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India with over one billion population has to face the challenge of providing healthcare to 75 percent of its people living in villages. Nearly half of these villages have no access to clean drinking water and over half of the population denied of basic sanitation. Over 4 million people suffer from vector borne diseases like Malaria, TB, Filariasis and Dengue fever and 6 lakh deaths are reported annually. 25 percent of the children born are characterised by low birth weight, 60 percent under five are mal-nourished and over 2 million die every year. It is practically impossible to offer surgical correction to over a lakh of infants born with congenital heart defects every year, with hardly 10 well-equipped hospitals. The number of people suffering from heart attacks, particularly among the middle-aged people, has been steadily increasing.
We have just about 40 medical practitioners and 80 beds per lakh of population that too concentrated primarily in urban areas. About 75 percent of our doctors practice in urban areas and 23 percent in semi-urban areas. This leaves just 2 percent of the qualified doctors, who are attached to about 23,000 primary health and 3000 community health centers, to attend to 70 percent of the population living in villages.
Promise of Communication Technology and Telemedicne
The advent of communication technology, especially, the SatCom combined with Information Technology, has given us the means to take the benefit of medical sciences to large section of people spread out in the remote and inaccessible villages. The Indian Space Research Organisation, ISRO, in pursuing its objective of taking the benefit of space technology to the population in rural and remote areas, took the initiative of establishing a space-based telemedicine network in 2001.
Telemedicine is a confluence of communication technology, information technology, medical engineering and medical science. The telemedicine system consists of customized hardware and software at both the patient and doctor’s end with diagnostic tools like ECG, X-ray and pathology provided at the patient end linked through digital connectivity via INSAT satellites by VSATs controlled by the Network Hub Station of ISRO. Generally, the medical record/history of the patient is sent to the specialist doctors who, in-turn, will study and provide diagnosis and treatment through video conference with the local doctor and patient.
ISRO Telemedicine Network
ISRO’s Telemedicine initiative is aimed at i) Providing Telemedicine Technology and connectivity between remote/rural hospitals and Super Speciality Hospitals for Teleconsultation, Treatment and Training of doctors and paramedics, ii) Providing the Technology and connectivity for Continuing Medical Education (CME) between Medical Colleges and Post Graduate Medical Institutions/Hospitals and iii) Providing Technology and connectivity for Mobile Telemedicine units for rural health camps especially in the areas of ophthalmology and community health.
ISRO is playing a catalytic role by providing proven technology for introducing SatCom based Telemedicine in the remote parts of our country through pilot projects. Government run hospitals and a few Trust/NGO-run hospitals are selected so that they get sufficient training and experience to run the facility and the users themselves can subsequently introduce telemedicine in an operational mode at national level. Presently ISRO telemedicine network covers 115 Hospitals – 88 Remote/Rural/District Hospital/Health Centre connected to 27 Super Speciality Hospital located in the major cities. They include hospitals in Jammu and Kashmir, Lakshadweep and North Eastern States. Also included in the network are Mobile Tele-hospitals visiting various villages in Madurai and Theni districts of Tamilanadu, Mobile Teleopthalmology Units for the Eye Care rural Camps, Onco-net project for cancer care. Temporary Telemedicine facility for 2 months is set up at Pamba at the foothills of Sabarimala shrine for the benefit of visiting pilgrims during December every year.
More than 100,000 patients have benefited with Tele-consultation and treatment using ISRO telemedicine network.
An Impact Study conducted on one thousand patients has revealed that the patients have saved 81 percent of cost, mainly because of savings in travel, stay and treatment at the Hospitals in the cities. In case of off-shore Islands the cost saving is enormous both to the government and the patients.
ISRO’s Telemedicine Project is gaining more acceptability and has potential to open up new frontiers for the rural health care in India. Many States have come forward to introduce Telemedicine in an operational mode and have prepared the District Hospitals with Telemedicine facility both for ambulatory and Intensive care for cardiac related treatment. Recently the State of Karnataka has initiated the establishment of SatCom Based Telemedicine facility in all their district hospitals and a few trust hospital which will be connected to different Speciality Hospitals in the major cities. Other States will soon follow this also. ISRO has plans to integrate telemedicine with tele-education wherever applicable to reach more rural areas in India.
