Message-ID: <199605041619.MAA19963@dartvax.dartmouth.edu> Date: Sat, 4 May 1996 12:19:57 -0400 From: "Susan.Almy." <mailto:Susan_Almy@VALLEY.NET> Subject: Telemedicine To: Multiple recipients of list DEVEL-L <mailto:DEVEL-L@AMERICAN.EDU>
Royce Robbins wrote: > Recently there was a thread on the issue of using "The Internet" in Africa
> to provide improved health care in rural areas via telemedicine.
> Eberhard, in his usual abrupt "you don't know squat about what it's REALLY
> like in Africa" style, pronounced that such projects don't work, can't
> work, and "aren't even being done in the US". I am appending verbatim, a
> memo from the Dean of the College of Medicine, The University of Arizona,
> (Tucson, AZ, USA) announcing the creation of a state-funded Telemedicine
> program, primarily to provide outreach services to rural physicians in and
> around the state of Arizona.
I have two comments. One concerns the fact that many of us too often dismiss proposed solutions for Africa without really thinking about them, because they are, as proposed, impossibly expensive or otherwise unadapted. If we give them some thought, sometimes they can give us better ideas. The other concerns the Arizona initiative, which I will get out of the way first.
New Hampshire-Vermont as a joint unit tried this a decade or so ago. My father, who helped start it, still thinks it is a great idea, and was greatly appreciated, but they couldn't manage the funding to keep it going. Arizona is possibly more concerned with medicine in remote places and may manage it for longer.. but if NH-VT can't do it (NH is niggardly but rich, and VT is very ready to pay for social goods) it'd be hard to argue an African state could find the money. Also, in Africa this would require paying for a lot more basic infrastructure to get it off the ground than in the USA - from the film-making capability in the center to the satellite dishes, TVs and generators in the hinterland, which in the US remote areas already exist.
*However* : Many villages in all but the poorest African countries are now endowed with a TV set and generator, which the owner feeds with videotapes from a regional distributor and often pays for by charging admission to his neighbors.
Many Africans who have been overseas have come back with hand-held camcorders. How about putting these facts together and getting medical schools to put together a program of amateur medical training videos for continuing education of the doctors in those places? The videos could even be distributed through the same channels, but for health personnel only. Of course, the WHO could be putting out more professional ones at the same time, for the schools to use as they wish. Most rural doctors in Africa didn't get enough training in the first place, have no updating and especially have only the drug company salesmen to tell them which new drugs are worth prescribing (why doesn't the WHO basic list get more circulation?). Rural doctors are also hopelessly overworked if they're any good, but an hour a week should be manageable if it teaches them something useful; a request for topics would help ensure that.