radiology to Marseilles for4 teleconsultations in radiology to Marseilles for Bamako University hospitalBamako University hospital
  • 14. 14©2005 Hôpitaux Universitaires de Genève Teleconsultation neurosurgery
  • 15. 15©2005 Hôpitaux Universitaires de Genève Results: Collaborative knowledge creation • NationalNational web portalsweb portals • e.g. Mali, Mauritaniae.g. Mali, Mauritania • Disease-specific contentDisease-specific content • e.g., rheumatic heart disease in Moroccoe.g., rheumatic heart disease in Morocco • Multi-siteMulti-site web-castingweb-casting • Combining web-casting with phone conferenceCombining web-casting with phone conference • South-NorthSouth-North teachingteaching • e.g., Leprosy, Malaria courses for Geneva tropical medicinee.g., Leprosy, Malaria courses for Geneva tropical medicine coursescourses • Dynamic web sitesDynamic web sites • Diagnostic and therapeutic approaches includingDiagnostic and therapeutic approaches including traditional practicestraditional practices • e.g., Pluriderm for skin diseasese.g., Pluriderm for skin diseases
  • 16. 16©2005 Hôpitaux Universitaires de Genève A library of created courses • Can be replayed, information can be addedCan be replayed, information can be added
  • 17. 17©2005 Hôpitaux Universitaires de Genève Discussion • Looking at these results should one not concludeLooking at these results should one not conclude that the application of telemedicine seems morethat the application of telemedicine seems more than justified in poor countries even if means ofthan justified in poor countries even if means of communication remain little developed?communication remain little developed? • However, the problem remains the weak band-However, the problem remains the weak band- width and the energy sources, which are notwidth and the energy sources, which are not impossible to circumventimpossible to circumvent • PragmatismPragmatism and theand the realismrealism with tools adaptedwith tools adapted to the context must remain the ruleto the context must remain the rule
  • 18. 18©2005 Hôpitaux Universitaires de Genève Conclusions • Developing countries haveDeveloping countries have different requirementsdifferent requirements than industrialized nationsthan industrialized nations • Telemedicine can have a strong impact in theseTelemedicine can have a strong impact in these countriescountries • CreatingCreating local knowledgelocal knowledge • Allowing remote parts to get access to medical careAllowing remote parts to get access to medical care • Local teleteaching (south-south) is often moreLocal teleteaching (south-south) is often more effective than north-south networkseffective than north-south networks • Better adapted toBetter adapted to local requirementslocal requirements and customsand customs
  • 19. 19©2005 Hôpitaux Universitaires de Genève Is IT a priority?