Ratanakkiri ‘Telemedicine’ Puts Villagers’ Illnesses Online

BANLUNG, Ratanakkiri province – An Internet link at Banlung’s main hospital opened Monday with the promise of allowing doctors there to ask doctors at hospitals in Phnom Penh and the US state of Massachusetts how best to treat their patients.

The project, which relies heavily on donated material, a satellite Internet link and agreements with hospitals in the US, makes it possible for the eight doctors at the Ratanakkiri Provincial Re­ferral Hospital to call on professional colleagues at Mas­sa­chu­setts Gen­eral, the Harvard Med­i­cal School and Phnom Penh’s Si­ha­­nouk Center of Hope.

Using digital pictures and e-mail descriptions of each patient, the doctors send e-mail to the distant hospitals and, hours later, receive second and third opinions on the best treatment.

“Ratanakkiri is very far from Phnom Penh, and every year we have to send patients to Vietnam for treatment,” said Ly Chanarith, vice director of the Ratanakkiri hospital, which sees 20 to 30 outpatients every day and 100 to 130 inpatients each year.

If doctors in Banlung were better informed and equipped to treat patients, they might not have to send people far away for treatment, he said.

It’s the second such project for Bernard Krisher, chairman of Amer­ican Assistance for Cam­bo­dia and publisher of The Cam­bo­dia Daily, who opened a similar clinic in Preah Vihear province two years ago as a test of an In­ternet hospital.

“We hope to show that people don’t have to travel for good medical care,” Krisher said.

There are many bugs to be worked out. The Internet connection is slower than people would like. The hospital’s X-ray and ultrasound machines are old and produce only marginally helpful images.

For now, the doctors will take digital pictures of the X-rays and ultrasound images and send them on to Phnom Penh and Boston, Massachusetts, but in the future, there’s hope of more modern equipment capable of sending digital images from the X-ray and ultrasound machines.

That will take more funding than what’s been made available so far: A $40,000 grant from the Markle Foundation of New York City, a private foundation which supports health care projects. The telemedicine project also relies on the donated services of Telepartners, a service developed at Massachusetts General. The service has paying clients but off­ered to help Cambodia free of charge, according to Krisher.

Dr Graham Gumley, director of the Sihanouk Center of Hope hospital, said the telemedicine link will also make it possible to train doctors in Banlung without sending staff to the remote provincial capital.

The concept driving the tele­medicine project is relatively new, and there may be more problems ahead, suggested an Internet expert based in Phnom Penh.

“Of course it’s a good idea, but not if the person at the other end does not really have a good un­der­standing of the environment from which this message is coming,” said Norbert Klein, founder of the Open Forum of Cambodia. “Thus, in some cases, it can lead to real problems. It can lead to assistance, but it can also lead to big frustration. Medical equipment may not be available.”

And it’s expensive, he said. “Especially when you come to the cost-benefit analysis. It is not at all something that can be multiplied,” he said.

The telemedicine project will be supported in part from profits made from a Ratanakkiri weavers project, essentially a Web page hawking their blankets. A coffee farm in Ratanakkiri will also sell beans online, and a portion of the profits will go toward the telemedicine project, Krisher said.

On Monday, patient June Mot, 50, became one of the first to have her case file sent to doctors online. Though the widower and mother of three had never surfed the Internet or even seen a computer, she hoped that doctors armed with technology could prescribe a drug for her persistent cough.

A survivor of the Khmer Rouge regime, she said she was never sick then, and never would have sought treatment if she had been.

“If I was sick during the time of Pol Pot, I would not survive be­cause Pol Pot does not like the sick,” she said. “Now I dare to tell people that I am sick.”

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