Lt Col Nazmul Huda Khan :
Telemedicine is a healthcare system using ICT technologies through different processes such as store-and-forward process, remote monitoring processes and real-time interactive process. Store-and-forward telemedicine process involves in acquiring data from a patient and then sends the data to a medical professional to analyze it at a convenient time and of course in offline. In remote monitoring processes, the doctors and the nurses use various types of electronic devices to monitor the patient and the patient has the capability to update the healthcare personnel on the exact schedule. This type of monitoring is very efficient in chronic diseases. Real-time interactive telemedicine works as real-time consultation but through an electronic device such as a computer, mobile or other interactive electronic devices. Main advantages of real-time interaction are that it covers many activities such as history review, physical examination, psychiatric evaluations, ophthalmological assessments etc. This method is the most convenient and an alternative to traditional in-person consultations.
Around 77 per cent of the total population of our country lives in rural areas. Rural health centers are often ill-equipped having less efficient human resources. There is a huge gap between the number of population and the healthcare facility in terms of hospital bed, physicians, nurses, per capita health expenditure, total expenditure, community health expenditure etc. Under these circumstances, there are two options to provide health care in rural area. One is to expand healthcare facilities and improve the infrastructure; another one is to take initiative to facilitate easy access of quality health care. Huge investment needs to incur to implement the first option. The telemedicine can fulfill the second one to provide better health care by using maximum utilization of limited resources.
During the Covid-19 pandemic, telemedicine is playing a vast role in developing both the quality and access to healthcare services; especially as a means of decreasing the risk of cross-contamination caused by close contact. At Kurmitola general hospital of capital city, telemedicine services have been provided to about 1.5 lac Covid-19 cases (both confirmed and suspected) through 2020-2022 during existing pandemic.
Telemedicine in Bangladesh has been emerged before 1999. First successful telemedicine link was established in the year 1999 by a charitable trust named Swifne Charitable. It established the email-based link between the Centre for the Rehabilitation of the Paralyzed (CRP) in Dhaka and Royal Navy Hospital, Haslar, UK. In the same year, Telemedicine Reference Center Ltd. (TRCL) Dhaka, Bangladesh a private company launched its journey with a telemedicine project to help doctor to identify diseases. Since April 2001, the Bangladesh Telemedicine Association (BTA) has been formed. Sustainable Development Network Program (SDNP) Bangladesh began in January 2003 in different parts of Bangladesh. Bangladesh University of Engineering & Technology (BUET) and Comfort Nursing Home started a Telemedicine project with the collaboration from European Union (EU) via email since 2003. In 2006 TRC Land Grameen phone started a unique telemedicine service “Healthline Dial 789”. The project ‘ICT in rural Bangladesh’ is working for the development of health care facilities in rural Bangladesh through ICT since 2007 in collaboration with Grameen Communications, Bangladesh; Grameen Phone, Bangladesh; Bangladesh Sheikh Mujib Medical University, Bangladesh and International Institute of Information Technology (IIIT), India.
Since 2017; more than 1.4 million of people from around the country have been served by the Shastho Batayon 16263. It is transmitting 5,500-6,000 calls regularly in a single day and the number is increasing. Jeeon connect is the first online platform for retail drug specialists and chemists in Bangladesh. Sebaghar is a telemedicine and video consulting service platform of BDtask Limited, a Bangladeshi software and IT company. Bachao-Health is a Facebook Messenger based telemedicine service. Tonic is the first health based digital offering service application in Bangladesh, providing variety of services. Pulse Health services Limited offers a cloud-based smart health monitoring system bundled with health insurance.
The scope of Telemedicine is quite large; few of them are: Telenursing where the away from the patient but provides services via information technology. In Telepharmacy, various pharmaceutical services are delivered by using telecommunication technology. Teletrauma care is the type of care where the trauma specialist gives treatment to the personnel who is severely injured or in disaster situation through the Internet or telecommunication devices. Telecardiology is the modern way of providing clinical support to the people who suffer from heart diseases. Telepsychiatry is a term used in Telemedicine to describe the way of providing psychiatric health services through telecommunication. Pathology practice among different locations by using modern communications technology is called Telepathology.
There are various advantages of Telemedicine. 24/7, 365 available service is the most appreciated service in this regard. It works as second eyes for doctors and nurses, most effective in emergency situations, the fewer possibility of contagious diseases and incur less waiting time. It is both cost-efficient and cost effective as well.
In Bangladesh, use of telemedicine is facing a number of barriers. Most of the people are not concerned about the use of telemedicine. The limitation of technical resources is another hindrance. The patient’s acceptance rate is also an issue as most of the people are habituated with the traditional way of visiting a doctor; they have lack of interest in adopting the new technology. As most of the target customers will be from rural areas, the employees of the companies will feel less motivated to work in those areas. Challenges of training and effective use of the stuff, the level of trust among the people may be lower, data connection is still costly, frequent changes in technology and consultation privacy is a question too among others. Health care workers in the medical sector also may have less interest to try out new technology.
As telemedicine is a new concept; it requires more circulation to reach people in remote areas. Still, we are having limited ICT infrastructural support like computers, Internet network, printers and other facilities for telemedicine. We need to improve internet connection, make signal and web access stable. Health sector should come forward in collaboration with ICT division along with NGOs and private sector.
Telemedicine is the blessing of the century. At present the total number of cellphone subscribers in Bangladesh is close to 80 million among all network providers. The smart phone users in Bangladesh are growing at a high speed and Internet connection is nearly available all over the country. So, feasible ground is prepared for the telemedicine to be the main branches of healthcare in Bangladesh.
(Lt Col Nazmul Huda Khan, MBBS, MPH, MPhil is a Public Health Specialist, Ex Assistant Director, Kurmitola General Hospital).
