News Column

Clinics of the Future

May 29, 2014

The company Tele-Med International envisions an Egypt where those in rural and impoverished areas would have easy access to top medical specialists with a click of their mobile phones.As the country's first tele-health service provider, Tele-Med's team of specialized doctors has already treated hundreds of patients in the most isolated areas of countryside. But challenges remain before such services can be expanded into more communities. 

By Dominika Maslikowski

Photography courtesy of Tele-Med International

local doctor in the Kharga Oasis, some 230 kilometers southwest of Assiut, had never seen a computer until the Tele-Med team arrived to set up the hardware that would allow patients there to access specialized doctors via the internet and other technology. A tech-savvy young man who sold internet access at a local kiosk was recruited to help launch the system. When it comes to bringing telemedicine into Egypt's rural areas, the Tele-Med team uses whatever resources they can find to create success stories, says the company's co-founder Dr. Wael Abdel Aal.

Dr. Moemen Moaz at the clinic in El Kharga Oasis consults Dr. Amr El Faramawy at the Aswan Heart Center about a case via a video conference.

Now a patient in Kharga with a complex heart disease, for example, can be connected to the nation's biggest heart centers and top specialists to receive care without traveling hundreds of miles. The patient goes to the local clinic, and if the case requires a specialist, then the local doctor works with Tele-Med to connect to the specialist, who can diagnose and manage the case remotely. Abdel Aal explains that this saves the patient a long journey to see the specialist in person, and if surgery is needed, the patient can then travel directly to a hospital.

Doctors in remote areas were skeptical of such technology at first, but now connecting to specialists throughout Egypt and abroad has become routine with a system that takes only minutes to set up. Tele-Med has so far set up its system in two rural clinics, one in the Kharga Oasis and another in Luxor. Once the system is set up, it doesn't require much money to run and locals quickly come around to the idea, Abdel Aal says.

"The benefit is that telemedicine defies geography and time," he explains, noting that patients don't have to travel to see a specialist and can schedule surgeries more quickly. "It's also cost-cutting, so the patient benefits as well as the local physician.

"Over time, the local physician gains online hands-on skills and knowledge through interaction with the specialized physician. We call them 'doctors 2.0'," the physician continues. "These doctors over time develop fantastic connections to different centers, and they develop lots of skills across medical issues and grow into a new type of doctor who can provide patients with very good service. It is a challenge for local doctors to accept the new technology. Those who do are pioneers who see the future."

The story of Tele-Med, headquartered in Mokattam, Cairo, began in 2005 when Abdel Aal began reading about the technology and the fast-paced changes in the delivery of healthcare. "I thought it was very challenging and that we need to think about it and start moving," he recalls. Abdel Aal spent the next few years researching deeper, traveling to the United States, becoming a member of the American Telemedicine Association and taking special courses in the field. He co-founded the company in 2009 when he connected Cairo patients to specialists at the Mayo Clinic in the US and the Royal Free Hospital in the United Kingdom. In 2011, the company took its services into Egyptian rural areas and worked to develop its own technologies that could function amid the poor internet connectivity of the country's isolated communities.

"Over time, the local physician gains online hands-on skills and knowledge through interaction with the specialized physician. We call them 'doctors 2.0'."

At the Aswan Heart Center, Drs. Magdi Yacoub, Sherin Abdel Salam, Wael Abdel Aal and Hatem Hosny review a patient's telemedicine data before doing his surgery.

Tele-Med sets up the equipment and provides services like video conferencing and digital file transfers of diagnostic medical imagery such as X-rays, EKGs and MRIs. A Tele-Med equipped clinic can also use special cameras to examine the patient's eyes or teeth while a specialist watches via the internet.

In addition to training clinic personnel to operate the system, Tele-Med also work as an appointment scheduler to connect rural doctors and patients with specialists. There are now some 20 doctors of various specialties around Egypt who work for Tele-Med on a volunteer basis, taking time out of their hectic schedules to offer top-quality care to impoverished and rural communities. They have offered treatment to some 400 patients of all ages since launching services in 2012.

Special gadgets have been developed abroad like cameras that can look at the skin of the patient and transmit the images over the internet to a specialist, or instruments that allow doctors to look at the eye and nose of the patient or listen to their heart, Abdel Aal says of the technology that's been now incorporated into apps for mobile phones.

A new telemedicine HD camera transmits an examination live to a doctor in another location.


