Telemedicine in Mauritius *
[Position Paper - July 2004]

prepared by

Sanjay P. Sood
Head of School
C-DAC School of Advanced Computing
Quatre Bornes, Mauritius

[sood] at [spsood.com]

Background
On January 25th, 2001 Honourable Pradeep Jeeha Minister of IT&T at a workshop in context of the PARITE Project (Programme d’Appui Regional aux Initiatives Telematiques sponsored by Indian Ocean Commission and the European Commission) highlighted the importance of ICT in the fields of e-commerce, distance learning and telemedicine. PARITE project was aimed at promoting the use of ICT in Training, Health, Business and small and medium enterprises. In recent past there has been a significant growth in the field of Telecommunication but the applications have been significantly restricted to a few areas only. As per Dr. L. Z. Karvalics of Budapest University of Technology and Economics, Budapest, Hungary while elucidating the concept of Information Society during his lecture at University of Mauritius (on 3rd July, 2004) affirmed that Mauritius is on the doorstep of becoming an information society but still impetus from all domains is essentially required, lest the opportunity may be lost.

ICT for play in Economic and Social Development
ICTs spur the creation of economic and social 'networks' of individuals and communities. The power of these networks is their ability to connect diverse groups by allowing them to access and exchange information and knowledge that is crucial for their socio-economic development. ICT offers the possibility of delivering basic health and education services more efficiently because people can have access to them from their own communities [1] thus facilitating the growth of Information Societies eventually helping to narrow down DIGITAL and KNOWLEDGE DIVIDEs. Information and Communication Technologies (ICT) can thus play a powerful role of an overall enabler of development, besides fostering sustainable economic development and enhancing social equity by acting. Many countries like Singapore, Malaysia, Hong Kong, Dubai and India too have already integrated ICT into the mainstream of their development activities and the results have been remarkably encouraging.

Introduction - ICT in Healthcare
Health and education being two important components of any country and ICT’s role in these fields can boost national economic and social status directly. “Telemedicine”, “TeleHealth”, “Tele-Care”, “Health Telematics”, “eHealth”, “Medical Informatics” or simply “ICT for health”? The terms for describing the same phenomenon are extensive [2].

Telehealth/telemedicine are broadly defined as the use of telecommunications and information technologies to provide health services, training and information to health care providers and consumers. The essence of telehealth/ telemedicine is the delivery of services and information to individuals in their own communities instead of the movement of patients to centers of health expertise. As such, telehealth/telemedicine
are significant new tools in addressing the cultural, socioeconomic, and geographic barriers to health services and information in underserved urban and rural communities. Benefits of telemedicine include local access to specialty care, enhanced primary-care services, and the increased availability of medical education and health information resources in medically underserved communities.(Annexure I)

Dissolving barriers such as distance, time, geography, weather, and economics, telemedicine and eHealth (TM/eH) applications are designed to bring services to clients rather than clients to services[3]. The common goal of any TM/eH application is to increase access and ease of health care, especially for rural/isolated and underserved populations.

In general, we are referring to the use of any form of information or telecommunications technology in the administration, management and delivery of health services. It includes services ranging from continuing medical education, to video consultations with patients, and to remote surgery. As highlighted by Prof. De Vries (Future Studies Health Care) at University of Twente, Netherlands, traditional healthcare systems need to respond to increasingly demanding care consumer and without the needed enhancements the traditional healthcare could find itself in a downward spiral. Prof. Vries opines that the best way to balance supply and demand in the health care services is the application of ICT (Information and Communication Technology) and in particular telemedicine. These are care innovations of the future for which government will also have to open their pockets. (Annex. II)

Telemedicine/Telehealth/eHealth is a tool that is in line with the vision of Mauritian government to exploit the immense possibilities that ICT offers in the new economy to improve the quality of life of the Mauritians. From over a decade now, relevant agencies at the international level [like International Telecommunications Union (ITU), World Health Organisation (WHO), European Health Telematics Observatory (EHTO – EU), and the UN] have been highlighting the need of initiating ICT applications in Healthcare, specifically for the African/ Latin countries. One such set of recommendations is presented below -

Recommendations of The African Regional Telecommunication Development Conference (AF-RTDC-96), held in Abidjan, 6-10 May 1996 hosted by International Telecommunications Union
1 that telemedicine and telehealth care merit serious study by telecommunications and health administrations in Africa;
2 that African countries should support any initiatives which will help gain their practical experience in telemedicine and telehealth;
3 that African telecom organizations should discuss the utility, logistics and feasibility of telemedicine delivery especially in remote and rural areas of their country;
4 that there should be at least one expert on telemedicine in each of telecom and health ministries,invites the G7 participants to ensure that the needs and economic realities of African countries are taken into account in planning global health care projects. (Annex. IV and V)

