When Dr. Mingmar Gyelzen Sherpa got transferred to the capital city after serving the mountainous people for 24 years in Solukhumbu district hospital, he thought of making links with them and created a website for providing his services-Rural Health Online Nepal. He later on knew that he had already started a sort of telemedicine. The website has been in operation for five years now.
As the director of Logistics Management Division of the Department of Health Services under Ministry of Health and Population, Dr. Sherpa is preparing for the operation of telemedicine in public hospitals of the country. Given this, Nandalal Sharma, Executive Editor of the Health Times, talked with Dr Sherpa about the scope of telemedicine in the country and how the Division is preparing for it.

How is the scope of telemedicine in Nepal?

Tele Medicine is particularly designed for a country like Nepal where health manpower is not available because of various reasons. The hospitals which are located in the remote districts of the country lack capacity to provide specialist health services. And majority of the people live in the villages. They are deprived of specialized services because the hospitals are not well equipped and we do not have sufficient specialists to go and provide services in those areas quickly. Hence telemedicine is a good alternative to provide services to the common people, especially to implement health rights as the fundamental rights as enshrined in the interim constitution.
It is not that telemedicine is only alternative for developing countries where majority of people live in the rural areas, even in the US, the most developed country, telemedicine is a viable option for providing specialist services to the citizens. In the US, the people of Alaska use telemedicine for treatment. Given this, it is high time that we incorporated telemedicine in our health service system so that the rural people do not need to travel to cities for the sake of many a times normal treatment.
 

Some Hospitals have already started telemedicine. How have you assessed their performance at a time when you are preparing for the same?

So far I have heard and also read in the newspapers that some hospitals have started telemedicine services as a business and they are connected to hospitals of some other countries like India. However, operating telemedicine as a business is one thing while running it with a view to providing healthcare to the vast majority is some other thing. In this sense, telemedicine has really not started in Nepal. Some claim that they have started but starting is not so important, the most important thing is how it functions and how it is sustained- whether it is actually utilized by the public, how much people have been benefited from this is very important.
What are the things needed for starting telemedicine for rural people?
Telemedicine requires four important things. The most important thing is electricity- stable electricity, the second is connectivity- reliable connectivity, the third important thing, I think, is man power to operate Telemedicine and the forth  and not the least important thing is attitude and interest of the health workers. We need electricity for running computers, connectivity for operating internet and manpower for exchanging problems and advice.

How is telemedicine possible given that district hospitals are not well-equipped in the country?

The way, the mechanism, the model that would like to introduce Telemedicine in Nepal is very simple. This is a very simple technique. It doesn’t require very sophisticated equipment. It is very simple, if we have reliable connectivity we can put all the patients’ record online which will be studied by the specialists at the centre or anywhere in the world and the specialists provide advice.
I do not mean to say that everything can be diagonised in the district hospitals; even in Kathmandu everything cannot diagonised. Yet there are many things that may be diagonised in districts as they are equipped with certain pathology services. Still then, for some complicated diseases, the patients have to come to the centre. The point is we have general physicians in the districts, and they can diagnose the patients and then consult the specialist of gynecology, obstetrics and other for medicine and treatment.

What steps have you taken or completed so far for operating public telemedicine?

We have provided week long training to physicians and health workers of some 25 districts. We have reached an accord with Patan Hospital as central hospital to provide specialist service and advice. And we have also established an office at Patan Hospital. Very soon we will introduce Telemedicine. We are waiting for connectivity and we would like to do this with VISAT technology. We have already published notice for the requirement of equipment and we are in the process of providing equipment to those areas. Once that is done, we would be ready to start Telemedicine.
 

Which are the district you have chosen and what are the reasons for the choice?

We are covering all mountainous districts because our interest is in the most remote part. So we are covering all the 16 mountain districts, 9 hill districts. Once it is used, once people start getting benefits, we will gradually expand the service. We have planned in a phase wise manner like first phase 25 district, second 40, third 60 and finally all the 75 districts. Thus we want to provide the services to people across the country.

How long will it take for the patients to have specialist services through telemedicine?

It should not take more than 24 hours, but in emergency immediate answer can be given and on condition like skin diseases, mental diseases, psychiatric problems, we have designed to offer advice twice a week as they are not so emergency problems.

 

Will it not be a time-consuming service? And what about providing online face-to-face consultation?

No, not so much as you have to take appointment time of the specialist even when you want to see the specialist directly. So far as a one-on-one talk between the patient and the specialist doctors is concerned, it is difficult for us. Even if you meet a specialist, you can get hardly have ten minutes talk. Moreover, it will be difficult for the specialist to talk to the patient directly and understand everything. So, the doctors in the given area will talk to the patient, write the problems and seek advice from the specialist. The general physician and the specialist will thus be involved in our ways of telemedicine. 

How long will it take you to start the public telemedicine?

I hope within two to three months we will have started telemedicine in at least 3 district and immediately after that the service will cover all the 25 districts.