Telemedicine, the INTERNET and the Developing World
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The INTERNET and the World Wide Web have been credited with the re-
alisation of Marshall McLuhan's vision the "Global Village". This was
accomplished by establishing free communication between people and
communities world-wide, regardless of politics, race, creed or lan-
guage. There is no one who would debate the value of communication
over the alternative - confrontation and hostility.
A less appreciated, but perhaps, a similarly valuable contribution of
the INTERNET is Telemedicine - an access to the immense knowledge
base of medical research and practice on a global basis. Indeed,
Telemedicine can assist specialists in the best equipped hospitals to
nurse practitioners at some remote village clinics serving the entire
field of health care. Telemedicine can facilitate diagnostic, consul-
tative and laboratory services across continents and oceans, in most
situations, around the clock.
One is prompted to ask: If Telemedicine is so good how come that we
don't have it? The answer is simple: COST. The world is still carry-
ing the telecommunication cost infrastructure of earlier times when
long-distance and satellite connection charges were treated as a form
of taxation to provide revenue for governments through state owned or
licensed telephone companies. Many politicians and bureaucrats no-
ticed the irony of the situation that one ministry - telecommunica-
tion - is blocking the efficient functioning of another ministry -
health - in consequence, it impedes national health care. It is easy
to have the respective officials agree that the prevailing situation
is absurd, but it is near impossible to have it changed. However,
there is a way how Telemedicine can be made affordable.
There are only a few nations within the Developing World with access
to the trans-oceanic global cable systems. In these cases it is a
matter of arranging an appropriate broadband (3 x ISDN) connection
with the local/national, public or private INTERNET service pro-
vider.(Broadband service is required for tele-consultation, tele-
radiology, surgical training and for other functions.) There are do-
nors who will gladly provide the necessary computational and video
conferencing equipment in addition to the various "interfaces" with
existing medical and laboratory devices. The cost of service may
range between 200 to 400 dollars per hour of connection. When it is a
question of travelling to an other country for consultation the indi-
cated connection charge may be considered tolerable. However, for
medical training such a cost may represent an unmanageable financial
burden.
The INTERNET is the backbone for the world's largest investment and
trading network operated by the United Nations Conference on Trade
and Development (UNCTAD) the United Nations Industrial Development
Organisation(UNIDO) and the World Bank's Investment Agency - IPAnet-
MIGA. The business opportunities provided by these investment and
trading services are exceptional, UNCTAD's Global Trade Point Network
transmits on average 2.6 million export-import messages daily to 165
countries. Offering FEE-BASED access to these business services
through established Telemedicine INTERNET connection is a viable and
practical approach to sharing and reducing cost to an affordable
level.
Cost sharing and reduction will become critical when the INTERNET
connection is accomplished through satellite service. The required
broadband connection charge can range from 16,000 to 20,000 dollars
on a monthly basis. However, the available video conferencing capa-
bility of Telemedicine is ideally suited for investment and tourism
promotion. Interested buyers or travel agents from most part of the
world can visit the object of their interests directly, ask ques-
tions, negotiate deals and enact business transactions in a secure,
confidential manner.
The same approach, combining Telemedicine with business service could
also provide funding for the expansion of INTERNET service to distant
rural communities by the means of wireless networks. The wireless
network can also provide public telephone and limited television
services. This service would facilitate inter-community communication
leading to trading, improvement in education and entrepreneurship de-
velopment.
The INTERNET and access to UNCTAD's Global Trade Point Network can
provide another significant opportunity for the improvement of na-
tional health care. All the major international medical equipment and
supply manufacturers and pharmaceutical producers offer "direct-from-
factory" purchasing opportunities at greatly reduced prices. By com-
bining the needs and requirements of group of hospitals and clinics -
purchasing in bulks - could be organised through open competition or
negotiation.
This brief expose is aimed to open the eyes and the minds of medical
and bureaucratic decision makers to the opportunities what Telemedi-
cine, the INTERNET, in combination with business service, could pro-
vide for the Developing World. The author is ready to provide assis-
tance to medical organisations and governments interested in explor-
ing how to make it work.
Dr Sigmund de Janos
Senior Consultant
de Janos & Associates Consultants
mailto:dejanos@rogers.wave.ca
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