title: An evaluation of the first year's experience with a low-cost telemedicine link in Bangladesh.
abstract: In July 1999, the Swinfen Charitable Trust in the UK established a telemedicine link in Bangladesh, between the Centre for the Rehabilitation of the Paralysed (CRP) in Dhaka and medical consultants abroad. This low-cost telemedicine system used a digital camera to capture still images, which were then transmitted by email. During the first 12 months, 27 telemedicine referrals were made. The following specialties were consulted: neurology (44%), orthopaedics (40%), rheumatology (8%), nephrology (4%) and paediatrics (4%). Initial email replies were received at the CRP within a day of referral in 70% of cases and within thee days in 100%, which shows that store-and-forward telemedicine can be both fast and reliable. Telemedicine consultation was complete within three days in 14 cases (52%) and within three weeks in 24 cases (89%). Referral was judged to be beneficial in 24 cases (89%), the benefits including establishment of the diagnosis, the provision of reassurance to the patient and referring doctor, and a change of management. Four patients (15% of the total) and their families were spared the considerable expense and unnecessary stress of travelling abroad for a second opinion, and the savings from this alone outweighed the set-up and running costs in Bangladesh. The latter are limited to an email account with an Internet service provider and the local-rate telephone call charges from the CRP. This successful telemedicine system is a model for further telemedicine projects in the developing world.
authors.affiliation: Royal Hospital Haslar and 33 Field Hospital, Gosport, UK. DJVassallo@aol.com
authors.forename: D J
authors.initials: DJ
authors.lastname: Vassallo
authors.forename: F
authors.initials: F
authors.lastname: Hoque
authors.forename: M F
authors.initials: MF
authors.lastname: Roberts
authors.forename: V
authors.initials: V
authors.lastname: Patterson
authors.forename: P
authors.initials: P
authors.lastname: Swinfen
authors.forename: R
authors.initials: R
authors.lastname: Swinfen
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D002675:Child, Preschool; D003195:Computer Communication Networks / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000175:diagnosis; D015397:Program Evaluation; D012017:Referral and Consultation; D019114:Remote Consultation / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D013118:Spinal Cord Diseases / Q000175:diagnosis*; D017216:Telemedicine / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data