Telehealth in the Developing World This page intentionally left blank Telehealth in the Developing World Edited by Richard Wootton Scottish Centre for Telehealth, Aberdeen, UK; University of Queensland, Brisbane, Australia Nivritti G Patil University of Hong Kong, Hong Kong, China Richard E Scott University of Calgary, Calgary, Canada Kendall Ho University of British Columbia, Vancouver, Canada International Development Research Centre Ottawa • Cairo • Dakar • Montevideo • Nairobi • New Delhi • Singapore © 2009 Royal Society of Medicine Press Ltd Co-published by Royal Society of Medicine Press Ltd International Development Research Centre 1 Wimpole Street, London W1G 0AE, UK PO Box 8500, Ottawa, ON K1G 3H9, Canada Tel: +44 (0)20 7290 2921 Email: [email protected] Fax: +44 (0)20 7290 2929 Website: www.idrc.ca Email: [email protected] Website: www.rsmpress.co.uk Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the UK Copyright, Designs and Patents Act, 1988, no part of this publication may be reproduced, stored or transmitted, in any form or by any means, without the prior permission in writing of the publishers or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the UK address printed on this page. The rights of Richard Wootton, Nivritti G Patil, Richard E Scott and Kendall Ho to be identifi ed as Editors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988. This publication has been generously supported by a grant from the International Development Research Centre, Canada; with additional contributions from HiiTeC and the Faculty of Medicine, University of Hong Kong. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN 978-1-85315-784-4 E-ISBN 978-1-55250-396-6 Distribution in Europe and Rest of World: Marston Book Services Ltd PO Box 269 Abingdon Oxon OX14 4YN, UK Tel: +44 (0)1235 465500 Fax: +44 (0)1235 465555 Email: [email protected] Distribution in the USA and Canada: Royal Society of Medicine Press Ltd c/o BookMasters Inc 30 Amberwood Parkway Ashland, OH 44805, USA Tel: +1 800 247 6553/+1 800 266 5564 Fax: +1 419 281 6883 Email: [email protected] Distribution in Australia and New Zealand: Elsevier Australia 30–52 Smidmore Street Marrickville NSW 2204, Australia Tel: +61 2 9517 8999 Fax: +61 2 9517 2249 Email: [email protected] Typeset by Saxon Graphics Ltd, Derby Printed and bound in the UK by Bell & Bain Ltd, Glasgow, UK Contents Contributors ix Foreword xiii Preface xv SECTION 1: BACKGROUND 1. Introduction 3 Richard Wootton, Kendall Ho, Nivritti G Patil and Richard E Scott SECTION 2: POLICY 2. Bridging the digital divide: Linking health and ICT policy 9 Joan Dzenowagis 3. Telemedicine in developing countries: Perspectives from the Philippines 27 Alvin B Marcelo 4. Information technology for primary health care in Brazil 34 Elaine Tomasi, Luiz A Facchini, Elaine Thumé, Maria FS Maia and Alessander Osorio 5. Community-based health workers in developing countries and the role of m-health 43 Adesina Iluyemi 6. Global e-health policy: From concept to strategy 55 Richard E Scott 7. Experiences and lessons learnt from telemedicine projects supported by the IDRC 68 Laurent Elder and Michael Clarke 8. Strategies to promote e-health and telemedicine activities in developing countries 79 Sisira Edirippulige, Rohana B Marasinghe, Vajira H W Dissanayake, Palitha Abeykoon and Richard Wootton v Contents SECTION 3: EDUCATIONAL 9. Telemedicine in low-resource settings: Experience with a telemedicine service for HIV/AIDS care 91 Maria Zolfo, Verena Renggli, Olivier Koole and Lut Lynen 10. Medical Missions for Children: A global telemedicine and teaching network 101 Philip O Ozuah and Marina Reznik 11. Telementoring in India: Experience with endocrine surgery 109 Saroj K Mishra, Puthen V Pradeep and Anjali Mishra SECTION 4: CLINICAL 12. Teledermatology in developing countries 121 Steven Kaddu, Carrie Kovarik, Gerald Gabler and H Peter Soyer 13. Cross-cultural telemedicine via email: Experience in Cambodia and the USA 135 Paul Heinzelmann, Rithy Chau, Daniel Liu and Joseph Kvedar 14. Telepathology and telecytology in developing countries 149 Sangeeta Desai 15. Internet-based store-and-forward telemedicine for subspecialty consultations in the Pacifi c region 156 C Becket Mahnke, Charles W Callahan and Donald A Person 16. Telehealth support for a global network of Italian hospitals 170 Gianfranco Costanzo and Paola Monari 