telemedicine in western africa (raft project)

Telemedicine in Western Africa (RAFT)

Medical Imaging and Telemedicine (MIT 2005) Cheikh Oumar Bagayoko, Henning Müller,

Antoine GeissbuhlerMedical Informatics Service

2©2005 Hôpitaux Universitaires de Genève

Outline

• TelemedicineTelemedicine• Goals and challengesGoals and challenges• Technical needsTechnical needs• Development of the RAFT networkDevelopment of the RAFT network• ResultsResults• DiscussionDiscussion• ConclusionsConclusions


Telemedicine

• Communication and sharing of medical Communication and sharing of medical information and knowledge over distancesinformation and knowledge over distances• TeleTeleconsultationsconsultations• TeleTeleteachingteaching• Knowledge creationKnowledge creation• Online and offline communicationOnline and offline communication

• Most often: TeleradiologyMost often: Teleradiology• Reduced film cost and transport problemsReduced film cost and transport problems• Possibility to obtain an expert opinionPossibility to obtain an expert opinion

• In remote areas, at night, …In remote areas, at night, …

• Influence strong where experts are rare, Influence strong where experts are rare, distances large, and infrastructure is limiteddistances large, and infrastructure is limited


Goals of RAFT

• Develop a Develop a South-SouthSouth-South network for distance network for distance continuing medical education and continuing medical education and teleconsultationsteleconsultations• Between teaching centers and regional hospitals Between teaching centers and regional hospitals

in French-speaking Africain French-speaking Africa

• Integrate first-line healthcare in the Integrate first-line healthcare in the telemedicine networktelemedicine network

• Develop Develop capacitiescapacities for local, high-quality, for local, high-quality, medical on-line contentmedical on-line content

• Develop tools for local needsDevelop tools for local needs


Challenges

• Low Low bandwidthbandwidth• Neither telephone lines nor electricity in rural areasNeither telephone lines nor electricity in rural areas• International bandwidth of RAFT countries is very International bandwidth of RAFT countries is very

limitedlimited• End 2004: 18 Mbps for the entire country, 1,34 bps/capita End 2004: 18 Mbps for the entire country, 1,34 bps/capita

(Mali)(Mali)• Switzerland 2002: 66.000 Mbps, 9.040 bps per capitaSwitzerland 2002: 66.000 Mbps, 9.040 bps per capita

• Source: ITU World Telecommunication Indicators DatabaseSource: ITU World Telecommunication Indicators Database

• Satellite transmission can help but is priceySatellite transmission can help but is pricey• Mobile communication is gaining groundMobile communication is gaining ground

• Unstable Unstable electricityelectricity supply supply• Solar panelsSolar panels• Batteries (car)Batteries (car)


Rural telemedicine : Dimmbal


Technical needs

• Low requirementsLow requirements for servers and clients to for servers and clients to be able to use old hardwarebe able to use old hardware

Requirements clientOperating system: Windows 95, 98 ,2000, Mac OS, Linux, Solaris, or Irix;

PC 166 MHz, 64Mb RAM;

Sound card;

Screen 1024x768 preferred, 800x600 possible;

Netscape 4.0 or Internet Explorer 4.0 or later, Java enabled;

28 kbits/s Internet connection (56 kbits/s bandwidth necessary for video images);

Real Player and Acrobat reader plugins

Requirements serverPC 500Mhz, Windows 98, 128 Mb RAM, sound card;

Webcam server AXIS 2400;

Microphone;

Document video camera WolfVision or equivalent;

Ethernet hub or switch, 10 or 100 Mbits/s.


