The Boston Globe, Feb. 16, 2001
ONLINE CHECKUP WITH A CLICK, CAMBODIA PATIENTS GET TOP MEDICAL CARE
Raja Mishra, Globe Staff, and Richard Sine, Globe
Correspondent
ROBIB, Cambodia - The 10-month-old girl had coughed and
sputtered since birth and her belly had swollen, leaving rice farmer
Thoung Pou convinced her daughter was at death's door until she got
word of the foreigners and their mysterious Internet.
There is no electricity or running water in this remote hamlet,
where incomes hover below the equivalent of 40 US dollars a year.
The entire region is just now emerging from decades of primitive
isolation under the rule of the genocidal Khmer Rouge. But
yesterday, Pou's daughter was examined by specialists at
Massachusetts General Hospital, who, sitting comfortably in front of
computer terminals in Boston, offered detailed recommendations for
her treatment.
"I don't know what the Internet is but I understand my daughter
will be healthy," said Pou. "If they hadn't come, I would
have been hopeless. We were very happy when we saw foreigners come
to help this village."
The consultation, one of four that took place yesterday, was perhaps
the most ambitious telemedicine effort to date, allowing some
of the world's best doctors to help some of the world's poorest
people. And at a time when the Internet's potential to empower the
poor is relentlessly hyped, yesterday's demonstration suggested
there is promise.
"We've just demonstrated we can bring to bear the highest level
of medical expertise anywhere in the world," said Dr. Joseph C.
Kvedar, assistant professor at Harvard Medical School who made the
initial contact with the Robib patients.
Kvedar heads the Partners Health Care telemedicine program,
which started five years ago and has since averaged 1,000 Internet
consults a year, mainly with Middle Eastern and Latin American
counties and Greece. Yesterday was the program's first contact with
Cambodia, an initial foray into the Third World.
The operation began when a creaky old Russian helicopter hurtled
over miles of dense, swampy forests and crazy-quilt patchworks of
rice paddies before descending onto a makeshift, dung-stained soccer
field. Robib, population 4,000, is nine hours by car from the
capital, Phnom Penh.
The helicopter was instantly surrounded by dozens of gawking young
children, some of whom had never seen an aircraft before. Cows
lazily roamed the hut-lined village. Robib was picked
precisely because of its remoteness, said Bernard Krisher, a
philanthropist and former journalist who, with the Massachusetts
Institute of Technology's Media Lab, is spearheading the effort.
"I asked my assistant to find the poorest area in
Cambodia," Krisher said.
The tiny village relies on roots and herbs from traditional doctors
for healing, said villagers. The nearest doctor is nearly three
hours away, and only for those who can afford the taxi trip, for the
town has nothing resembling an ambulance.
But on this day, nurse Koy Mon Tha examined all comers, armed with a
laptop computer, a digital camera, and a list of medical questions
devised by MGH doctors.
The first patient was a 48-year-old man, Noung Kim Chhand, a teacher
who complained about his irregular heartbeat, shortness of breath,
and a dry cough he'd nursed for five years.
On the other side of the world, in Lynnfield, Kvedar was awakened at
1 a.m. by his alarm.
He went to the computer in his den and got the rundown on Chhand. He
also saw a photo of the patient, a man with brown, parched skin
covering his face. He read through the nurse's report, and set about
typing:
"His image suggests that he is chronically ill and short of
breath at rest - either chronic mitral stenosis or tuberculosis
could produce that. . . I will see if I can get an internist to
comment in the next 12 hours," e-mailed Kvedar to the nurse.
He also suggested some vaccinations and additional tests, which the
nurse arranged.
This sort of Internet consultation is not for every case. Nothing
can replace face-to-face interaction between doctor and patient,
said Kvedar. But the difficult cases, in which local doctors are
unsure of their diagnosis, can benefit from the consultations. In
fact, Massachusetts doctors routinely seek help from specialists at
area academic hospitals.
Little effort was required by Boston doctors involved in yesterday's
effort - simply a read of the e-mail from Cambodia, a quick check of
medical texts, and a return e-mail.
The next patient was the rice farmer's baby, followed by a 10-
year-old girl who had blurred vision since birth, and a 23-year-old
male with symptoms that included an irregular heartbeat. The latter
was diagnosed with valvular heart damage, and was advised to undergo
more tests and, possibly, surgery. But the girl with vision problems
demonstrated the limits of Internet medicine.
"A little bit of additional information would be useful. . .
the difficulty could range from simple nearsightedness to the result
of a congential condition or infection," e-mailed Kvedar.
Kvedar will forward the test results to a Mass. General
ophthalmologist, but said that the girl needs to see a specialist.
Kvedar and everyone else involved in yesterday's venture are
donating their time and services, something they all admit they
cannot sustain. They will do consultations once a month but hope an
international nonprofit charity will see fit to fund the effort.
"The power of this can't be underestimated," said Kvedar.