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Telemedicine puts AP village on health map
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Posted online: Wednesday, September 07, 2005 at 0011 hours IST

Dr. V. Vilmanathan ARAGONDA , SEPTEMBER 6: Aragonda in Chittoor district, a remote hamlet, was even farther from medical care till 2000. It had six-seven RMPs (Registered Medical Practitioners) and one primary health centre with one doctor.

This doctor had to cater not only to Aragonda but also to six other hamlets surrounding it as well as the villages of the adjoining Thavanampalle Mandalam. Clinical and laboratory evaluations could be done only in Chittoor (20 km away) and Vellore (65 km away).

All that changed in April 2000. The Apollo group of hospitals chose the village for its pilot telemedicine project — Aragonda was lucky for it is the home village of Apollo Chairman Dr Pratap C Reddy. It was to be the country’s first experiment with rural telemedicine.

With ISDN and VSAT lines — which the Indian Space Research Organisation helped to set up — the village was connected to the Apollo hospitals in Hyderabad and Chennai, bringing tertiary care virtually to the doorsteps of the villagers.

Besides seasonal ailments like malaria and water-borne diseases, untreated cases of diabetes, hypertension and cardiological problems were a major source of worry. And with the national highway connecting Bangalore with Chennai running in its backyard, there were several accident and trauma cases to be dealt with.

The telemedicine centre was located in a new one-storeyed, 50-bedded hospital — built with an initial investment of Rs 2 crore — which was equipped with a CT scan, ultrasound and X-ray machine besides medical personnel. It was the telemedicine centre which proved to be a hit.

It could facilitate one-to-one interactions between the doctor and specialists located either in the Hyderabad or Chennai group hospitals or 75 other centres of the group across the country and abroad. No wonder it proved to be a giant leap for the village.

In the first year (2000-2001), about 18,300 patients visited the hospital. Next year the figure went up to 25,400. ‘‘We even got follow-up cases from the Christian Medical College Hospital, Vellore, Tirupathi, Puthur and even from faraway places like Ananthapur (about 300 km away),’’ said Dr. V Vilmanathan, the paediatrician at the hospital.

How tertiary healthcare arrived at doorsteps
Patients with complicated case histories, who would have normally rushed to Chennai and Hyderabad, began to queue up in front of the telemedicine room. ‘‘We were consulting superspecialists in Chennai and at other Apollo centres for complicated cases related to cardiology, dermatology, urology and neurology,’’ said Dr. Vilmanathan. With five years of consecutive drought affecting the villages, the farmers were even given psychiatric counselling through telemedicine from remote Chennai.

Significantly, the doctors could even study the echocardiogram and ultrasound data of patients live. ‘‘We ensured that patients needed to visit superspecialty hospitals just once — for surgery. The diagnosis and other consultations were done online,’’ explained Dr.K. Murugesan, general surgeon at the hospital.

For S Rasheed and his wife, Mahubjaan of Gajulapalle, 2 km from Aragonda, such consultation considerably lessened the trauma of having their three-year-old daughter, Faheeda Banu, undergo a complicated heart surgery. ‘‘The diagnosis and consultations was done online from here. We had to go to Apollo Hospital in Chennai just twice — once for the surgery and recently for a follow-up. She is fine now,’’ said Mahubjaan. And the couple spent only Rs 10,000 because of a subsidy.

Even for the doctors it has been a learning process. ‘‘For us (seven specialists, including a surgeon, gynaecologist, paediatrician, radiologist, anaesthetist and orthopaedician working at the hospital) it has been a learning process. There is constant updating of knowledge, thanks to the continuous interaction with the superspecialists,’’ said Dr. Vilmanathan.

The telemedicine process involving connectivity between a telemedicine consulting centre (TCC — the Aragonda hospital) and a telemedicine specialty centre (TSC — a superspecialty hospital in Chennai perhaps) is rather simple. The TCC has medical equipment like CT Scan and Colour Doppler that are interfaced with the telemedicine software. Thus the specialist at the TSC would be able to view the live medical images of the patient.

The consulting centre has a high-end scanner for scanning X-Rays and transmitting to the specialty centre, web camera and video-conferencing equipment for net meetings with the specialists. The connectivity from the TCC to the TSC can be through ISDN, VSAT or a leased line.

For Apollo Group, the Aragonda venture has not been a financial success but its growing popularity is a consolation. Dr Pratap Reddy’s attempts to subsidise healthcare for the villagers by introducing an insurance scheme has failed. ‘‘The villagers complain they are not getting their money’s worth — they have to give Rs 365 annually — because there are too many pre-conditions,’’ says G Harinath Reddy, panchayat secretary. So, most of the 1350 families who availed of the scheme refused to renew it. From July 2003 to July 2004, the number came down to 715 families. This year, only 229 families have opted for it.

Undeterred, the Apollo group wants to extend the telemedicine scheme to many more villages.

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