Telemedicine Sister

Telemedicine Sisters providing real-time Tele-consultation of qualified doctors at doorsteps of rural people, combining other health and support services. 

Most rural people in the Third World do not have access to qualified doctors who prefer to live in cities. For this reason rural people take medicines on the advice of quacks or drug sellers, leading to maltreatment, misuse of antibiotics and steroids. Tele-consultation with qualified doctors living in cities could be a solution but most available solutions are targeted to tertiary healthcare, assuming that a general physician or an expert paramedic is available at the patient end, which is clearly not solving the problem for the Third World. There has been approaches through extensively trained health-workers prescribing limited drugs and providing referrals to city doctors. However, since the health-workers do not have the deep understanding of the human body, diseases and medicines as qualified doctors have, this may lead to maltreatments and eventual complications. Again, there has been many attempts to complement the expertise of these health-workers with mobile apps for diagnosis and treatment, but mobile apps, however intelligent they are, may fail to catch certain symptoms and causes. For example one third of pain sufferers have referred pain which occurs on the opposite side of the source of the pain. Again, there are large person to person variations. A health-worker following set questions of a mobile app may easily be misguided in such situations.

We want to propose a combination of services through roving female workers, whom we named ‘Telemedicine Sisters’. They will go from door to door with a smartphone, firstly, providing tele-consultation of remote qualified doctors (living in the cities) right at the rural homes. This teleconsultation will involve patient data registration, inputting of basic physical and health data, real time video conference between patient and doctor, real time transfer of stethoscopic sound and ECG data, if needed, software aided prescription generation by doctor and archiving of all records in a cloud server. The archive will allow big data analysis later to help emergency interventions in epidemics and helping Government policy-making. Here we do not use mobile apps, rather we use direct tele-consultation with qualified doctors, depending on human intelligence and expertise, which is cost effective and more reliable in a Third World condition. All this will be done using technology already developed and tested by us.

Telemedicine Sisters will also provide health awareness education, disseminate simple technologies for public health such as for drinking water and sanitation, distribute essential medicines and hygiene products such as sanitary napkins, connect rural patients with appropriate doctors, midwives and physiotherapists in the neighbourhood, get ambulances in necessity, etc. Thus they will become trusted friends to rural people.

Since the technology is developed by us, and we do not take any patents, we will share the technology with appropriately knowledgeable and skilled persons throughout the Third World so that they can adapt and deploy the solutions in an effective way. Since Third World is home to 80% of the global population, therefore, our technology and the methods for their deployment will contribute to the world in a significant way.

This is essentially an innovation in the process of solving a challenge, but also involves innovations in technology appropriate to Third World conditions. Telemedicine Sisters have to work with people who are not used to consult a qualified doctor for primary ailments. That rural patients who have to travel miles to see a doctor will be able to consult a doctor right from their homesteads, is a disruptive social innovation. It needs to be mentioned that the existing telemedicine technology was also developed by us which already incorporates innovations in terms of technology and social adaptation. 

The main advantage of our method is the use of digital technology, i.e., telemedicine using smartphone, computer and internet technology, and all of that developed indigenously. Therefore, technology is integral to our solution. This will also allow analysis of big data later.

We plan to appoint Telemedicine Sisters under 10 to 15 of our existing rural telemedicine centres, each team having two members. The Telemedicine Sisters will be trained in all the activities outlined earlier in the first two months and deployed for the rest ten months. They will go from door to door of the rural homes following a certain time schedule to provide these services. This will give us important feedback which we will analyse through adequate survey of relevant stakeholders. This will help us to scale up the system for local expansion and global application in future.

We have initiated working with a large NGO, BRAC which has tens of thousands of rural health workers in Bangladesh. Ideally, we would like to convert this whole workforce to our proposed activity gradually. In the next five years we can expect employing about 2000 teams of Telemedicine Sisters covering about 8 million people. Side by side we would work with other NGOs covering an additional few million. We would also extend our programme abroad through BRAC’s establishments which will be in the introductory phase within this 5 year period.

The Telemedicine Sisters will work under a rural telemedicine centre which is already operational for six days a week. The Telemedicine sisters will visit several clusters of rural homes each working day of the week following a pre-announced schedule. Therefore, the beneficiaries will have both the opportunities of taking the service from the Telemedicine Sisters on appointed days of the week, or come to the telemedicine centre on other days. We will also try to accommodate special call services at home.

Each of our existing rural telemedicine centres covers about 30,000 people in a ‘Union’, the lowest administrative tier of the Government. An entrepreneur runs the centre on self-funding while we provide management and doctors’ services. Patients come to the telemedicine centre to get tele-consultation of doctors including a prescription. Using our recent smartphone based system we ran a field trial offering Tele-consultation at the doorsteps of people. One team of two Telemedicine Sisters covered homes having a population of about 6,000. In four months about 700 patient consultations were provided by four such teams working in four different areas.

Since the proposed service will include multiple activities, providing awareness for health, water & sanitation, referrals, etc., in addition to Tele-consultation of city based doctors, the population coverage will be slightly less per teams of Telemedicine Sisters compared to that mentioned before for telemedicine only. Assuming a coverage of 4,000 people per team, in the next 12 months we expect to cover about 60,000 people with 15 teams. They will go to peoples’ doorsteps on a weekly or fortnightly schedule, besides emergency call services. In the next 3 years we plan to cover about 20 times of the above.

Our team, comprising of more than 10 committed Physicists and Engineers, has expertise in electronics, microcontrollers, computers (interfacing and software), Biomedical Engineering, indigenous technology based industry and leadership. The project leader, with a PhD in Electronics (1978, Southampton University, UK) has been actively working with a goal to use appropriate technology to enhance the quality of life of the common people since his return in 1978 and has gathered a vast range of expertise and experience including entrepreneurship and human psychology which has helped him to attract and lead all these young people and take up direct application oriented projects.

We need about USD 2.00 per patient consultation to be self-sustaining but we are now charging only about USD 0.60 per consultation. This is because for primary care, the rural people are not used to consult a qualified doctor. They get a free ‘consultation’ from drug sellers and quacks, people not qualified to prescribe medicines. Therefore, it needs a change of understanding and mind-set. In fact when an ailment gets complicated, rural people spend many times the above amount in going to city hospitals or clinics, going through a lot of hassles. We feel, if we can sustain the programme for about 5 years at a certain rural area, we may expect people to pay the full amount mentioned above.

Through the proposed Telemedicine Sister programme, we expect to achieve this change in mind-set sooner than without any such programme. Since the Sisters will be closer to people and meet them often, this interaction will build a trust. Besides, when people will ‘see’ that consulting a qualified doctor through telemedicine benefits them in the long run, they will be ready to pay the consultation fees readily.

Solve will expose us to potential collaborators for enhancing the technological aspects, agencies who can help in dissemination of the service to other low resource countries, and funding organisations.

The key barriers are lack of contacts to extend the services to other low resource countries and funds where MIT solve can help. Although we have adequate technological expertise, connecting with MIT Solve can help in achieving international standards, permissions and confidence for dissemination of technology to other Third World countries.