October 21st, 2004

By Kendall Madden
The Stanford Daily

A patient walks into a clinic in a rural town in India, talks to a doctor, receives a diagnosis and a prescription, and leaves the office. Sounds like a normal visit to the doctor, doesn’t it? Except in this case, the doctor is thousands of miles away and conversed with the patient via video camera.

Impossible? Don’t tell that to Stanford doctors.

Rather than traveling around the world to visit patients, American and Indian doctors are hoping to revolutionize medicine in rural areas with a package of technologies known as telemedicine, through which patients correspond with a doctor through videoconferencing, audio communication technology and e-mail.

Doctors are in desperate need in rural areas around the world. In many developing countries, the idea of an accessible general practice doctor is dream — a specialist is even less likely. In rural India, for example, there is one doctor on average for every 15,500 people. Specialists are only found in the metropolitan areas that are not accessible for the majority of the rural population.

Many enterprises are springing up on the basis of new telemedicine technology to alleviate the scarcity of doctors and specialists in these other areas of the world.

One such telemedicine enterprise is currently under development at Stanford in conjunction with the Digital Vision Fellows Program. The Global Telemedicine Project, initiated and directed by Dr. Renée J. Chin and Dr. Jack Higgins, is an innovative attempt to mobilize the skills of doctors in the wealthiest countries to provide care for individuals in developing countries.

The Project is working with a community in Kuppam, India, in partnership with Hewlett Packard’s E-Inclusion program. HP’s program consists of two vans equipped with computers that circulate through the community, providing Internet access and educational programs. A third van is being designed as a mobile medical clinic and will contain computers for the purpose of telemedicine consultations.

“Our vision for the Global Telemedicine Project is to develop a database of physicians from all over the world to serve patients in rural communities like India, South Africa or Vietnam,” Chin said.

“Where programs like Doctors Without Borders and the Peace Corps require volunteer health practitioners to travel for extended periods of time, the Global Telemedicine Project will ask volunteers to commit to only about four to eight hours per month,” Chin said.

Most importantly, doctors, specialists and health practitioners will be able to work from their own home or office”

The Project is modeled after a domestic program, founded by Higgins, called the HouseCall Foundation. Using the similar telemedicine, HouseCall connects a free clinic in San Jose to a diabetes treatment center in Redwood City.

The technology itself is simple, according to visions held by the Higgins and Chin plan. The Project will work in conjunction with Video HouseCall Network, the operator of a Web-based telemedicine system of audio- and video-conferencing.

In some cases a live, real-time consultation may not be possible and will be substituted with a “store-and-forward” system of video clips, photographs and text messages. Since the information can be transmitted over the Internet, the only hardware required is a laptop computer and small video camera, the latter of which could be acquired used, costing approximately $50 to 250.

According to Higgins, the HouseCall program has been extremely successful. He said he hopes for the same positive results from the new global initiative. Before the project may be implemented, significant research into the region and the community of Kuppam must be carried out.

Chin, an ethnographer whose research has centered on the role of technology in community dynamics and healthcare systems, emphasized the need for an ecological perspective in development of the project.

“Approaching the project from an ‘ecological perspective’ means that we are interested in the relationships and interactions between a people and their environment as part of their relationship to health and health care,” Chin explained.

“For example, health practices and caring for one’s health is done within social networks, that is, family, friends, and community activities,” she continued. “Compliance with medicines and learning new health practices such as washing hands more often may have more success if the social network is included in the prescription.”

Though the Global Telemedicine Project is not the first such program to use telemedicine technology to reach rural, developing communities, it differs from existing programs in that it hopes to provide direct care from doctor to patient.

Telemedicine initiatives have been increasingly popular in India as method of improving rural healthcare, but the structure has largely been to provide specialist skills in regions where there is only a general practice doctor. Doctors in rural settings rarely have the special training necessary for certain procedures and diagnoses.

Telemedicine is often a cheaper alternative to sending specialists to the rural regions to practice. Such initiatives within India have, therefore, aimed at providing rural patients with the opportunity to be examined by a specialist if a rural doctor is unqualified, and they also provide the means of instructing rural doctors in skills that they might not have and training them for some specialist procedures.

Telemedicine technology also enables rural doctors to consult with their urban peers in the process of a surgery or complicated procedure. The Global Telemedicine Project hopes to reach out to even more of the under-served population by eliminating the need for the on-site doctor.

Chin and Higgins plan on having the telemedicine system up and running by December of this year, with the ultimate goal of expanding to other developing countries.

“When I let myself dream about it,” Higgins said, “I imagine this growing big and spreading out: A revolution of the way healthcare is provided the world over.”

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