Telemedicine based Project for Tsunami affected victims

 

Introduction

The recent Tsunami had a devastating effect on millions of families, mostly poor. It not only resulted in a huge loss of life, but also, displacement and disruption of livelihoods. Immediate relief measures have succeeded in attending the immediate problems of food, shelter and health. Still, for restoring normalcy, gigantic efforts would be required to rehabilitate the affected population. One of the main concerns needing urgent attention is the adverse affect on Mental Health of the survivors. Though, this problem is universally prevalent and is fast reaching a pathological status, there is inadequacy of specialized skills to address it. In this situation, SATHI volunteered to OXFAM TRUST India to work out a program wherein application of telemedicine could become a force multiplier. This would ensure most efficient utilization of limited number of specialists and facilitate delivery of services right upto coastal villages where the Tsunami survivors are suffering. This project has been called “The Healing Touch”

The responsilibities of SATHI as per MOU with OXFAM were as follows:-

SATHI in particular will take the turnkey responsibility for the following:

1. Rapid Assessment of Health needs of the Tsunami affected population
2. Develop plan for prevention of outbreak of communicable disease and provide technical guidance for implementation
3. Co-ordinate with government and other agencies for proposed health care intervention
4. Monitor health situation particularly with regards to communicable disease and relevant determinants
5. Provide technical inputs to other experts for integrated relief actions
6. Designing of the telemedicine system
7. Supply and installation of the equipment
8. Providing advice for the best tele communication option
9. Training of the involved persons
10. Coordinating linkages with other specialists at the regional center in Chennai
11. Facilitating the operation till it is fully functional
12. Designing the disease surveillance system
13. Defining the methodology for use of the Telemedicine system for counseling
14. Development and incorporation of the monitoring system for public health measures

 

The Healing Touch Project essentially is a network of telemedicine centres located at coastal villages in Tamilnadu and connected to a central specialized facility in Chennai. While the village level centres are manned by the community volunteers, local NGO partners of OXFAM and frontline health workers, the specialist end is manned by Medical Specialists particularly Psychiatrists (in view of the predominant need of Mental Health assistance). This system has been designed after a needs Assessment and field observations. It has met the approval of all the stakeholders, namely the Government, NGOs, the community members, WHO and development support agencies. There has been voluntary and enthusiastic response from Medical Professionals and Institutions.

 

About us

SATHI – Society for Administration of Telemedicine and Health Informatics – is a registered society formed by professionals belonging to various related disciplines such as medicine, information and communication technology, community development and public health with the objectives to enhance the access to quality and timely health care services to the most needy people irrespective of the location of their living and availability of the services through telemedicine. It aims at bringing technology to the benefit of the rural poor.

Key People Involved

Prof Sneh Bhargava                Former Director AIIMS[1]

Dr T Lazar Mathews                 Ex Director INMAS[2], Ex Director DEBEL[3]

Dr S B Gogia                             Vice President IAMI[4]     

Dr M R Surwade                        Ex Health Officer, UNICEF

Dr Sanjay Bedi                          Coordinator National Cancer Registry, Editor IAMI

Mr Ramesh Chandra                  ITS (Retd), Ex Member Telecom Commission

Dr R S Tyagi                              Deputy Director of Computer Applications AIIMS

Mr Susheel Chandra                   Scientist Grade E, INMAS

Dr. Aboli Gore                            Project Officer Unicef

 

SATHI took the initiative in volunteering to visit the tsunami affected regions to assess the health needs, assist OXFAM in working out the strategies for health care of the tsunami victims, and preparedness for prevention of outbreaks of diseases. Based on the assessment of the health needs and the situation, SATHI designed the telemedicine system for ensuring access to health care services to the victims. It is planned to be sustainable supportive system which will help not only timely medical care but also strengthen the existing primary health care delivery system of the government. It will also strengthen the partnership between government and NGOs. It will contribute to community empowerment through enabling them to articulate their health needs and access to information.

 

To ensure that the planned telemedicine system works effectively, we mobilized support from health professionals and institutions such as SCARF, AIIMS, as well as the NGOs working closely with the community, Professional bodies such as Psychiatrists Association of India etc. It was done by orienting them on the situation and the strategy planned, defining their roles, developing operation guidelines and training modules etc. We are also facilitating development of epidemiological modules for application of telemedicine in disaster management. Thus SATHI, apart from technical assistance, has coordinated for bringing all stakeholders around the telemedicine system and the programme of health care of tsunami victims. We liaised with WHO for technical guidance specially regarding mental health. The guidelines developed by WHO on psychosocial interventions were taken into account while SATHI developed a training module. The Mental Health Division of WHO at its HQ in Geneva has appreciated our project and shared with us the situation analysis report.  

