1of 3
OPERATION VILLAGE HEALTH
Operation Village HealthPartners Telemedicine Supporting Quotes
Operation Village Health has affected the lives of its clients, the patients served by the pilot project, in profound ways. Villagers whose health problems had been neglected for an average of two years are receiving answers to their questions, and treatment for their illnesses. Beyond each individual patient, however, Operation Village Health has had an impact on the community, the region, and every member of the Operation Village Health partnership. The ability to help patients in such challenging circumstances from across the globe inspires consulting physicians to donate their time and expertise, and enables them to envision public health from a new perspective. The project’s dissemination of Internet access has implications for Cambodia’s leaders and communities, by introducing new methods of providing services and expanding commerce. Partners Telemedicine and its partners are not just bringing medical attention to the villages of Operation Village Health, but are bringing global access and connectivity.
In the words of our Partners:
ADD: Tom Glynn, Graham Gumley, MD, villagers
“This is the first time that the province of Ratanakiri has received a donation of high technology in the collaboration to serve the health of the people and the bringing in such technology would provide an opportunity to help develop the human resources in the province and it is also a contribution to the reduction of poverty.”
Mr. Chhoum Bun Khorn, deputy governor of Ratanakiri
In “Telemedicine for People in Ratanakiri,” Monday 14th April 2003 by the Khmer-language newspaper of Raksmei, Kampuchea
“Providing care for citizens of Cambodia is an honor. I see this as a wonderful, satisfying contribution of my skills and knowledge to those in need. Serving people who are unable to access the quality of care we have here in the United States is one of the reasons many of us went to medical school. The use of technology makes this possible on a regular basis and in a convenient manner for the patients, nurses in Cambodia and physicians here at Partners. I feel I have been able to help many by using my knowledge and this exciting technology that allows rapid, convenient, global communication. I see this as a model for providing health care to many regions of the world where the need is great and the resources are limited.”
Robert C. Goldszer, MD/MBA
Associate Chief Medical Officer, Brigham and Women's Hospital
“Telemedicine has allowed me to reach out to patients in need around the world. While the technology can be impressive, including the digitized images so useful in making certain diagnoses, the human element remains paramount. The greatest challenge is knowing that our partners in Cambodia are often village nurses with limited therapeutic and technological resources, and that my own recommendations must fit into that context. Helping patients in such need provides itsit own unique gratification.”
Dr. Olga Smulders Meyer, MD
Women's Health Associates, Massachusetts General Hospital
“Cambodia and the developing world are in need of many contributions but to be effective any person or organizations must consider the limits of what any one entity can do effectively. If one has a vision and direction and conclusion then it is a way to begin…Yes, other public health efforts, such as a safe water system, are needed and there are institutions, government programs and larger international organizations who should, can and must handle this. It is not the role, nor can it be effectively managed and established on a large scale by a hospital such as ours. We are, however, through our experience and track record, able to develop and improve a telemedicine service and demonstrate it as a model that could be expanded by other organizations and international funding to serve other regions in Cambodia and in the developing world. How has it helped? It has saved a number of lives by discovering and treating ailments that never would have been discovered in time to provide treatment in time. One just needs to visit Robib to learn how it has helped hundreds of people there and saved lives.”
Bernie Krisher
Founder of American Assistance for Cambodia, Chairman of the Sihanouk Hospital Center of Hope, and Founder of the Village Leap project
"Our telecommunication technologies are bringing Harvard Medical School standards of practice to the developing world. We not only participate in direct care by electronic exchange of patient history, physical exam and digital images, but we can promote physician education by a similar exchange of information. Equally exciting is the impact on societal development. Citizens who are healthier are more economically productive. Our success in Cambodia demonstrates that with some incremental funding, we can bring high quality, cost-effective health care to a larger portion of the world community."
Dr. Joseph Kvedar
Corporate Director, Partners Telemedicine
“I would like to commend Telepartners [Partners Telemedicine] for its outstanding contribution in creating and operating (with the Sihanouk Hospital Center of Hope) the invaluable telemedicine project in Preah Vihear and Ratanakiri. Poor, sick patients in these communities are examined once a month by a nurse who transmits the medical data by Internet to the Telepartners [Partners Telemedicine] team in Boston who then respond with a diagnosis and suggested method of treatment. Thus the poorest, most forsaken person in these villages has the same expert medical attention as a rich person in a big city. It is a small beginning but a model for the future in bringing equitable medical care to the developing world”.
His Majesty Norodom Sihanouk, King of Cambodia
“Operation Village Health is helping to meet the challenge of providing health care in the most rural areas of Cambodia. Health care needs in Cambodia are great, and telemedicine can overcome the shortage of resources to deliver health care services to Cambodians most in need of them. It is my hope that Partners Telemedicine will continue to expand this project in collaboration with Cambodian and international partners, bringing improved public health and fostering development throughout the country.”
