The document describes the limitations of healthcare in developing countries like Solomon Islands, including shortages of specialists and limited transportation and communication infrastructure. It then discusses the implementation of a telepathology system for Solomon Islands, including establishing a local histology lab and enabling remote consultations with pathologists in other countries to improve diagnostic services. The initial results found high diagnostic accuracy and a significant reduction in turnaround time compared to sending specimens overseas.

1. Solomon Islands

2. Solomon Islands

3. Solomon Islands
Solomon Islands
Capital: Honiara
Population: 450‘000
Islands: ~1000
Independence: 1978

4. Solomon Islands
Solomon Islands National Referral Hospital
Capital: Honiara
Population: 450‘000
Islands: ~1000
Independence: 1978

5. Solomon Islands
Solomon Islands National Referral Hospital
Capital: Honiara Doctors: 15 - 30
Population: 450‘000 Radiologists: 1
Islands: ~1000 Pathologists: 0
Independence: 1978 Dermatologists: 0

6. 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)

7. Limitations in Developing Countries
 Limited Transportation

8. 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

9. 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)

10. 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

11. Suggested solution
Telemedicine:
 Access to advice and diagnosis from
remote specialists with the help of
telecommunication technologies.

12. Solomon Islands
Telepathology:
Phase 1: Histology Lab
- September 2001
Phase 2: Establishing remote diagnostics
- 2001-2003
Phase 3: Routine diagnostics
- 2003 - ....

13. Phase 1: Histology Lab
Needs for Histology Lab:
 Operational under local conditions:
- frequent power cuts
- high temperature and humidity
 Sustainable
- locally available spare parts

14. Phase 1: Histology Lab
Tissue Processing

15. Phase 1: Histology Lab
Tissue Processing
Preparing blocks

16. Phase 1: Histology Lab
Tissue Processing
Preparing blocks
Cutting

17. Phase 1: Histology Lab
Tissue Processing
Preparing blocks
Cutting
Staining

18. Phase 1: Histology Lab
Tissue Processing
Preparing blocks
Cutting
Staining
Histology slides

19. Phase 2: Remote consultations
Step 1:
Selected images captured with digital
camera (Nikon CoolPix 990) and
submitted to server in Basel via email
Step 2:
Cases are reviewed by a
group of 7 pathologists
(Switzerland, Germany
and South Africa)

20. 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)