With regard to technology of software and hardware for medical applications ISRO, IT industry, Software and equipment industries and some of the healthcare providers have done extensive work. National Committee constituted by DIT has come out with standards and guidelines for the practice of Telemedicine in India which has been available at the DIT website and being referred extensively by the interested users. A Telemedicine manual published and released by ISRO during the International Conference on Telemedicine INTELEMEDINDIA 2005 has brought simple lessons about the technical and clinical aspects of Telemedicine, which can act as a guide for Doctors, Administrators, Technologists, Healthcare Providers and Hospitals.
Distance Medical Education
Mushrooming growth of medical institutions from just 20 in 1957 to over 400, particularly with the entry of self-financing private institutions has increased the demand for quality medical education. On the other hand, the spectacular advances in genetic engineering is on the verge of giving birth to molecular medicine, which can transform medical dispensation from a treatment based to a prevention based discipline. With the initiation of the third wave Information and Communication Revolution, where knowledge and skills now stand alone as the only source of competitive advantage in the globalised world, extensive use of tele-medicine education alone can ensure the quality of medical education in the country and prevent practicing doctors from becoming obsolescent.
Sustenance of Telemedicine
The cornerstone of the tele-medicine programme has been the continuous effort for cost reduction and technology upgradation of hardware, software and communication targeting efficient communication and bandwidth optimization and server-browser based telemedicine software and miniaturised video-conferencing system have been introduced.
While the capital expenditure for the establishment of ground facilities and the satellite Ku-band link could be borne by the States for the pilot project, a nationwide operational network, requiring establishment of at least 3,000 nodes, can only be operationally sustained if it is made largely self-reliant. On the technical side it is necessary to develop a standardised, simple and easily operable system around commercially available cost-effective technology. Dedicated doctors and other auxiliary medical personnel both at the patient and the super-speciality hospital ends, need to be adequately compensated for their time and service. Revenue earning and management models for running such a system need to be carefully worked out to ensure that the fee charged to the patients is truly affordable and management structure is fully accountable and totally transparent.
Towards evolving the self-sustenance of Tele-medicine, a unique project for Distance Healthcare Advancement (DISHA) was launched in July 2005 in Madurai District of Tamil Nadu. The project is jointly undertaken by ISRO, Philips India, Apollo Telemedicine Networking Foundation (ATNF) and the Madurai based NGO, namely, Development of Human Action (DHAN). DISHA is a telemedicine initiative to provide distance healthcare to the under-served population at affordable cost. Under the project, a tele-clinical van, complete with diagnostic equipment provided by Philips will be travelling through Theni District in Tamil Nadu along with dedicated doctors and other para-medical staff. ISRO is providing the connectivity through VSAT and allocating the required bandwidth on its INSAT satellite. DHAN foundation is playing a key role in building trust and credibility for the project by interacting with the local community. This pilot project will be evaluated and the results used to build a business model for healthcare delivery system including the pricing for such facility.
ISRO had also organised an International Conference on Telemedicine in March 2005 at Bangalore and a round table discussion held as part of the conference involving doctors, health care providers, technologists and NGO’s recommended constitution of a task force to work out the technical and operational details and evolve a comprehensive blue print for the establishment and management of the telemedicine system through a specially constituted trust, composed of eminent people, IT experts, Government representatives, Specialist doctors and health care providers.
Conclusion
The development of technology based Healthcare Delivery System through satellite medium can substantially augment the existing Healthcare programme especially in rural and remote areas. Tele-medicine can also open up the employment potential for the Healthcare industry, improving the skills of healthcare workers and potential market for indigenous software and equipment industry in the country. We need to now concentrate on gainfully employing the various technological tools available to us, to rapidly build a strong and healthy nation.
*Secretary, Department of Space
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