: Health Care Services through Mobile Telemedicine Vehicle (Van & Boat) for Rural Distress People (HS-MTVRD)
: Our country does not have the infrastructure to provide emergency assistance such as medicines or necessary medical services or medical equipment in remote areas. These marginalized people in rural areas are most at risk as the entire country is locked down due to the epidemic of Covid-19. As a solution to this problem, mobile telemedicine vans or boats can provide medical services, medicines, and other life-saving equipment to these places in a very fast, safe and efficient manner.
Priority Issue: Maintaining social distance, telemedicine has improved healthcare services for rural people at minimal cost and reduced the risk to professional doctors and nurses.
Mention the existing problems that the initiative will address:
According to the World Health Organization, the most acceptable way to survive coronavirus in today's world is to maintain social distance. And while maintaining this social distance, telemedicine is the safest and most reliable way to provide medical services. It is very difficult to retain the right doctor for the treatment of rural people at the local level, as all social facilities, including infrastructural weaknesses and social security vulnerabilities, are inadequate. Telemedicine refers to the use of various telecommunications by physicians and companies that provide healthcare to their patients electronically or digitally. Telemedicine employs technology that makes it possible for healthcare providers to take care of their patients at home or in other remote areas. It is not only a combination of communication technology, information technology, biomedical engineering, and medical science, it also helps patients in remote rural areas to travel long distances to get timely advice from specialist doctors, which is a huge expense.
Due to the availability of 4G internets in remote areas of our country, the mobile telemedicine unit has customized medical web-based software connected to the computer hardware with which diagnostic tools such as ECG, X-ray, pathology and microscope can be easily connected online. The facility transmits patients' medical images and medical history in advance or in real-time to specialist doctors who study it, identify and advise the local doctor or paramedic towards the end of the patient during two-way audio and video conferencing. Besides providing timely medical assistance, telemedicine is also affordable.
Since telemedicine is a new concept in Bangladesh, making it attractive and acceptable to rural people and to provide healthcare at an improved level compared to that provided by existing facilities pose great challenges. This will call for innovative management, marketing and delivery of healthcare, and of course, commitment and dedication.
Background of the project:
Telemedicine can be one of the best ways to treat the coronavirus situation. The whole world is very upset by the attack of Covid-19. The health sector is looking for ways to avoid this catastrophe at the riskiest stage. As a result, seeing normal patients is being severely hampered. According to the World Health Organization, the infection rate of COVID-19 is very high. This is why doctors and nurses are at the highest risk. For all these reasons, patients suffering from other diseases are being deprived of services. The most worrying thing is - there is no guarantee in how many days the epidemic will be eradicated. It is not known when specific drugs for vaccination or treatment of COVID-19virus will be discovered. Telemedicine can be in the midst of such extreme uncertainty - one of the best ways to keep medical services out of the risk of our most vulnerable doctors or nurses.
This project is responsible to provide health care facilities through Mobile Telemedicine vehicles out of the risk of our doctors or nurses. In this world infected with the coronavirus, we believe that investment in the health sector is highly linked to productivity and plays an important role in reducing poverty. The economic gains to the poor from improved health are significant since they bear a disproportionate burden of disease. Moreover, the income of the poor usually depends on physical labor and so illness robs them of a large part of their income. The poor usually do not have much savings, they are even more anxious about the near future worries at this time of lockdown. At this time they need more health care, but in the hard reality of the coronavirus - it is difficult to get treatment for the common people in the village. Our proposed project will play a vital role to reduce child and maternal mortality, especially in the rural areas and this project, will also help to government initiatives of attaining MDGs target become successful. Other goals, such as women empowerment, poverty reduction, prevention of HIV/AIDS will indirectly support the other program (income-generating work, advocacy, training, awareness) of SAMAMA, which is highly related to this project. The United Nations Development Program in its ‘Human Development Index’ (HDI) also encourages investments in health. Such investment reduces deprivation and provides the poor with the immediate welfare gain of relief from physical suffering.
The proliferation of antibiotics in pharmacies without a doctor's advice has led to an alarming increase in the misuse of life-saving antibiotics.
According to a study, there are 20 types of antibiotics in Bangladesh with more than 400 names produced by different companies. According to the relevant sources, Ciprofloxacillin worth more than Tk 1 crore is being used in the country every day. 80 percent of which is sold without a doctor's prescription. As a result, all brand items of antibiotics are within human reach.
From fake doctors to drug dealers or pharmacy owners selling antibiotics, they are handing over these antibiotics to the buyers in one way or another without heeding the law. The danger is increasing. In the meantime, seven or eight important antibiotics have become resistant, meaning they have become ineffective against germs.
Antibiotic abuse is on the rise across the country. Doctors say the antibiotics are not working due to misuse and even if the disease is cured temporarily, the patient may suffer side effects later. It is not possible to cure the disease even after using harsh medicines.
Mobile telemedicine vans or trawlers can be one of the most helpful ways to prevent antibiotic abuse during or after the current epidemic, Covid-19. This is because mobile telemedicine activities provide directly documented printed prescriptions. The obligation to purchase antibiotics will then be successfully enforced.