Telemedicine began in the 1960s with the US space agency NASA, which used telemetered technology to record physiological changes in astronauts on space missions, Abdel Aal says. NASA continued to lead the race in telemedicine, and by 1972 it had the first mobile van equipped with medical instruments to transmit medical information via microwave from the Papago Indian Reservation in Arizona. Now telemedicine in general is evolving at a lightning pace with telerobotics, for example, allowing a physician to guide a robot that performs a surgical procedure while they're in another part of the hospital or in a different country.

"This is where everything is moving. And this is not only a dream, this is reality," Abdel Aal says. "Some of the hospitals in the Western world have magnificent use of telerobotics that are doing even better than humans because of their sophisticated technologies."


Trouble Connecting

There are still limitations of what telemedicine can do in Egypt. Abdel Aal says that Tele-Med at first targeted five sites mainly for their remoteness and dire need of services: Kharga Oasis, Shalateen and Abu Simbel near the Sudanese border, Rafah on Sinai's northern border, and Salloum near the Libyan border. After field visits, Shalateen and Abu Simbel were found to have no communication networks that could support the service, while Rafah and Salloum were security threats. In the end the team selected Kharga Oasis and Luxor, where the patients were seen free of charge and the doctors contributed their time while Tele-Med paid the expenses.

To meet the challenges of working in Egypt's rural areas, Tele-Med has developed a cloud-based portal that's used as a scheduling and file transfer system, and a video conferencing system that works well with low-bandwith internet.

The main challenge that keeps Tele-Med from expanding into more of Egypt's rural areas is the quality of internet connections, as well as power outages that sometimes force doctors to cancel sessions. When Tele-Med tried going into Shalateen, there was no communication there at all and only the national bank there had internet access.

Tele-Med also needs more funding and the help of the Ministry of Communications and Information Technology, Abdel Aal says. He's currently in talks with the ministry about taking the services into Fayoum and Upper Egyptian cities like Aswan, Abu Simbel and Kom Ombo.

"Without going into politics, I personally see the delivery of healthcare as a whole needs to change. Improving what we have will not work. However much money you put into it, it won't work. You need to change the parameters according to the era we're living in, and at the beginning of the revolution I thought that's what would happen. We have lost a lot of time over the past 20 years, but we have another chance. We really could start at an advantage by not trying to fix the whole," Abdel Aal says.

With radiology images onscreen,Dr. Sherin Abdel Salam in Aswan speaks with Dr. Moez and the family of a sick child in El Kharga Oasis.

Abdel Aal hopes that eventually telemedicine will be delivered across Egypt, and says one of his goals is to make the health community more aware of the technology and its potentials to offer solutions that don't involve expensive equipment but simple systems that can be accessed online.

"The Ministry of Health can and should benefit from such systems. We're talking with the Ministry of Communications, and they're very open in helping out with this technology. I think we may be able to extend the rural area system. Hopefully the Ministry of Health will come on board. One of the biggest challenges is the funding for such programs: We've been trying our best, but we're a private company and we've been actually losing a lot of money. But our intention as a company is purpose oriented rather than purely business."

Based on Tele-Med's experience thus far, Abdel Aal doesn't foresee much resistance at the local level. "This is not replacing the way healthcare is delivered, it is adding to it. Throughout the video conference, the patient is still sitting with the local doctor. And the doctors gain more trust from their patients, who now understand that the doctor is willing to take the initiative to help, get them better service and was brave enough to take the step. Now those doctors are the champions of the region, and they're primary health doctors who've gained experience from specialized doctors from around Egypt."

Besides offering telemedicine services to rural populations, Tele-Med is trying to bridge the gap between doctor and patient and make healthcare more preventative. The company is working on developing portals for health education that will allow doctors to share their expertise and learn from each other, as well as give the public access to videos and information from top experts. As part of that project, the company's website features hundreds of videos in Arabic and English presented by doctors on diverse topics from parenting skills and healthy meals to epilepsy and the treatment of headaches.

The company has also developed mobile apps that take away the difficulty and intimidation some patients may feel while tracking down a specialist.

"A doctor can have his own app and provide different information and a connection. The patient can look if they have a certain disease and connect to a doctor immediately," Abdel Aal says. "What we envision is that the 21st century is going to be very fast moving in the education parameter, the delivery of healthcare and across the board. It's not about renewing or improving the old systems. It's a new world and we cannot fix the old. We need to change completely." et

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Source: Egypt Today

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