 

Tsunami work in Chennai

The telemedicine system designed by SATHI for OXFAM envisages ten telemedicine units along coast in Tamil Nadu and a specialist centre at SCARF (Schizophrenia Research Foundation) in Chennai. In the first phase four units will be set up in Nagapattinam district which is the worst affected. The locations were identified on the basis of a survey. Government officials and associated NGOs were oriented.

 

In view of the predominant need for mental health assistance, dialogue was initiated with SCARF headed by Dr R. Thara who have agreed to provide voluntary services of the psychiatrists and clinical psychologists for providing mental health assistance through the telemedicine system.  Adopting WHO guidelines on this, SATHI has developed training modules and operational guidelines to develop the skills of the frontline workers to counsel tsunami victims. SCARF will train the frontline workers on –the-job through telemedicine system.

 

Technical support from WHO and AIIMS has been organized for the project.

 

Though mental health assistance is the predominant need, the telemedicine system will also facilitate delivery of other health services particularly those of medical officers from hospital both in government and private sectors. Sundaram Medical Foundation in Chennai has agreed to provide the same. Similarly the Government Hospital for Communicable Disease in Chennai has also agreed.

 

Discussions with AIIMS

AIIMS is the premier Medical Institution in our country. The key members of SATHI including Prof Sneh Bhargava, Dr T Lazar Mathews, Dr S B Gogia, Dr M R Surwade, Dr Rakesh Kumar, Dr R S Tyagi have studied and worked at AIIMS.

Regarding Tsunami, SATHI Presented the Telemedicine proposal developed for the Tsunami affected to the AIIMS authorities who promptly responded by appointing a coordinator and committing support from various departments especially the dept of Psychiatry.

 

Plan for Andamans

The experiences of AIIMS team to Andaman and Nicobar Islands were shared with SATHI and jointly a strategic plan for providing much needed mental health assistance has been developed. In view of geographical situation and the logistics problems, AIIMS team has recommended telemedicine system to overcome these barriers. Unlike Tamil Nadu, due to paucity of landlines, satellite links are mandatory.  Based on their on the spot assessment, the AIIMS team provided mental health assistance. They used innovative and participatory methods such as role play and   interactive sessions with Tsunami survivors. Since Hindi is widely spoken and understood, AIIMS team did not find language as a barrier. The required follow up relief measures can be provided through Telemedicine. A module for the telemedicine systems for Andamans is ready.

 

Our main focus

SATHI has always endeavored to bring the fruits of technology in healthcare to the Rural Poor. Despite the availability of such technologies and abundant skills in India, its application to address the common health problems is still a sketchy. Access to adequate health services by the Rural masses is still very poor. Application of telemedicine systems in remote areas can bring healthcare within easy reach. Such a paradoxical situation is there because a successful operational model for telemedicine is required.

 

SATHI has taken the initiative and successfully tested such a model in Madhya Pradesh. A similar model is being operationalized in Tamilnadu and needs to be replicated in Andamans

 

Also, Telemedicine needs to be made an integral part of the disaster preparedness and management plan in view of the frequency of natural disasters.

 

Our need

Our systems have not yet become operational due to lack of connectivity. Two systems have been installed one at Scarf and the other at Tharangammbadi in Nagapattinam District. The room is ready, staff and doctors have been trained. Test runs of SCARF with other locations have been successful. But interconnectivity has been hampered due to lack of a local exchange which can provide ISDN linkages. WE hope that this problem will soon be resolved or we would need help from other organzations/ ISRO for the same. We had been promised connectivity through INMARSATs (on loan from ESA) with free satellite time as a loan for a short period but that has not materialized as the INMARSAT units have been unable to provide anything more than voice transfer.

 

Our Operational model in Tamilnadu is also applicable for Andamans with suitable modifications.

Telemedicine is required for Andamans more than it is for Tamilnadu. Through OXFAM is likely to provide funding, a large scale need for Telemedicine systems calls for additional funding. This will help in expanding the Telemedicine network and thus coverage of Tsunami affected population. We would also require satellite connectivity through ISRO for the Andaman region – although ISRO has installed many systems there, the team from AIIMS had identified a need fro many more.

 

The developments described above are of great significance, since natural disasters keep striking somewhere or the other at all times. The lessons learnt in case of Tsunami as to how to apply Telemedicine in emergency response program would go a long way in global preparedness with India leading to respond immediately to future disasters.