Telemedicine/Telehealth/E-health in Mauritius (TiM)
Telemedicine is not new to Africa. Over years African countries like Ethiopia,
Mozambique, Senegal, Kenya etc. are very much in touch with the concept. (Annexure V and VI) Unlike education and governance, healthcare is one such domain in Mauritius, where impetus is ‘now’ required to initiate the ICT the applications. The stage is all set specially when Mauritius has an inherent advantage of having a strong telecommunication connectivity not only within the country but also through the state of the art submersed fiber optic connectivity – the SAFE project, providing a high speed connectivity of up to 80 Gigabits. The country also is far ahead of in case of teledensity 28% (as against around an average of 8% for the continent).
Mauritius telecom, now a matured world class level service provider, is responsible for managing a nationwide data communication/fully digital network providing high quality and efficient telecommunication facilities enabling the country to be a key telecommunications infrastructure provider in Africa. Hence with relevant initiatives and preparations for introducing telemedicine initially within Mauritius, the country has all reasons to emerge into a regional hub for providing medical expertise to the member
states of Indian Ocean Commission besides other needy African countries.

Benefits
For the benefit of its population, Mauritius can have a national telemedicine network not only to provide tele-consultation/expert opinion but also for an effective and efficient Public Health Management. The benefits of such a network can lead to the following :
• Fewer patients (from Mauritian islands) need to be referred to hospitals in mainland which saves time and money spent on travel for the patient. Reflecting savings in terms of time and efforts at the nationally regional hospitals too.
• Health care professionals in isolated areas/islands can tele-consult specialists in mainland hospitals leading to learnings through the specialists acting as mentors at a distance (telementoring).
• Health care professionals can keep up to date information through access to the latest information in their fields contained in medical data bases (if set – up).
• Periodic lecturing by specialists (tele-education) for general physicians and paramedics on islands like Rodrigues and Agalega etc.
• Reliable communications and connectivity can help hospitals and health ministry officials improve public health management, disease management, disaster management as well as equity w.r.t. delivery of health care services to all parts of their country.
• Rescue workers are better able to coordinate their response to emergencies for mitigating the affects.

Popular Science June 2004 reports :
"I know these patients better than anyone on the floor right now," asserts critical-care specialist Dr. Joseph T. Cooke, who's checking up on 38 ICU patients at New York-Presbyterian hospital--from across the street. Welcome to the electronic ICU, where bedside manner means ringing a doorbell before observing patients via video camera, then checking vital signs on four remotely located monitors. Surreal? Sure. But it's telemedicine that seems to be, gingerly, living up to the hype. Most agree that traditional ICUs are costly and hard to manage: ICU admissions account for only 10 percent of inpatient beds and 30 percent of hospital costs. And up to 20 percent of ICU patients never check out. The e-ICU, where one doctor and nurse can keep 24-hour watch on as many as 50 patients at once, is boosting chronically short-staffed on-site care. A recent study reported a 27 percent drop in ICU mortality and 17 percent shorter stays since the first e-ICU set up a few years ago.

With expertise at Ministeries / Institutions and Organisations like :
• Ministry of Health and Quality of Life
• University of Mauritius
• C-DAC School of Advanced Computing (and C-DAC India)
• Ministry of Information Technology and Telecommunications

University of Mauritius and C-DAC School of Advanced Computing call for putting together a National Telemedicine (Pilot) Project and a National Task Force for formulating regulatory issues pertaining to ICT applications in Healthcare on the island.

This all, with an eventual motive to enhance healthcare delivery system for the population of Mauritius in tune with the call for proposals by Alliance for Health Policy.

and Systems Research for projects on Governance and Equity in Health sponsored by The International Development Research Centre (IDRC), Canada (in collaboration with WHO). (Annexure VII)

References:

[1] World Summit on Information Society (Geneva 2003)
http://www.itu.int/wsis/basic/faqs.asp

[2] Norwegian Centre for Telemedicine
http://www.telemed.no/index.php?cat=4636a

[3] California Telemedicine & eHealth Center http://www.cttconline.org

* Abridged version

Annexures:

I ICT has tremendous potential to improve health, education, governance, says Secretary-General in message at launch of Ghana-India Kofi Annan Centre.

II ICT and telemedicine help out health care – Prof. Theo de Vries special professor Future Studies Health Care at the University of Twente.
http://www.innovations-report.com/html/reports/medicine_health/report-9293.html

III ICT – Health Initiatives
URL : http://www.opt-init.org/framework/pages/appendix2.html

IV EPIAIM – Health, Epidemiology and Telematics European Co-operation with Latin America and Africa In Collaboration with WHO
URL : http://www.ehto.org/aim/volume2/epiaim.html

V Telemedicine and Africa
http ://www.itu.int/ITU-D/tech/telemedicine/medabi.html

VI Midjan Group (with EHTO) – Telemedicine techniques (Developing countries)
http ://www.ehto.org/midjan/

VII Call for Proposals: Strategic Research on Governance, Equity and Health for Eastern and Southern Africa.