Oceans Away - Are new medical systems shrinking our planet?

By Peter McKenzie-Brown

Tyranny and egotism grip many countries, and these are deplorable. But civility and kindness remain widespread, and the basic decency that evolved with liberal democracy and economic prosperity remains a source of kindness and empathy around the world. Take the case of a few people in Calgary, and their impact on the other side of the Pacific and Indian oceans. Their vehicle of change is a tiny charity named CHILD Foundation, which founded, funded and now operates a hospital in rural India.

To put its work in perspective, India has a population of 1.35 billion. Most physicians work in cities, which provide more conveniences, yet 70 percent of the country’s population live in the countryside. According to Calgary physician Bhavini Gohel, rural Indians lack access to basic medical care. Citing a study conducted by the Indian Institute of Public Opinion, she says 89 per cent of rural patients have to travel “long distances over miserable, crowded roads to access even basic medical treatment. Given the lack of basic infrastructure in rural India, it’s awfully difficult to retain doctors in village hospitals,” which themselves are uncommon. The inequalities in health care access between rural and urban people are huge.

Construction begins....

Dr. Gohel sits on the hospital’s 13-member board, as does my spouse. This has sometimes led to odd conversations at the dining table. For example, one evening, my wife started using what to me sounded like gobbledygook. “We’re having discussions with ICE Health Systems to develop a telemedicine-type system we call Medicine at Home. It will facilitate health care by satellite through our hospital to remote villages and the broader community,” she began.

“Hmm?” I asked.

“This will enable us to broaden the patient base and the geographic area we serve. Our Maya Devi Hospital will become the hub for the expanded provision of service. It’s an exciting project.” My eyes widened. It was beginning to make sense.

A decade ago, my Rotary club had instigated a project to support the work of Calgary businessman Anil Jain and his family. Years earlier, his family had registered a charity named Canadian Health, Immunization, Learning and Development (CHILD) Foundation, and my wife was one of the first to join the new organization’s board. From small beginnings, the project grew quickly – spurred to a large degree by fund-raising events in Calgary, substantial grants from Rotary, and matching grants from the province of Alberta. In those days, you may remember, oil prices were high and Alberta’s outlook rosy. Everything seemed possible.

The project’s original aim was to provide a clinic for women in a “small village” (population 60,000) in the state of Uttar Pradesh, India. The board organized a number of fund-raising events, however, and soon the charity had funding enough to build and operate a 20-bed hospital instead of just a clinic. The new facility “saw a lineup of patients on its first day,” Jain says proudly. “Designed to serve only 3,000 patients in its first year, it treated 14,000.”

Working with MOTHER Foundation, which Anil’s Delhi-based brother founded in India, hospital construction began on a small piece of land donated by the late mother of the two men – a woman named Maya Devi, after whom the hospital was named. Because the grid was unreliable, an early order of business was to install solar panels to provide reliable power. The facility soon began hiring staff and grew – recently adding a badly-needed X-ray system.

CHILD has done a remarkable job in raising funds, addressing education in nutrition and hygiene among local families and obtaining sanitary napkins at cost thanks to an arrangement with Johnson & Johnson Corporation. Initially working with the Calgary-based Centre for Affordable Water and Sanitation Technology, it has also sponsored programs teaching villagers how to inexpensively purify their drinking water, and improve sanitation and hygiene in their own homes.

Telehealth and telemedicine. But the big story was in the future, and that future is now. Although there are numerous languages and dialects in India, the country has only two official languages: Hindi and English. The country’s increasing fluency in English is an important asset for the application of telehealth systems in the country. Calgary physician Bhavini Gohel, who is also a member of CHILD’s 13-person board, claims the idea as “my baby.” She it was who put the notion on the agenda, about a year ago.

The notion is still embryonic, but the beating heart of the matter is simple. Although telehealth tools have been available in Canada for decades, the idea is now going global. In recent years there has been a considerable amount of interest in harnessing technology to reduce differentials in the distribution of health care services. From mobile health monitoring systems to telemedicine, she says, technology is increasingly narrowing the gap in health delivery.

CHILD’s Maya Devi Hospital will soon be a significant beneficiary of these new technologies. “This year we will be launching a fully integrated electronic medical record system that has telemedicine capabilities,” she says. The system will integrate into a wider program designed to deliver primary and tertiary care in the village. A recent development on the international scene, telehealth tools “enable long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and even remote admissions, telehealth can bridge gaps brought on in rural settings by poor transport and mobility and lack of trained staff.”

These systems provide distance learning. They enable online meetings, supervision, and videoconferencing among practitioners. They provide online integration of health data management and healthcare systems. “They even enable robotic surgery through remote access,” according to Gohel. Physical therapy can now take place through “digital monitoring instruments, live feed and application combinations,” she says. Tests can be forwarded between facilities for interpretation by a other specialists. Home monitoring can take place by continually sending in patient health data. “You can even get videophone interpretation during a consult.”

These systems can also be used as a mobile record system enabling healthcare professionals to provide assessment and care in homes throughout the town, she adds. “Such mobile functionality will allow professionals in Delhi, for example, to provide immediate decision making and care for patients. There’s big potential in this for saving both time and money.”

As the sole health record system in the CHILD-funded hospital in Sarurpur, ICE Health Systems already provides such services as keeping the hospital’s clinical records, lab data, integrated imaging and pharmacy support. Most importantly, she says, “our integrated telehealth system will soon enable doctors in rural Sarurpur to consult with specialists.”

Human touch is pivotal in patient care, of course. “We need to be sensitive to cultural concerns about having technology provide medical care, something which is still foreign to Indian society.” As the CHILD Foundation’s board and the staff at Maya Devi Hospital implement these systems, “we must not be oblivious to these systems’ challenges.”