Download From Cambridge to Cambodia: Experience with a telemedicine

From Cambridge to Cambodia:
Experience with a telemedicine project in
the developing world
Joseph C. Kvedar, MD
Director, Partners Telemedicine
Vice Chair, Department of Dermatology
Harvard Medical School
www.villageleap.com
Three Components of Development
• Health
• Education
• Economic stability
Snapshot of Robib
• Population, 900
• Per capita income, $40/year
• With the web site Villageleap.com,
villagers have made over $6,000 in
~1 year, selling crafts via e commerce.
Village Leap Project
• Individual donor funded schools
• Each equipped with a solar panel
• 60 complete
• 70 planned
• At present, only one has Internet connectivity
Telemedicine in Robib
• Simple store and forward email solution.
• Evolved from the posting of general health
questions to specific case presentations.
• Nurse from Pnom Penh travels monthly.
• Information includes history, nurses PE
and some digital images.
Work Flow
Boston
Robib
Pnom Penh
Case Mix
•
•
•
•
•
•
•
•
Cardiovascular
Endocrine
Musculoskelatal
Pulmonary
Infectious diseases
Eye
Others (DERM, GI, GU, GYN)
Total
8
5
4
2
2
2
5
28
• Chief complaint: mother says
child has mild fever and dry
cough since birth
• Abdominal distension
observed
• pulse 145, resp. 40, temp.
37.9, 5 KG
• Lungs crackle all lobes, heart
normal but tachycardia,
abdomen is tender, Positive
hepatosplenomegaly, positive
bowel sound, skin mild pale
Patient #1: Som Tol, male, 48 years old
Chief complaint: Feel burning on both
soles and palms, palpitation, frequency of
urination, blurred vision. Last 6 months
chest pain.
BP: 100/60
Pulse: 104
Resp.: 20
Temp. : 37.0
Past history: not significant
Lungs: clear both sides
Heart: regular rhythm, no murmur
Abdomen: soft, flat, not tender
Bowel sound: positive
Skin: warm to touch, no edema
Limbs: numbness and feel burning in all
limbs
Urinalysis: Glucose: ++++, Ketone: +,
Protein: +
The most likely diagnosis is peripheral
neuropathy due to uncontrolled diabetes.
Better glucose control with insulin or oral
agents has been associated with less
neuropathy. Unlikely to reverse the
symptoms but better control may prevent
worsening. An EMG and NCS would be
most definitive in establishing the
diagnosis. Infrequently a demyelinating
component can be seen which responds to
IV gammaglobulins.
Concerns/next steps
• Incomplete medical data
– Easy to capture more data
• System to implement advice needs thought
– Supplies
– Human resources
– Local expertise
Contributors
(incomplete list)
• Partners Telemedicine
– Kathleen Kelleher, Remote Consultation Coordinator
– Countless physicians
• Sihanouk Hospital Center for Hope
– Graham Gumley, MD
– Maetha, RN
• Project Villageleap
– Bernie Krisher
– David Robertson