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स घ सघ sangha A community building communities Hina Sharma, M. D. April 25, स घ सघ sangha A community building communities Hina Sharma, M. D. April 25, 2007 Internet 2 South Asia Conference

Sangha • Nonprofit organization • Dedicated to using technology and cutting edge ideas to Sangha • Nonprofit organization • Dedicated to using technology and cutting edge ideas to improve access to healthcare, education and enterprise • Partners: local government, Community Based Organizations • Partnered with Florida International University

Key Points ● Rising burden of disease in developing world (demand for health) ● Key Points ● Rising burden of disease in developing world (demand for health) ● Decreased supply of Health Care Providers ● Telemedicine’s role in Primary Care ● Lessons learned: Andaman and Nicobar Islands

Supply and Demands of Health Burden of Disease Andaman and Nicobar Islands__ • Acute Supply and Demands of Health Burden of Disease Andaman and Nicobar Islands__ • Acute Respiratory Tract • • Infection. Pyrexia of unknown origin. Leptospirosis. Gastrointestinal Disorder. Nutritional Deficiency (Anemia & Vit. Def. ) Malaria. Diabetes. Hypertension.

Why Is Health Important? • Developing countries share disproportionate burden of avoidable disability, morbidity, Why Is Health Important? • Developing countries share disproportionate burden of avoidable disability, morbidity, and mortality • Preventable infectious diseases, malnutrition, complications of childbirth, and chronic disease

Why Is Health Important? • Exponential health costs of a country’s poorest • population Why Is Health Important? • Exponential health costs of a country’s poorest • population effects GDP with parallel income loss may cause a dangerous recession causing decades of setback. In the words of Nelson Mandela, “The imperative to act on this urgent, life and death matter can no longer be ignored. We must not fail to achieve the vision contained in the Universal Declaration of Human Rights. ”

Telemedicine “In terms of disease management, there is [a] 99% possibility that the person Telemedicine “In terms of disease management, there is [a] 99% possibility that the person who is unwell does not require [an] operation. If you don't operate you don't need to touch the patient. And if you don't need to touch the patient, you don't need to be there. You can be anywhere, since the decision on healthcare management is based on history and interpretation of images and chemistry … so technically speaking, 99% of health-care problems can be managed by the doctors staying at a remote place—linked by telemedicine. ” – Dr. Devi Prasad Shetty, prominent Cardiothoracic Surgeon, Philanthropist

What Is Available • Specialty, Problem-Focused – Store and forward information • Port Blair, What Is Available • Specialty, Problem-Focused – Store and forward information • Port Blair, Andaman and Nicobar Islands Tele-ophthalmology Link – Shankar Nethralaya, Chennai

m MYANMAR m K 600 K . Km 00 12 CHENNAI 5 125 VIZAG m MYANMAR m K 600 K . Km 00 12 CHENNAI 5 125 VIZAG 1367 Km CALCUTTA BANGLADESH 45 . 113 0 Km Km 0 THAILAND . LOCATION of A&N Islands 1400 Km 70 SRI LANKA 163 Km 0 K INDONESIA m. SINGAPORE

Primary Care • How best to begin delivery of Primary Care? • Address gender Primary Care • How best to begin delivery of Primary Care? • Address gender inequality – Women’s health – Only pregnancy focused care available (Infant Mortality Rate 20%) • Address Special Health Care Needs – Disabled Children – Female Development

Women’s Health Project • Championed by the Director of Health Services of Andaman and Women’s Health Project • Championed by the Director of Health Services of Andaman and Nicobar Islands, Dr. Sadasivan • Local Gynecologists will see patients at the Sangha clinic twice a week ● Telemedicine - increase primary care knowledge - improve capacity to caring women and children

Sustainability • True sustainability = effective physicianpatient or physician-physician interface • Capacity building of Sustainability • True sustainability = effective physicianpatient or physician-physician interface • Capacity building of local medical resources • Building Databases • Collaboration with local specialists • Avoid fragmentation • Broadband Access

Technology to Make a Physician Interface Technology to Make a Physician Interface

Quality Assurance • Continual update of knowledge with ongoing • • bilateral feedback Promotes Quality Assurance • Continual update of knowledge with ongoing • • bilateral feedback Promotes international standardization of care Marketing to local physicians is essential for success especially through demonstrations providing the highest quality interface between physicians and teaching continuing education and procedures

Quality Assurance • Increasing awareness of South Asian physicians (mainland or other islands) about Quality Assurance • Increasing awareness of South Asian physicians (mainland or other islands) about the true potential for telemedicine will provide the confidence that you can teach anything with telemedicine • See one, do one, teach one • Thus, rapid increase in demand for technology (Broadband Access, etc. )

Rapid Deployment of Crisis Intervention • Tsunami • Pandemics • Disaster Management • Continued Rapid Deployment of Crisis Intervention • Tsunami • Pandemics • Disaster Management • Continued Specialty referral not otherwise available