sanghasanghaA community building communitiesA community building communities

सं�घ सं�घ

Hina Sharma, M.D. April 25,2007

Internet2 South Asia Conference

SanghaSangha

• Nonprofit organization Nonprofit organization • Dedicated to using technology and Dedicated to using technology and

cutting edge ideas to improve access cutting edge ideas to improve access to healthcare, education and to healthcare, education and enterpriseenterprise

• Partners: local government, Partners: local government, Community Based Organizations Community Based Organizations

• Partnered with Florida International Partnered with Florida International UniversityUniversity

Key Points Key Points

●● Rising burden of disease in developing Rising burden of disease in developing world (demand for health)world (demand for health)

●● Decreased supply of Health Care Decreased supply of Health Care ProvidersProviders

●● Telemedicine’s role in Primary CareTelemedicine’s role in Primary Care

●● Lessons learned: Andaman and Lessons learned: Andaman and Nicobar IslandsNicobar Islands

Supply and Demands of Supply and Demands of HealthHealth Burden of Disease Andaman Burden of Disease Andaman

and Nicobar Islands__and Nicobar Islands__

• Acute Respiratory Tract Acute Respiratory Tract Infection.Infection.

• Pyrexia of unknown Pyrexia of unknown origin.origin.

• Leptospirosis.Leptospirosis.

• Gastrointestinal Disorder.Gastrointestinal Disorder.

• Nutritional Deficiency Nutritional Deficiency (Anemia & Vit. Def.)(Anemia & Vit. Def.)

• Malaria.Malaria.

• Diabetes.Diabetes.

• Hypertension.Hypertension.

Why Is Health Important?Why Is Health Important?

• Developing countries share Developing countries share disproportionate burden of avoidable disproportionate burden of avoidable disability, morbidity, and mortalitydisability, morbidity, and mortality

• Preventable infectious diseases, Preventable infectious diseases, malnutrition, complications of malnutrition, complications of childbirth, and chronic diseasechildbirth, and chronic disease

Why Is Health Important?Why Is Health Important?

• Exponential health costs of a country’s Exponential health costs of a country’s poorest population effects GDP with parallel poorest population effects GDP with parallel income loss may cause a dangerous income loss may cause a dangerous recession causing decades of setback.recession causing decades of setback.

• In the words of Nelson Mandela, “The In the words of Nelson Mandela, “The imperative to act on this urgent, life and imperative to act on this urgent, life and death matter can no longer be ignored. We death matter can no longer be ignored. We must not fail to achieve the vision contained must not fail to achieve the vision contained in the Universal Declaration of Human in the Universal Declaration of Human Rights.” Rights.”

TelemedicineTelemedicine““In terms of disease management, there is [a] In terms of disease management, there is [a] 99% possibility that the person who is unwell 99% possibility that the person who is unwell does not require [an] operation. If you don't does not require [an] operation. If you don't operate you don't need to touch the patient. operate you don't need to touch the patient. And if you don't need to touch the patient, you And if you don't need to touch the patient, you don't need to be there. You can be anywhere, don't need to be there. You can be anywhere, since the decision on healthcare management is since the decision on healthcare management is based on history and interpretation of images based on history and interpretation of images and chemistry … so technically speaking, 99% and chemistry … so technically speaking, 99% of health-care problems can be managed by the of health-care problems can be managed by the doctors staying at a remote place—linked by doctors staying at a remote place—linked by telemedicine.”telemedicine.” – Dr. Devi Prasad Shetty, – Dr. Devi Prasad Shetty, prominent Cardiothoracic Surgeon, prominent Cardiothoracic Surgeon, PhilanthropistPhilanthropist

What Is AvailableWhat Is Available

• Specialty, Problem-FocusedSpecialty, Problem-Focused– Store and forward informationStore and forward information

• Port Blair, Andaman and Nicobar Port Blair, Andaman and Nicobar IslandsIslands

Tele-ophthalmology LinkTele-ophthalmology Link

– Shankar Nethralaya, ChennaiShankar Nethralaya, Chennai

SRI LANKA

1400 Km

MYANMAR

600

Km

THAILAND450 Km

INDONESIA

163 Km

SINGAPORE

700 Km.

BANGLADESH

1367

Km

1130 Km.

CHENNAI1200 Km

.

VIZAG

CALCUTTA

1255 Km

.

LOCATION ofA&N Islands

Primary CarePrimary Care

• How best to begin delivery of Primary How best to begin delivery of Primary Care?Care?

• Address gender inequalityAddress gender inequality– Women’s health Women’s health – Only pregnancy focused care available (Infant Only pregnancy focused care available (Infant

Mortality Rate 20%)Mortality Rate 20%)

• Address Special Health Care NeedsAddress Special Health Care Needs– Disabled ChildrenDisabled Children– Female Development Female Development

Women’s Health Project Women’s Health Project

• Championed by the Director of Health Championed by the Director of Health Services of Andaman and Nicobar Islands, Services of Andaman and Nicobar Islands, Dr. Sadasivan Dr. Sadasivan

• Local Gynecologists will see patients at the Local Gynecologists will see patients at the Sangha clinic twice a weekSangha clinic twice a week

● ● TelemedicineTelemedicine

- increase primary care knowledge - increase primary care knowledge

- improve capacity to caring women - improve capacity to caring women and and children children

SustainabilitySustainability

• True sustainability = effective True sustainability = effective physician-patient or physician-physician physician-patient or physician-physician interfaceinterface

• Capacity building of local medical Capacity building of local medical resourcesresources

• Building DatabasesBuilding Databases• Collaboration with local specialists Collaboration with local specialists • Avoid fragmentationAvoid fragmentation• Broadband AccessBroadband Access

Technology to Make a Technology to Make a Physician-Physician InterfacePhysician-Physician Interface

Quality AssuranceQuality Assurance

• Continual update of knowledge with Continual update of knowledge with ongoing bilateral feedback ongoing bilateral feedback

• Promotes international standardization of Promotes international standardization of care care

• Marketing to local physicians is essential Marketing to local physicians is essential for success especially through for success especially through demonstrations providing the highest demonstrations providing the highest quality interface between physicians and quality interface between physicians and teaching continuing education and teaching continuing education and proceduresprocedures

Quality AssuranceQuality Assurance

• Increasing awareness of South Asian Increasing awareness of South Asian physicians (mainland or other physicians (mainland or other islands) about the true potential for islands) about the true potential for telemedicine will provide the telemedicine will provide the confidence that you can teach confidence that you can teach anything with telemedicine anything with telemedicine

• See one, do one, teach oneSee one, do one, teach one• Thus, rapid increase in demand for Thus, rapid increase in demand for

technology (Broadband Access, etc.)technology (Broadband Access, etc.)

Rapid Deployment of Crisis Rapid Deployment of Crisis InterventionIntervention

• TsunamiTsunami

• PandemicsPandemics

• Disaster ManagementDisaster Management

• Continued Specialty referral not Continued Specialty referral not otherwise availableotherwise available