International Health Care and Development and the Innovative Use of Telehealth

This article features an interview with Dr. Jim Katzenstein, an international consultant, educator and organisation systems design expert bringing telehealth solutions to developing countries. He is Executive Director of HealthSpan International, an organisation which works primarily in Tanzania and in Mizoram, India - using the technology that supports telemedicine to build relationships, communicate ideas, and move projects along in between face-to-face visits. His forward-looking vision is to increasingly promote the use of telemedicine to link people from all parts of the work together in a network of learning and sharing - for better health.

Based on the conviction that simplicity is frequently more important than flexibility when it comes to the level of technology, HealthSpan's telemedicine system uses 8X8 cameras at each end and television sets as monitors. The organisation also uses computers with web cams for higher-quality still pictures and to transmit data. When the nurse at the clinic needs to consult with a doctor, she calls the doctor on a cell phone and the doctor places the patient-at-a-distance in her queue of face-to-face patients. When it's the remote patient's turn, the doctor calls the nurse on the cell phone, turns on the cameras and starts the consult. "This eliminates the need for precise scheduling, which is foreign to the local culture." (HealthSpan's model involves partnering with local organisations - who "know what their problems are and they frequently have a good idea of what is needed to solve them" - to build confidence and self-sufficiency when it comes to introducing technology.)

To cite one example of a project that HealthSpan is pursuing, an individual in Sudan is working with the organisation to develop a tele-education system connecting his university with those in other countries. "We are using a store and forward technology to deliver a basic set of information and then following it up with an interactive SKYPE conference. We are at the very beginning of this but I think the methodology is new."

Drawing on experiences like these, Dr. Katzenstein describes a pattern he has observed in the physician-patient relationship and communication channels. He says, "When I was a boy, medical care was delivered to the home by physicians who made house calls. The process has evolved away from that, partly because it is more cost efficient for all the patients to come to the doctor than for the doctor to go to all the patients. This model is ubiquitous through out the world. As telemedicine becomes more cost efficient, I see no reason why the pendulum shouldn't swing back - even in developed countries. We are busy and so don't have time to sit in a doctor's office for an afternoon and then get stuck in traffic on the way back to our office for a dinner meeting. Far more efficient to have a quick teleconference between meetings and have the prescription delivered."