Development

• 2001: 2001: MaliMali: 4 sites in Bamako, 3 regional : 4 sites in Bamako, 3 regional hospitals, 1 rural hospitalhospitals, 1 rural hospital

• 2002: 2002: MauritaniaMauritania: 7 sites in Nouakchott, 8 : 7 sites in Nouakchott, 8 regional hospitals, 1 rural telecentre regional hospitals, 1 rural telecentre

• 2003: 2003: MoroccoMorocco (Marrakech) (Marrakech)• 2004: 2004: Burkina-FasoBurkina-Faso, , SenegalSenegal, , TunisiaTunisia• 2005: 2005: CameroonCameroon, , Ivory CoastIvory Coast, , MadagascarMadagascar, ,

DjiboutiDjibouti, , NigerNiger


Results: Teleteaching

• 50 teachings from Geneva hospitals 50 teachings from Geneva hospitals to Raft to Raft countriescountries with important subjects e.g: HIV , with important subjects e.g: HIV , obstetrical surgery, fistulas in urology …obstetrical surgery, fistulas in urology …

• 48 48 from Bamakofrom Bamako to Geneva physicians and to Geneva physicians and medical students and others RAFT counties medical students and others RAFT counties on e.g: malaria , leprosy , dermatologyon e.g: malaria , leprosy , dermatology

• In October 2005, every RAFT country will In October 2005, every RAFT country will have a system for teleteaching diffusionhave a system for teleteaching diffusion

• Thanks to this system an MD agreed to go Thanks to this system an MD agreed to go 875 km from Bamako because otherwise he 875 km from Bamako because otherwise he saw himself cut from the rest of the worldsaw himself cut from the rest of the world


Teleteaching from Bamako


South - North Collaboration


Results: Teleconsultations

• 10 teleconsultations 10 teleconsultations to Genevato Geneva in in neurosurgery for 15 children in Mali neurosurgery for 15 children in Mali

• 2 teleconsultations 2 teleconsultations to Bamakoto Bamako in leprosy and in leprosy and dermatology for Geneva University hospitals dermatology for Geneva University hospitals and another clinic in Geneva (de la Tour)and another clinic in Geneva (de la Tour)

• 4 teleconsultations in radiology to 4 teleconsultations in radiology to Marseilles for Bamako University hospital Marseilles for Bamako University hospital


Teleconsultation neurosurgery


Results: Collaborative knowledge creation

• National National web portalsweb portals • e.g. Mali, Mauritaniae.g. Mali, Mauritania

• Disease-specific content Disease-specific content • e.g., rheumatic heart disease in Moroccoe.g., rheumatic heart disease in Morocco

• Multi-site Multi-site web-castingweb-casting• Combining web-casting with phone conferenceCombining web-casting with phone conference• South-North South-North teachingteaching

• e.g., Leprosy, Malaria courses for Geneva tropical e.g., Leprosy, Malaria courses for Geneva tropical medicine coursesmedicine courses

• Dynamic web sitesDynamic web sites• Diagnostic and therapeutic approaches including Diagnostic and therapeutic approaches including

traditional practicestraditional practices• e.g., Pluriderm for skin diseasese.g., Pluriderm for skin diseases


A library of created courses

• Can be replayed, information can be addedCan be replayed, information can be added


Discussion

• Looking at these results should one not Looking at these results should one not conclude that the application of conclude that the application of telemedicine seems more than justified in telemedicine seems more than justified in poor countries even if means of poor countries even if means of communication remain little developed?communication remain little developed?

• However, the problem remains the weak However, the problem remains the weak band-width and the energy sources, which band-width and the energy sources, which are not impossible to circumvent are not impossible to circumvent

• PragmatismPragmatism and the and the realismrealism with tools with tools adapted to the context must remain the adapted to the context must remain the rulerule


Conclusions

• Developing countries have Developing countries have different different requirementsrequirements than industrialized nations than industrialized nations

• Telemedicine can have a strong impact in Telemedicine can have a strong impact in these countriesthese countries• Creating Creating local knowledgelocal knowledge• Allowing remote parts to get access to medical Allowing remote parts to get access to medical

carecare

• Local teleteaching (south-south) is often Local teleteaching (south-south) is often more effective than north-south networksmore effective than north-south networks• Better adapted to Better adapted to local requirementslocal requirements and and

customscustoms


Is IT a priority?

telemedicine in western africa (raft project)

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