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No limits to healing
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Though considered futuristic and experimental, telemedicine is ideal for India. Quality medical services can be made available to a patient, says DR. K. GANAPATHY.
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"WATSON, come here. I want you," said Alexandar Graham Bell on March 20, 1876, when he inadvertently spilled battery acid on himself, while making the world's first telephone call. Little did Bell realise that this was indeed the world's first telemedical consultation. We have come a long way since then. Today, even tele-surgery is a reality.
What is telemedicine?
Telemedicine is a method by which patients can be examined, investigated, monitored and treated by doctors in far-off places. Tele is Greek for "distance" and Mederi is Latin for "to heal". Time magazine called telemedicine "healing by wire". Though considered "futuristic" and "experimental", telemedicine is today a reality. One transfers the expertise, not the patient. Hospitals of the future will drain patients from all over the world without geographical limitations. In Cyberia, after all, one is a netizen!
High quality medical services can be brought to the patient, rather than transporting the patient to distant and expensive tertiary care centres. The goal of telemedicine is to eliminate unnecessary travelling of patients and their escorts.
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Table 1: Health scenario in India
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620 million live in rural India
Bed population ratio 1: 1333 (1991) vs ideal of 1:500
Two million beds required as against 0.7 million available
Seven hundred hospitals of 250 beds each, needed every year costing
Rs. 25,000 crores annually
Only nine per cent of 1 billion are covered under health schemes
Only two per cent of GDP for health (WHO recommendation 5 per cent)
Five per cent of annual family income spent towards curative health care
Few specialists in sub-urban or rural areas
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Image acquisition, storage, display and processing, and image transfer represent the basis of telemedicine. This system is becoming an integral part of health care services in the United Kingdom, the United States, Canada, Italy, Germany, Japan, Greece and Norway. India has jumped on the bandwagon but is neither following the West nor piggyback riding. We are actually playing leapfrog in the exciting new discipline of telemedicine.
Today a few trailblazing hospitals in India are in the process of developing tailor made, cost effective specific telemedicine solutions. This includes use of ISDN lines, VSAT satellites and the Internet.
In Utopia, every citizen has immediate access to the appropriate specialist for medical consultation. In the real world, this cannot even be a dream. Table 1 clearly shows that even thinking of providing access to adequate health care for all Indians would be foolhardy. It is a fact of life that "All men are equal, but some are more equal than others". We are at present, unable to provide even total primary medical care in the rural areas. Secondary and tertiary medical care is not uniformly available even in the suburban and urban areas. Though Table 2 specifically refers to neurosurgeons, the number of all super specialists in the country is low. What is more dismal is their distribution. Chennai has more neurosurgeons (68) than the 250 million of North Eastern India have. Incentives to entice the few specialists available to practice in suburban areas have failed. After all professional isolation would lead to mediocrity, which is one step away from entering Jurassic Park. Obviously "Health for All" will continue to be a slogan even in the next decade unless of course we change our mindset and look upon telemedicine as the panacea. After all India is indeed the land of the future (Table 3).
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Table 2: Neurosurgical services in India
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Ready access to neurosurgical
care provided by 720 neurosurgeons
and 100 trainees restricted
to 450/ 1050 million.
New neurosurgeons qualifying
per year 80 to 100.
Training programmes 55 (Five
national institutes, four
deemed universities, 25 medical
colleges, 17 corporate, private
and trust hospitals)
centres of excellence 12-15.
Government Medical Colleges
having neurosurgery departments
75/160.
Corporate hospitals having neurosurgery
departments 25 - 30.
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It is generally considered that areas most likely to benefit from telemedicine are those least likely to afford it or have the requisite communication infrastructure. This may no longer be true. In contrast to health care, computer literacy is fast spreading. Computer prices are falling. Health care providers are now looking at telemedicine as their new found avatar. Theoretically, it is far easier to set up an excellent telecommunication infrastructure in suburban and rural India than to place hundreds of medical specialists in these places. The Government has already realised that the future of telecommunications lies in satellite-based technology and fibre optic cables. Providing health care in remote areas using this is not as absurd as it may initially appear.
Telemedicine is India is still in an embryonic stage. Successful pilot projects indicate that the period of gestation will soon be over.
Small to medium nursing homes where basic neurosurgery is done 115.
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Table 3: India - Land of the future!
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Sixty-five per cent to 1100 million
will be literate by 2005
Sixty per cent of rural India has
access to TV coverage
About 600,000 existing PCO's.
internet kiosks
About 375,000 villages already
have telephone connections
Internet users in India one million
December 2000, 8.5m
2003 VSAT satellites, wireless
internet available
Hardware, software and brainware
available
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The first generation of telemedicine enthusiasts should not forget that technology should be used as a support to treat patients and not viewed as a goal in itself. The challenge today is not confined to overcoming technological barriers, insurmountable though they may appear. It is true that available technology still has scope for improvement. Rather the challenge is why, where and how, to implement which technology and at what cost. A needs assessment is critical. Due to pressure from powerful vendors the perceived needs for telemedicine may not conform to the actual needs. The take off problems, facing telemedicine are legion. Telemedicine today sounds hep and cool, but the reality may be quite different. The future however promises to be exciting. So ladies and gentlemen hang on for the ride! Telemedicine will be more than a roller coaster trip. The journey will well be worth the wait. Time alone will tell whether telemedicine is a "forward step in a backward direction" or to paraphrase Neil Armstrong" one small step for man but one giant leap for mankind.
The writer, a neurosurgeon, is also the Medical Director of Apollo Telemedicine Enterprises, Chennai. He is an adjunct professor at the Anna University, Chennai and a visiting professor at the Indian Institute of Information Technology and Management, Thiruvananthapuram.
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