Treatment Across Borders

By Alecks Pabico

RATANAKIRI, Cambodia – The villages here deep in the lush highlands of Cambodia may look idyllic and the epitome of peaceful living. But while the proud inhabitants of this northeastern province treasure living amid such untouched natural beauty, their isolation is costing many villagers their lives.

In a country considered by the World Health Organization as having the direst health situation in the Western Pacific region, Ratanakiri’s indigenous peoples are among those who experienced the worst. Indeed, they have been known to succumb to curable diseases such as malaria, tuberculosis, acute respiratory infections, and even diarrhea simply because medical help came too late.

Ratanakiri’s considerable inaccessibility is largely to blame for that. Although eight of the province’s nine districts have a health center  — Vouen Say district even has two — they are inaccessible to those living in the upland areas. And up until April 2003, most of those who had consulted the doctors at the health centers and left without being cured probably just put their fate in the hands of the jungle spirits.

No longer. Since early 2003, even the Khmer Loeu — the collective term used to refer to the eight ethnic tribes who live here — have been able to enjoy the benefits of modern-day medicine through a new kind of health center: a telemedicine clinic, located in Banlung district, in Ratanakiri’s only provincial hospital.

A relatively new medical innovation, telemedicine harnesses the powers of information and communication technologies (primarily the Internet) to facilitate the exchange of medical information and provide faster health-care delivery.

So far, the clinic has handled 81 cases, 10 of which involved cardiac patients who were eventually sent to Phnom Penh for treatment. A 79-year-old Laoy villager was also diagnosed with prostate disorder that had to be treated through surgery. He was later admitted free of charge at the Preah Kossamak Hospital.

But Banlung doctors can now treat with confidence cases of normal tuberculosis and malaria. Sok San, a 31-year-old general practitioner who has lately been focusing on TB patients, says part of that confidence comes from being part of the telemedicine setup.

“Before, it was difficult for me to treat the patients because of my limited knowledge,” says the 2000 medical school graduate. Assisting in the telemedicine sessions has expanded his knowledge on diseases and how to treat them.

The Banlung telemedicine clinic has a dedicated satellite uplink to allow attending doctors in the Ratanakiri Referral Hospital to send e-mail of a patient’s initial diagnosis, as well as digital images of his or her x-ray, ECG or ultrasound results, to medical experts in Phnom Penh or as far as the United States. Every month, five to 10 patients from Banlung and the other districts who have serious or complicated illnesses are selected for the telemedicine program.

Ly Channarith, the hospital’s deputy director who is now in charge of the clinic, outlines the rest of the routine: “We send information about the schedule of the clinic to the village schools so that the teachers can locate the patients. Then we inform the partner hospitals in advance so that they can open their computers and be able to reply immediately.”

Established by the Markle Foundation, the Banlung clinic’s medical partners are Sihanouk Hospital Center of Hope in Phnom Penh and the U.S.-based Partners Telemedicine, which in turn brought in two more helping hands from the United States:  Brigham and Women’s Hospital and the Massachusetts General Hospital.

Another crucial tie-up was the one with the non-profit organization American Assistance for Cambodia (AAfC), whose 15 solar-powered rural primary schools here enjoy Internet connectivity via the Internet Village Motoman Project. This project makes use of motorcycles equipped with mobile access points to allow the sending and receiving of data as they pass by the schools and the main hub in Banlung.

At the health centers, patients are checked by a nurse. Their conditions are transmitted to the clinic via the schools’ wireless connection to the Internet. Those who are selected come to Banlung to undergo examination.

Usually, an e-mail from health specialists in the partner hospitals arrives the following day. The team of doctors in Banlung then holds a meeting to discuss the assessment of the findings, as well as the recommendations regarding treatment and followup care, from their counterparts in Phnom Penh or Boston. “That way,” says Ly Channarith, “we ensure that we make the right diagnosis and provide the proper medication.”

One advantage of the telemedicine concept, says Dr. Gary Jacques, director of the Sihanouk Hospital Center of Hope in Phnom Penh, is that it allows volunteer health specialists to train and mentor their less experienced colleagues in the remote areas.

Financial constraints on the health system have limited opportunities for further training for the country’s health professionals. Thus, as in other provinces across Cambodia, Ratanakiri’s health-care services suffer from a lack of doctors with specialization in the various medical fields. It was only recently, in fact, that the Ratanakiri hospital was able to hire two surgeons.

But there are also benefits for the specialists participating in the telemedicine program:   they learn the practice of medicine in poor, resource-deficient countries like Cambodia.

Aside from the Banlung facility, Cambodia has another telemedicine clinic in  Robib village in Rovieng, Preah Vihear province, (how far from Banlung?)  It was set up in 2000 by the same partners of Markle Foundation.

But of course, telemedicine can only do so much. “We can’t use it for emergency cases,” says Ly Channarith.

In May, for instance, a two-year-old boy from Village III in Koun Mon district suddenly became seriously ill, and soon was unable to eat and drink. He had very high fever, and had difficulty breathing. He could not urinate or defecate. He died on the way to Banlung. – Alecks P. Pabico

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