King Sihanouk
Operation Village Health
Bridging the digital divide in health care for the developing world
1. Introduction
In two small, remote villages in northern Cambodia, villagers bring their health problems to the most unlikely of medical practitioners: the world-renowned physicians ofdoctors of two Partners Healthcare Harvard affiliated hospitals, Massachusetts General Hospital and Brigham and Women’s Hospital in Boston, MA, and physicians at Sihanouk Hospital Center of Hope in Phnom Penh, Cambodia. . A partnership between Partners Telemedicine, Sihanouk Hospital, and and Village Leap, a project of American Assistance for Cambodia/Japan Relief for Cambodia that brings technology to the developing world, has brought telemedicine to the regions of Roviengbib and Rattanaikiri, Cambodia.any These areas do not have Now these villages with no runningpiped water, electricity or telephone lines, but now systems have access to some of the best medical advice in the world. This is theis is the mission of Operation Village Health, to leverage technology to reduce inequities in health care..
Operation Village Health is the initiative of two doctors, Dr. Joseph Kvedar, Director of Partners Telemedicine in Boston, and Dr. Graham Gumley, Director of the Sihanouk Hospital Center of Hope in Phnom Penh. Partners Telemedicine has developed state of the art technology for electronic medical consultations. This technology is being used in the United States and abroad, by major hospitals and major corporations to bring the most advanced medicine to patients. The mission of Partners Telemedicine is to use technology to “extend knowledge, create access and improve care.” After hearing of this technology, Dr. GumleyOperation Village Health has givenave Partners Telemedicine thean opportunity to test test this theory in the mostthe benefits of remote consultations in the most challenging circumstances, in remote, isolated, and poor villages with minimalnearly no access to health care at all. Nearly 80% of Cambodians living in rural areas do not have an operational health care facility in their village. Partners Telemedicine has taken the challenge, and the partnership has already improved the lives of many Cambodians in the two regionsvillages of Roviengbib and Rattanaikiri.
2. Impact Demonstration (Insert blurbs, quote, or case study)
3. History of project, preceeded by brief history of Partners Telemedicine
Partners Telemedicine, a department within Partners HealthCare System, the nonprofit parent organization of Massachusetts General Hospital and Brigham and Women’s Hospital, is an outgrowth of the telemedicine work that began at Massachusetts General Hospital and employs leading telecommunication and Internet technologies including ISDN and IP videoconferencing, Internet-enabled video streaming, and a robust HIPAA-compliant interactive store-and-forward clinical website. Through publications, work with the American Telemedicine Association and the Center for Telemedicine Law, and through frequent speaking engagements Partners Telemedicine is actively engaged as a thought leading organization in the telemedicine field. Partners Telemedicine recently secured a teledermatology contract with the Centers for Disease Control and Prevention, in collaboration with a rural hospital in Puerto Rico is helping to telemedicine to a rural underserved area of Puerto Rico, and, collaborating with the Markle Foundation and others, is working with the South African government to improve care in the region.
Nominated by Bill Gates of Microsoft Corporation for inclusion in the Smithsonian Institution’s Permanent Research Collection and one of five finalists in the Medicine category of the 2000 ComputerWorld Smithsonian Awards – the judges having determined that the work of Partners Telemedicine was “among the most important applications of information technology to society” in 2000 - Partners Telemedicine has been facilitating access to the specialists of its world class medial affiliates and enhancing quality healthcare interactions through communications and technology since 1995. With a needs-based philosophy, a mission to leverage technology to extend the reach of its 4,000 specialists, and a vision that healthcare decisions should be made in a manner that facilitates rapid care delivered to the point of need irrespective of time and place, Partners Telemedicine has facilitated more than 9,000 specialty consultations, 7,000 educational videoconferences and a plethora of multimedia productions, many of which are increasingly streamed over the web. Partners Telemedicine has ongoing clinical investigations involving technology applications and continues to build upon its track record of healthcare innovation.
Telemedicine involves moving medical information rather than moving patients so that anyone, anytime, anywhere can benefit from the best health care available, which is usually centered in large metropolitan areas. Throughout history medical experts have tended to congregate in centralized areas, exposing those in remote areas to a lower standard of care than afforded those residing near medical experts and their institutions. Telemedicine is changing all this.
Telemedicine offers the promise of bringing the expert knowledge and experience of specialists to any location in the world set up to receive information via telecommunications channels, even more universally now through the Internet. Someday a villager in Robib may be assured of getting the same healthcare as a Bostonian at the Massachusetts General Hospital in the U.S. While it may still take time and learning to achieve this level of care, we hope this link will be a first step in that direction for Robib and all villages of the world.
24. Introduction of Model, program description – HOW IT WORKS. Discuss low tech telemedicineCambodia Telemedicine Clinic
Operation Village Health is integrating technology into local development in an innovative model that has potential for changing modern approaches to global development. TIf the program is making an can make a lasting impact in these most humble of circumstances, and the vision is to further develop and test thise model so that it can be used anywhere in the world to improve lives through better health and health education.
