TeleEducation in North Africa: A U'S'Morocco Partnership for Childrens Health

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Tele-Education in North Africa A U.S.-Morocco
Partnership for Childrens Health

• May 14, 2007 ATA Annual Meeting
• Molly Reyna, BA¹, Craig Sable, MD¹, Philip
  Hopkins¹,
• Najia Hajjaj-Hasanni, MD², Nezha Mouane, MD³
• ¹Childrens National Medical Center, Washington,
  DC ²Faculty of Pharmacy and Medicine, Rabat,
  Morocco ³Hopital DEnfants, Rabat, Morocco.

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Childrens National Medical Center

• Top 10 United States Childrens Hospital
• Over 200 subspecialists provide highest level of
  patient care, education, advocacy, and research
• International program facilitates collaboration
  and patient referrals from Middle East, Africa,
  Asia, and South America
• Successful regional, national and international
  telemedicine and distance education programs

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Background Morocco

• Located on the Northwest coast of Africa
• Estimated population of 29 million, approximately
  half of the population is under the age of 20
  (United Nations Population Division, 2003)
• Although Arabic is the national language, the
  preferred language of business/education is
  French
• Chronic diseases, such as asthma and bronchitis,
  rheumatic illnesses, malaria, typhoid, and viral
  hepatitis are prevalent

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Marrakech
Fes
Rabat
Casablanca
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Morocco Healthcare System

• Selective, targeted training programs lack a
  comprehensive development for training healthcare
  workers
• Variable technology infrastructure across the
  country makes it difficult to collaborate within
  the Moroccan medical community
• Utilization of technology for training, education
  and patient care is the current focus of Ministry
  of Health

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Foundation Support
The Mosaic Foundation is dedicated to improving
the lives of women and children, while fostering
cultural, educational, and professional dialogues
between the peoples of the Arab world and the
United States
An American Charitable Foundation Sponsored by
the Spouses of the Arab Ambassadors to the
United States
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Project Description

• Establish an international Tele-education network
  for pediatric medical specialties of concern to
  health care providers, their patients and
  families in Morocco.
• Utilize distance learning to improve community
  and health care provider knowledge and practices
  related to significant children's health care
  issues.
• Our partnership with the Hospital Teaching
  Faculty in Rabat will focus on improving
  education, technology and healthcare staffing,
  all of which are critical components to improve
  the level of pediatric care available in the
  region.

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Project Design Year One

• Objective 1 Activation
• Establish a partnership between CNMC Rabat
  Childrens Hospital
• Develop Educational Content Install Technical
  Components necessary for Distance Learning
  Training
• Objective 2 Management
• Implement Distance education and medical
  consultation
• Live and computer based lectures (translation)
• Live and computer based consultation

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Project Development

• Visits with the Moroccan Ambassador to the U.S.,
  and the U.S. Ambassador to Morocco
• Met with Moroccan Ministry of Health in Rabat
• Onsite visits at Medical University Centers and
  Childrens Hospitals in Rabat, Casablanca, Fes,
  Marrakech
• Met with medical school deans and hospital
  leaders
• Developed key physician and technical contacts
• Assessed technical/telemedicine equipment at each
  site
• Gave telemedicine lecture to students and faculty
  
• Identified educational priorities nutrition,
  hematology, cardiology, infectious diseases

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Telemedicine Applications

• ViTel Net MedVizer IP and ISDN
• Incorporates main camera and multiple medical
  device cameras
• Supports live case presentation and
  store-and-forward consultation
• Live consultation at 384 512kbps
• Store-and-forward patient information is captured
  in an episodic record and transferred via IP
  connection to a server located at CNMC
• Software functions allow the referring site to
  push the information to CNMC and pull the record
  back once the consultation is completed.

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Telemedicine Consultation - Rabat
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Distance Learning Applications

• Live Distance Learning Tandberg Cisco IPTV
• Connects to CNMC and other sites via ISDN 512kpbs
• Cisco IPTV Streaming Product in implementation
  phase
• Video-On-Demand Cisco Digital Media System
• Content edited with Mac FinalCut Pro
• Utilizes Cisco Portal for Content Access
• Currently connected to three sites in Rabat and
  Casablanca
• Launch three additional sites in 2007 Faculty
  Buildings in Fes and Marrakech, MOH Rabat

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Live Lecture - Rabat
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Live Lecture - Rabat
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Video-On-Demand Portal

• CNMC Portal Link

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Video-On-Demand Content
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Lessons Learned

• There is a greater need for French translation
  than initially anticipated
• Technical support is lacking and inconsistent by
  location
• Telecommunications technologies are not easily
  accessed and are not 100 reliable
• More time on the ground was needed than
  originally anticipated.

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Project Successes

• Installation of telemedicine and distance
  learning workstations in Rabat and training of
  approx. 40 physicians and technical staff.
• A telemedicine workstation, patient data server,
  streaming media system and content storage system
  was installed at CNMC 50 lectures available
• 15 live lectures and case presentations progress
  towards connecting Rabat physicians with their
  colleagues in Marrakech, Fes, and Casablanca.
• MOH staff are developing community health modules
  and physician administrator training.
• Project efforts have increased communications
  between multiple physician groups within Morocco.

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Year-Two and Beyond

• Objective 3 Outcomes Evaluation
• Evaluate Tele-education Services to continually
  improve project performance
• Project partnership should improve treatment
  outcomes for Children with targeted health needs
• Objective 4 Sustainability
• Strengthen local partnerships to benefit Moroccan
  children and their health care providers
• Develop partnerships with other international
  groups who have tele-education initiatives in the
  region.

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Foundation and Vendor Support

• Mosaic Foundation Government Support
• Board of Trustees, Mosaic Foundation
• Mrs. Felicia Mekouar, Trustee from Morocco
• HH Mekouar, Moroccan Ambassador to U.S.
• Mr. Thomas Riley, U.S. Ambassador to Morocco
• Ms. Mona Hamdy, Executive Director Mosaic
  Foundation

• Project Vendors
• ViTel Net
• Cisco Systems
• Tandberg
• Visionality
• Intelsat
• Dimension Data
• Logicalis
• iDirect

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Acknowledgements

• CNMC Telemedicine Team
• Craig Sable, MD, Telemedicine Medical Director
• Philip Hopkins, International Technical
  Coordinator
• Ron Dixon, Technical Support
• Sam Sabouni, Cardiology Technical Support
• Oussama El Baba, Director International Programs
• Peter Holbrook, MD, Chief Medical Officer
• Kate Paulsen, Director of Development

• Morocco Telemedicine Team
• Pr. Najia Hajjaj-Hassani, Dean Rabat School
  of Medicine
• Pr. Nezha Mouane, Chief of G.I. Rabat Childrens
  Hospital
• Dr. Kouhrassani, Director Rabat Childrens
  Hospital
• Mohammad Karra, Tech. Dir., Rabat School of
  Medicine
• Ms. Souad Jawhari, Ministers Conseillere Morocco
  Ministry of Health
• Mr. Zouhir, Technical Support

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Questions

• Molly Reyna
• CNMC Pediatric Telemedicine Program
• Washington, DC
• 202.884.3412
• mreyna_at_cnmc.org