About 13 years ago, soon after Apollo Hospitals set up its first telemedicine centre in Aragonda village in Andhra Pradesh, Dr K. Ganapathy, neurosurgeon and President of Apollo Telemedicine Networking Foundation in Chennai (ATNF), noticed a lull in complaints, including a few cases of migraine.
He was puzzled, even disappointed, but soon realised that the doctor at the village centre had learnt to handle the patients independently by observing him. “It is a fantastic way of elevating the skills of doctors in rural areas — they notice a pattern in the complaint, and how we handle it. It does for a doctor what no book or lecture can do,” he says.
This telemedicine venture has since grown several-fold, conducting over 75,000 consultations in 25 specialities through 115 centres. Eighty per cent of the tele-consultations are reviews. Continuing medical education programmes are also on.
Recently, in collaboration with AfroIndia Medical Services, telemedicine units have been set up in Lagos, Port Harcourt and Abuja in Nigeria. More will come up in East and West Africa, including Benin, Togo, Gambia, and Ghana. The Apollo group has also opened a hospital in Abuja and another is under construction in Tanzania.
Hundreds of Africans visit its hospitals in India, but many are unable to return for reviews due to the distance and expense involved, says Dr Ganapathy. Now such reviews can be done remotely and cost about Rs 1,000 to Rs 1,500.
Estimating that telemedicine can take care of 60 per cent of the patients, Dr Ganapathy says, “A large number of patients can be managed in Africa itself, with guidance from here, for both treatment and review.”
ATNF also works with the Pan African e-Network Project, a partnership between India and 39 African countries to build capabilities in medical education and tele-consultation. But not many doctors or patients know about it yet, he says.
Apollo’s telemedicine centres have no doctors and a staff member, usually a graduate, is in charge, assisting patients with tele-consultations.
Dr Ganapathy pulls out a stethoscope, a blood pressure monitor and other diagnostic tools that connect through a cable to a USB port. Staff at the remote centre use these to transmit heartbeat and other readings, and the doctor at the other side can scan them. In fact, the centres are now ready to move from these decade-old equipment to wireless devices. Through electronic, virtual house visits and peripheral medical devices, Apollo plans to help patients connect with trained healthcare providers and doctors at all times.
But can poor connectivity hamper telemedicine and, possibly, even lead to diagnostic errors
“Ideally we need 2 Mbps bandwidth, but we can manage with 512 kbps. We expect the consultant to be mature enough to not give an opinion when there is no clear picture,” says the neurosurgeon. If the video quality is not good enough, images and scans can be transmitted through other means. “It’s the difference between travelling in a Mercedes and a Nano. Both get you to your destination,” he explains. “As a doctor, all I want is the minimum that won’t make me miss a diagnosis.”
In Africa, only 256 kbps bandwidth is available in most places, but connectivity is slightly better in urban areas and the hospital mainly uses this.
Language, cultural and time differences, as also ego issues, are the other problems facing the Pan African e-network project, which operates through government channels. “It’s a long haul, it’s in their interest to contact us. Success stories will convince them, ” adds Dr Ganapathy.