17. Telemedicine in Nepal 182 Mohan R Pradhan 18. Telemedical support for surgeons in Ecuador 193 Stephen Cone, Edgar J Rodas and Ronald C Merrell 19. A low-cost international e-referral network 203 Richard Wootton, Pat Swinfen, Roger Swinfen and Peter Brooks 20. Telehealth in China: Opportunities and challenges 212 Jie Chen and Zhiyuan Xia 21. Telemedicine in South Africa 222 Maurice Mars 22. Telemedicine in sub-Saharan Africa 232 Maurice Mars 23. Telehealth for mountainous and remote areas of northern Pakistan 242 Hameed A Khan and Irfan Hayee vi Contents 24. Teleneurology: Past, present and future 252 Usha K Misra and Jayantee Kalita 25. Telepaediatric support for a fi eld hospital in Chechnya 262 Boris A Kobrinskiy and Vladimir I Petlakh 26. Web-based paediatric oncology information and registries: An international perspective 273 André Nebel de Mello 27. E-health in international networks: New opportunities for collaboration 287 Shariq Khoja and Azra Naseem SECTION 5: THE FUTURE 28. The future use of telehealth in the developing world 299 Richard Wootton Index 309 vii This page intentionally left blank Contributors Palitha Abeykoon Ministry of Health, Colombo, Sri Lanka Peter Brooks Faculty of Health Sciences, University of Queensland, Brisbane, Australia Charles W Callahan De Witt Army Community Hospital, Ft Belvoir, Virginia, USA Rithy Chau Sihanouk Hospital Center for HOPE, Phnom Penh, Cambodia Jie Chen Key Laboratory of Health Technology Assessment, Ministry of Health; School of Public Health, Fudan University, Shanghai, China Michael Clarke International Development Research Centre, Ottawa, Canada Stephen Cone Virginia Commonwealth University Medical Center, Richmond, Virginia, USA Gianfranco Costanzo Ministry of Labour, Health and Social Policies, Alliance of the Italian Hospitals Worldwide – Secretariat for Technical Assistance, Rome, Italy Sangeeta Desai Department of Pathology, Tata Memorial Hospital, Mumbai, India Vajira H W Dissanayake Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka Joan Dzenowagis World Health Organization, Geneva, Switzerland Sisira Edirippulige Centre for Online Health, University of Queensland, Brisbane, Australia Laurent Elder International Development Research Centre, Ottawa, Canada Luiz A Facchini Department of Social Medicine, University Federal of Pelotas, Pelotas, Brazil Gerald Gabler Department of IT and Telecommunications, Graz University Clinics and General Hospital, Graz, Austria Irfan Hayee COMSATS Headquarters, Islamabad, Pakistan ix Contributors Paul Heinzelmann Center for Connected Health, Partners HealthCare; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA Kendall Ho Faculty of Medicine, University of British Columbia, Vancouver, Canada Adesina Iluyemi Centre for Healthcare Modelling and Informatics, School of Computing, University of Portsmouth, UK Steven Kaddu Department of Dermatology, Medical University of Graz, Graz, Austria Jayantee Kalita Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India Hameed A Khan Pakistan Atomic Energy Commission, Islamabad, Pakistan Shariq Khoja Faculty of Health Sciences, Aga Khan University, Karachi, Pakistan Boris A Kobrinskiy Moscow Research Institute of Paediatrics and Children’s Surgery, Moscow, Russia Olivier Koole Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium Carrie Kovarik Department of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania, Philadelphia, USA Joseph Kvedar Center for Connected Health, Partners HealthCare; Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA Daniel Liu Sihanouk Hospital Center for HOPE, Phnom Penh, Cambodia Lut Lynen Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium C Becket Mahnke Tripler Army Medical Center, Honolulu, USA Maria F S Maia University Federal of Pelotas, Pelotas, Brazil Rohana B Marasinghe Centre for Online Health, University of Queensland, Brisbane, Australia Alvin B Marcelo National Telehealth Center, University of the Philippines, Philippines Maurice Mars Nelson R Mandela School of Medicine, University of KwaZulu- Natal, South Africa Ronald C Merrell Virginia Commonwealth University Medical Center, Richmond, Virginia, USA x Contributors Anjali Mishra Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India Saroj K Mishra Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India Usha K Misra Department of Neurology, Sanjay Gandhi Postgraduate Institute of