The Hindu Business Line : Distance does not matter

Telemedicine can bring quality healthcare within the reach of the rural poor. Here are a few instances to show how it's happening in and around Madurai.

Dr N. Sivaprahasam, Professor of Surgery at the Government Rajaji Hospital, offers consultation through telemedicine to a patient in Checkaanurani village.

THE Government Rajaji Hospital (GRH) in Madurai is bustling with activity on a Wednesday morning. Hundreds of patients and doctors are crisscrossing the long verandah inside the old building. However, at the conference room of the department of surgery, Dr N. Sivaprahasam, Prof of Surgery, GRH, is busy chatting on the Web through a personal computer that has a camera and speakerphone.

At first glance, one assumes he is chatting with a friend or relative. But, as it turns out, he is actually chatting with a doctor attached to a public health centre (PHC) on the outskirts of Madurai, a temple city in southern Tamil Nadu. He is helping a junior doctor at T. Kallupatti village PHC, about 50 km from Madurai, diagnose a complicated case wherein a newborn baby had Meningomyelocoele — an external projection of the spinal cord and its contents in the lower back due to a congenital defect. This can be a fatal condition if not treated on time. Dr Sivaprahasam asked the child's mother (sitting in the PHC) to bring the child immediately to the GRH for an operation.

Dr C. Geetha, Medical Officer at the public health centre in Checkaanurani village, consults doctors at Madurai's Government Rajaji Hospital through telemedicine.

In another case, from Thirumangalam village PHC, a patient had abdominal pain with bleeding PR (per rectum). Dr T. Subramanian, Prof of Medicine at GRH, also advised the patient to come to Madurai for treatment. It was a different scene during a visit to some of the PHCs, which handle around 300 patients a day. For instance, at Checkaanurani PHC, near Madurai, the medical officer, Dr C. Geetha, raised an obstetrics and gynaecology query to which Dr R. Rajarajeswari (of the obstetrics and gynaecology department at GRH) replied. Similarly, at T. Kallupatti PHC, Dr A. Sudhamathi consulted the GRH on a swelling in the inguinal region for a patient since birth (the inguinal region is basically the groin and swelling in that area denotes a hernia most often.). Paediatricians at the GRH, Dr Marudhupandi, Dr Meikandan and Dr Balasankar replied to the query through a videoconference. The bandwidth connectivity (through the telephone line) fluctuated during the conversation, but the online consultation took place successfully.

These are a few examples of online consultations that happen daily between GRH and over 10 PHCs in and around Madurai through telemedicine. There are about 10 consultations happening every day, says Dr Sivaprahasam. He supervises the telemedicine system at GRH.

Spearheading telemedicine in and around Madurai is Tata Consultancy Services (TCS). "We are taking telemedicine to the grassroots through a cost-effective solution," says Dr Sumanth C. Raman, Advisor-Life Sciences and Health Care Practice, TCS.

Telemedicine involves integration of telecommunications, information, human-machine interface and medical-care technologies to enhance delivery of healthcare. It involves transfer of medical data, including images, sounds, and live video and patient records, from one location to another through the Internet. Patients can consult physicians and specialists and receive specific assessment of his/her case with advice and suggestions regarding therapy and treatment options available, he says.

Over 600 million live in rural India. The doctor-patient ratio in the country is one doctor for nearly 2,000 persons (in the US it is 1:400), and most specialists are concentrated in towns and cities. More than a dozen hospitals have telemedicine connectivity and are servicing their own or partner rural clinics. Two examples of telemedicine services that have been viewed as successful in India are those that were set up during the Gujarat earthquake and during the Kumbh Mela in Uttar Pradesh, he says.

Some telemedicine systems set up at high cost are lying unused. Telemedicine is often viewed as a high investment and technology intensive system, and this concept can be self-defeating sometimes. For instance, Dr Raman says, does a small village clinic have good electrical supply? Can sophisticated medical equipment, movie cameras and electronic equipment be put in a rural set-up? Can doctors and the administrative staff maintain the facilities in good condition? Can several lakh rupees be invested in each centre? Does usage justify this? Then again, how many centres will you equip in this way?

TCS has a solution to these queries, he says. A baseline telemedicine model provided by webhealthcentre.com requires a personal computer (Pentium III and above), multimedia (sound card and speakers), Web camera, modem, Internet connection/account and a flatbed scanner. The investment is less than Rs 50,000, whereas some of the telemedicine projects using VSAT could run into a few lakh rupees or even a crore. Most PHCs have the basic infrastructure, including a personal computer, and additional investment on Web camera, speaker and Internet connection is all that is required, he says.

Using TCS' webhealthcentre.com, a health portal, doctors can view the specialist at a remote location and share medical data. The patient can also interact with the specialist. It operates on any available connectivity. The twin option of store and forward, and real time consultation, gives the physician at one end the opportunity to raise his doubts, and the specialist at the other end, the flexibility to answer queries later, if both are not free at the same time. The platform also offers a multi-specialty telemedicine software solution, and is designed to enable quick and easy creation of telemedicine referrals, he says.

The Electronic Medical Records on webhealthcentre.com have been prepared by doctors and can capture and archive data in a structured fashion. Further, the progressive medical history of the patient can be maintained. ECGs (electro cardiogram), X rays and other scanned diagnostic images can also be stored and viewed both by patient/remote hospital/ primary health centre as well as the super speciality hospital to facilitate better diagnosis, he says. The audio-video exchange helps specialists talk to patients in remote locations. The specialist at a tertiary care hospital can make a better assessment of a patient's condition. The audio-video interface happens in real time and saves time on patient care despite distances. "The only problem that we face is the fluctuating bandwidth through telephone lines. This is, however, out of our view. Investing in a leased line is a costly proposition," says Dr Raman. All the data sits on a central server that is maintained by TCS, he says.

But, what does telemedicine mean to people in rural areas? Says Dr Sivaprahasam, "It saves a lot of time and money for them." For instance, if a patient travels to Madurai, he/she spends about Rs 300 for the trip. This includes transportation charges, lunch and stay for at least two people. This can be avoided through online consultation and a patient need come to Madurai only during emergency, he says. The entire telemedicine expenditure for a PHC is about Rs 300 a month, including Internet connectivity charges. "We are happy even if we get one or two consultations a day. It will bring us the return on investment on the project," he says.

According to Dr Sivaprahasam, a lot more awareness needs to be created, at PHC level, to use telemedicine. The concept is a boon to villagers, who are often beyond the reach of specialists.

Pictures by Bijoy Ghosh

raja@thehindu.co.in

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