Telemedicine in Western Africa RAFT

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Telemedicine in Western Africa (RAFT)

• Medical Imaging and Telemedicine (MIT 2005)

Cheikh Oumar Bagayoko, Henning Müller, Antoine
Geissbuhler Medical Informatics Service
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Outline

• Telemedicine
• Goals and challenges
• Technical needs
• Development of the RAFT network
• Results
• Discussion
• Conclusions

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Telemedicine

• Communication and sharing of medical information
  and knowledge over distances
• Teleconsultations
• Teleteaching
• Knowledge creation
• Online and offline communication
• Most often Teleradiology
• Reduced film cost and transport problems
• Possibility to obtain an expert opinion
• In remote areas, at night,
• Influence strong where experts are rare,
  distances large, and infrastructure is limited

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Goals of RAFT

• Develop a South-South network for distance
  continuing medical education and
  teleconsultations
• Between teaching centers and regional hospitals
  in French-speaking Africa
• Integrate first-line healthcare in the
  telemedicine network
• Develop capacities for local, high-quality,
  medical on-line content
• Develop tools for local needs

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Challenges

• Low bandwidth
• Neither telephone lines nor electricity in rural
  areas
• International bandwidth of RAFT countries is very
  limited
• End 2004 18 Mbps for the entire country, 1,34
  bps/capita (Mali)
• Switzerland 2002 66.000 Mbps, 9.040 bps per
  capita
• Source ITU World Telecommunication Indicators
  Database
• Satellite transmission can help but is pricey
• Mobile communication is gaining ground
• Unstable electricity supply
• Solar panels
• Batteries (car)

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Rural telemedicine Dimmbal
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(No Transcript)
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Technical needs

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

Requirements client Operating 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 server PC 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.
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Development

• 2001 Mali 4 sites in Bamako, 3 regional
  hospitals, 1 rural hospital
• 2002 Mauritania 7 sites in Nouakchott, 8
  regional hospitals, 1 rural telecentre
• 2003 Morocco (Marrakech)
• 2004 Burkina-Faso, Senegal, Tunisia
• 2005 Cameroon, Ivory Coast, Madagascar,
  Djibouti, Niger

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Results Teleteaching

• 50 teachings from Geneva hospitals to Raft
  countries with important subjects e.g HIV ,
  obstetrical surgery, fistulas in urology
• 48 from Bamako to Geneva physicians and medical
  students and others RAFT counties on e.g
  malaria , leprosy , dermatology
• In October 2005, every RAFT country will have a
  system for teleteaching diffusion
• Thanks to this system an MD agreed to go 875 km
  from Bamako because otherwise he saw himself cut
  from the rest of the world

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Teleteaching from Bamako
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South - North Collaboration
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Results Teleconsultations

• 10 teleconsultations to Geneva in neurosurgery
  for 15 children in Mali
• 2 teleconsultations to Bamako in leprosy and
  dermatology for Geneva University hospitals and
  another clinic in Geneva (de la Tour)
• 4 teleconsultations in radiology to Marseilles
  for Bamako University hospital

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Teleconsultation neurosurgery
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Results Collaborative knowledge creation

• National web portals
• e.g. Mali, Mauritania
• Disease-specific content
• e.g., rheumatic heart disease in Morocco
• Multi-site web-casting
• Combining web-casting with phone conference
• South-North teaching
• e.g., Leprosy, Malaria courses for Geneva
  tropical medicine courses
• Dynamic web sites
• Diagnostic and therapeutic approaches including
  traditional practices
• e.g., Pluriderm for skin diseases

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A library of created courses

• Can be replayed, information can be added

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Discussion

• Looking at these results should one not conclude
  that the application of telemedicine seems more
  than justified in poor countries even if means of
  communication remain little developed?
• However, the problem remains the weak band-width
  and the energy sources, which are not impossible
  to circumvent
• Pragmatism and the realism with tools adapted to
  the context must remain the rule

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Conclusions

• Developing countries have different requirements
  than industrialized nations
• Telemedicine can have a strong impact in these
  countries
• Creating local knowledge
• Allowing remote parts to get access to medical
  care
• Local teleteaching (south-south) is often more
  effective than north-south networks
• Better adapted to local requirements and customs

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Is IT a priority?