Roviengbib consists of a number of small villagesis a small village with a population of 900, located in the northern Cambodian province of Preah Vihear. The people of this remote areavillage are isolated and have been almost inaccessible to outsiders since the 1970's, when the Khmer Rouge regime killed an estimated 1.7 million people in an effort to transform the country into an agrarian utopia without education or religion.
Describe how school was built, solar panels, computer and Internet access added. Incorporate economic development model briefly.
In 1999, American Assistance for Cambodia pioneered the Village Leap program, which was designed to bring education, electricity and information systems connectivity to villages throughout Cambodia. To date, many villages (including in Rovieng Robib) have been outfitted with schools and solar electrical panels thanks to a World Bank matching funds program. Some schools receive additional donor funding for solar panels, computers, and, in the case of Rovieng, a satellite dish which allows for Internet connectivity.
A telemedicine clinic was established in February 2001 between a village in Roviengthe Robib village, and the Massachusetts General Hospital, a Harvard affiliated hospital of Partners HealthCare in Boston, Massachusetts, and Sihanouk Hospital. A mobile nurse makes am almost 9 hour journey along poor roads from Phnom Penh to Rovieng for a monthly clinic. The nurse takes a medical history and performs a physical examination. This information is sent with digital photographs via e-mail to Partners Telemedicine and Sihanouk Hospital for physician consultation. Consultations are returned within 24 hours of receipt. The nurse uses this advice to decide whether to treat patients in the village or transfer them to an area hospital.
When the telemedicine program in Rovieng was first launched, Operation Village Health queried local residents on medical issues and concerns they face in order to provide targeted information on local public health. Physicians at the Massachusetts General Hospital provided responses with information on the prevention, diagnosis, and treatment of common diseases that may affect the region, including malaria, tuberculosis, yellow fever, and HIV. Partners Telemedicine is exploring ways in which Operation Village Health can be the conduit of more education programs in the future.
A second telemedicine clinic in Rattanakiri was launched in April 2003. The clinic is based at the regional hospital, and therefore has greater diagnostic capabilities, including laboratory tests, x-ray images, and ultrasound images that are transmitted with consultations.
’s efforts have enabled ill people in Robib to have their symptoms and physical findings reviewed by physicians in Boston within the span of an afternoon so that treatment and further diagnostic measures could be initiated. This burgeoning effort has brought change and transformed some of the lives of residents in theseis remote regions of Cambodia that havewho had been minimallynot been exposed heretofore to organized healthcare. Through telemedicine links established among Robib, Phnom Penh's Sihanouk Hospital Center of Hope (SHCH) and Partners Telemedicine, we are bridging the cultural divide as well as the digital divide. Health, and world-class health care is making its way to rural Cambodia through the use of simple technology. Robib. The technologies employed are simple, namely the Internet, standard email and digital images.
A second telemedicine clinic in Ratanikiri was launched in April 2003. The clinic is based at the regional hospital, and therefore has greater diagnostic capabilities, including laboratory tests, x-ray images, and ultrasound images that are transmitted with consultations that are sent to Partners’ hospitals and Sihanouk Hospital for physician advice.
A nurse from the Sihanouk Hospital Center of Hope visits once a month (a nine and a half hour drive from Phnom Penh) to conduct basic patient check-ups. She records case information and takes digital photographs of the symptoms. The information is then sent via the satellite Internet connection and the nurse awaits a diagnosis and recommendations.
3. Impact Demonstration RattanakiriThere have been over 200 visits to our telemedicine clinics. patientsduring, funded by the Markle Foundation,Rattanakiri
Quality of Life
We are committed to measuring the outcomes of our telemedicine clinic. We recently conducted a quality of life survey in Rovieng. Meng Dy is a Cambodian who administered the surveys and had the opportunity to speak with many of the villagers. He found that the telemedicine clinic is changing people’s lives: “They said they can be alive because of our telemedicine clinic. Some of them said they are having next life because of our telemedicine clinic. And they thank us very much.” The analysis of the quality of life data is in progress for publication.
Public Health
In addition to impacting individual lives, the telemedicine clinic in Rovieng has allowed us to recognize and begin to address some important public health problems. We noted a high prevalence of goiters, or enlarged neck masses (picture), which led us to detect iodine deficiency in the population. The harmful effects include goiter, hypothyroidism, severe mental retardation, decreased school attentiveness, and poorer economic productivity. We are in contact with officials from UNICEF, WHO, and the International Council for the Control of Iodine Deficiency Disorders (ICCIDD) to develop a sustainable supplementation program.
Broadening the Impact
Our experience of over two years has demonstrated that telemedicine clinics using simple low cost technology can provide access to health care in some of the most remote and isolated areas of the world. We have also demonstrated the potential for positive public health impact. Funding is needed to ensure the success of these endeavors and to enable the opportunity for more robust research around the feasibility of using telemedicine to deliver health care to the developing world in a manner that is cost effective, sustainable, and improves the quality of care.