Mention how the problems will be addressed by the initiative:
To address the above issues, SAMAMA has developed the necessary software to transfer appropriate diagnostic data, some in real-time, to the Internet. The choice of items was made on the advice of physicians working for rural healthcare. The software has also been developed for complete management of the system, including remote prescription facilities. And this whole system will be 100% moveable with the vehicle. Where paramedics will collect clinical data of patients from behind the glass and upload it in web-based software. And from Dhaka or any other big city, the doctor will send the prescription through a real-time video chat with the patient through video conference. The paramedic's cum operator will immediately print the prescription and give it to the patient, as well as provide free or low-cost medicine if needed.
Here we say at the beginning, paramedics cum operator, driver and paramedic’s assistant will use all kinds of safety equipment including PPE. Clean the car and the virus properly every day. A mobile telemedicine-van is capable of serving multiple locations in a single day. Once a space operation is completed, the entire mobile telemedicine unit is sterilized and moved to the next location.
I. Multipurpose PC based imaging device on a stand with flexible arm (based on a high-end webcam, 2 MegaPixel), to capture and transmit pictures of the body, particularly of skin for dermatological problems, through the internet. The camera will also be used to capture and transmit X-ray film images and any written records, if necessary.
II. Standard commercial devices like a thermometer, blood pressure meter, weighing scales (for babies and adults) and glucometer will be procured. The outputs will be typed into the PC manually.
III. Software for acquisition, transmission and monitoring of all the above diagnostic information together with the online prescription facility. The latter has integrated databases of symptoms, advises and some available medicines to reduce the time demand on the doctor.
The organization named SAMAMA Social Development Organization (an NGO with the acronym of ‘Sadharon Manusher Majhe’), working for several years with the aim of providing improved healthcare in rural areas of Bangladesh. SAMAMA has also developed a model for the deployment of telemedicine in the rural areas which may lead to a self-sustained service in the long run.
SAMAMA will manage the entire field activity with the support of the recruited qualified and licensed MBBS doctors. For providing service through telemedicine SAMAMA has already received the necessary permission from the DG Health.
a. It is possible to easily identify potential COVID-19 infected people early by consulting skilled doctors. It will be easy to provide accurate instructions on where to contact, test, and treat a potential COVID-19infected person. Without it, those in charge of the administration can be informed quickly.
b. This will provide feedback on the technology of the tools that will be used in the improved versions.
c. This will provide a response to the model for the successful promotion of these new technology-based services in a non-technical and resource-poor environment. So the model for delivery will be very advanced.
d. Another aspect of the mobile telemedicine project is the pharmaceutical business. In other words, it is easy to set up a pharmaceutical company in a commercial way subject to investment guarantee along with services. And if this is done, the sustainability of the project will be enhanced and it will be possible to maintain the quality of medicine, quality of service, and low cost.
e. Once a pharmaceutical company is established, a large portion of the profits can be used to distribute free medicines, management costs, and physicians' expenses.
It will complement the Bangladesh Government for giving improved healthcare to all the people of Bangladesh.
Mention the long term impacts of the project:
a. In rural areas where there are no registered doctors, the project will bring the services of the necessary medical specialists to the doorsteps of the general public across the country and even in remote rural areas during this epidemic season of COVID-19.
b. Although telemedicine cannot match a face to face consultation, it is much better than no consultation at all.
c. The rural poor, especially the marginalized people, women, and the physically challenged are deprived of the advice of a qualified physician for most of their ailments as it is physically and financially difficult to go to any hospital or clinic in the city. Mobile telemedicine vans can offer the opportunity to consult a skilled doctor at a reasonably low cost or free of charge at a place very close to their place of residence.
d. Even in remote areas of industrially developed countries telemedicine has rooms to play.
e. The use of indigenously developed or improvised software for telemedicine has opened up the possibility of spreading this service out to a much larger population. We will add online diagnostic equipment in a very short time - especially since all tests can be done locally very quickly without any major inconsistencies, such as blood sugar tests. Conceptually, the whole of Bangladesh can be brought under one network at an affordable cost.
f. Since the software is locally developed, local maintenance and repair, and that at low cost, is ensured, in turn ensuring sustained service. As experience builds up this model may be scaled up easily. The software has been developed with this in mind. It will just need more centers and management. If we think this way, a center each may be set up at each of the 68,000 villages in Bangladesh in the future. This would be never possible without Gov. Fund.
Therefore, if this project is given the necessary support, the lives of the rural people of Bangladesh are expected to see a big change with respect to improved healthcare within a few years. Once this technology and implementation model is successful in Bangladesh, the idea will be to make it easier to replace this model in other third world countries, which will bring a big positive change globally.
Potential of developing partnerships with relevant organizations:
i. The project itself relies on making many rural partners who will deliver the service in the rural area as small entrepreneurs.
ii. It may be possible to form partnerships with large established NGOs in the future for the smooth delivery of telemedicine in different areas of the country.
Is there any research/publication on the problem statement? (Mention briefly with source):
WHO report on Telemedicine: opportunities and developments in the Member States: report on the second global survey on e-Health, 2009. Available at: http://www.who.int/goe/publications/goe_telemedicine_2010.pdf