August 23rd, 2007

Most of what I have done thus far seems like it would have promising results, but I can’t too sure. While my meetings usually end with gratifying promises, contact info exchange, and sometimes even a firm follow-up date, I’m not sure how much we discuss will actually translate into implementation. Nevertheless, I feel like there is much potential for the work I am doing, both in ‘evaluating this telemedicine system’ and in ‘optimizing it to maximize benefit to the rural poor’-my two major tasks.

Meetings with SEWA Gram Haat (the rural marketing/distribution organization), the Research office in SEWA Academy (where they conduct action-oriented studies of SEWA activities), and SEWA Health (a part of SEWA’s Social Security) have resulted in identifying datasets that might be useful for evaluation/research purposes. However, I haven’t actually received much of this information yet, as I plan on meeting with SEWA Academy tomorrow, the Gram Haat data is at their processing facility in the Sabarkantha District, and SEWA Health has yet to get back to me.

My meetings outside SEWA have been more interesting. Last Thursday, I went down to Apollo Hospital for a VRC session on tele-consultation for skin diseases to see the expert end of the VRC telemedicine network in action. By the end of the 3-hour-long session, the dermatologist seemed spent. While technical difficulties and poor camera-handling slowed down the session significantly, the biggest problem appeared to be in the Electronic Medical Record (EMR) forms filled out by each district for each patient in advance. For whatever reason, patient description and medical history often did not correlate with what was on paper. This became apparent when a rather large woman was reported to weigh 42 kilos (~92 lbs) when she was clearly at least double that weight, if not moreso. This was corroborated by the male/female mix-up which followed. It was clear that the current telemedicine system was ‘suboptimal,’ and we started discussing ideas for things to change.

At Apollo, I also had the chance to sit down and talk with their director of telemedicine in Gujarat (as Apollo has its own telemedicine network in addition to the VRC system). As we went through their different business models for telemedicine, I found that none were particularly sustainable just yet. A lot of the telemedicine that is currently being used is based on CSR (corporate social responsibility) or the intrinsic motivation of particular doctors. While this may have dented my faith in the concept of telemedicine a little, it made me admire the efforts put forth by Apollo and the specialist doctors a little more.

On Tuesday, I went down to Vadodara (Baroda) to met with the District Health Officer (DHO). We told him about our VRC system, and he seemed incredibly supportive. He lent us the use of his PHC (Public Health Center) in Bodeli, one of the our VRC sites. This opened the door for telemedicine applications from a wide range of specialties. Currently, SEWA’s VRCs don’t have any diagnostic equipment, and thus are confined to teleconsultation for skin diseases alone (as the video camera is enough for diagnosis). With use of blood pressure monitors, ECGs, and blood testing at the PHC, not to mention the doctors and medicine dispensary, much more detailed information can be sent to Apollo for specialty consultation. The DHO asked SEWA to compose a Memorandum of Understanding (MoU) of what it wanted to do exactly.

In the next week or so, we plan to meet with the PHC doctors, a block level health officer, and Apollo Hospital once again to put together some sort of framework for expansion of telemedicine. Hopefully the ideas we are getting from talking to all of these people will not die with just that, all talk.

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August 2007
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