Limitations in Developing Countries Shortage of general practitioners - many rural clinics are run by nurses only Shortage of medical specialists - many countries have no dermatologists, pathologists, ophthalmologists, radiologists, etc. Limited access to current information - medical libraries have no current material, no continuing medical education (CME)
Limitations in Developing Countries Limited Transportation
Limitations in Developing Countries Limited Communication Infrastructure Example: many islands in Solomons have no telephone – communication only my VHF radio. Existing telephones are often slow and too unreliable for stable internet access. Limited financial resources
Implications Patients - cannot afford to visit hospital - visit hospital late Doctors - no access to specialist knowledge - no advise for patient management - no experience with rare diseases - no communication with patient (unless at hospital)
Solomon Islands Pathology Problem for Pathology Services: – Specimen sent to Brisbane (AU) by air – Time until diagnosis: 60 days! Patients do not return: – No communication infrastructure – Limited transport
Suggested solutionTelemedicine: Access to advice and diagnosis from remote specialists with the help of telecommunication technologies.
Phase 2: Remote consultationsStep 1:Selected images captured with digitalcamera (Nikon CoolPix 990) andsubmitted to server in Basel via email Step 2: Cases are reviewed by a group of 7 pathologists (Switzerland, Germany and South Africa)
Phase 2: Remote consultations Results: 360 cases submitted and diagnosed turn-around time 10 days (1-3 days for diagnosis) Quality of diagnosis (preliminary results, n=80)*: 80% identical diagnosis 23% minor discrepancies 7% major discrepancies** * Full report in preparation ** Includes two cases of sampling errors (false negative needle biopsies)