Pakistan: Diagnosis from a Distance

Pakistan is experimenting with a relatively new model of healthcare delivery: telemedicine. For distance-based medical services to be successful, however, projects must grapple with challenges like inadequate infrastructure and patient distrust of the concept.

By Sonya Rehman

In the 10 months since the organization TeleSehat opened a second pilot telemedicine center in the Pakistani city of Gujar Khan, more than 3,000 patients have been treated. Such numbers point to the great potential of telemedicine to bridge the healthcare divide in Pakistan.

Due to an insufficient healthcare budget, a shortage of good doctors, and poor, ill-equipped public hospitals, Pakistan is unable to provide all its citizens with even basic healthcare services. Given the sheer lack of healthcare facilities in remote villages, villagers suffering with serious illnesses and health emergencies often have no other option but to travel extensive distances into the main cities. As the cost of traveling is prohibitive for many who survive on meager incomes, these villagers either rack up great debts or forego medical attention entirely.

Closing the healthcare gap between those who live near medical facilities and those who do not was the impetus behind TeleSehat (‘Sehat’ is Urdu for ‘Health’). Asad Karim (also the CEO of a local technology firm, Comcept) and Syed Mahmood Hussain launched TeleSehat in the summer of 2008. They founded the organization to establish telemedicine centers to deliver healthcare to Pakistanis living in inaccessible locations.

A doctor demonstrating the use of a digital notepad – Photo by: Bilal Farooq

Telemedicine is not a completely new concept to Pakistan, and certain projects have been quite noteworthy. Launched in 2001, the Tele-Health Programme, for instance, was the country’s first telemedicine initiative. Jaroka Tele-healthcare, Sehat First and TeleDoctor, all similar local telemedicine initiatives, soon followed.

But the question remains: Can telemedicine prove successful in a country like Pakistan?

“Telemedicine is the only hope for countries like Pakistan,” insists TeleSehat’s head of business development, Nabeel Ahmad Malik. “However, this can only prove successful if the service delivery model is designed in a way that it suits all the stakeholders, that includes hospitals, doctors, TeleSehat itself, the local population and the respective government.”

Virtual medical consultation

In late 2009, TeleSehat opened its first pilot telemedicine center, or “telecenter,” at the Holy Family Hospital in Rawalpindi in December 2009. Approximately 300 patients visit Holy Family on a daily basis. Doctors would consult with the hospital’s large pool of patients from a telecenter situated on another floor in the hospital. The doctors in the telecenter served as experts who were available in the case of a medical emergency in a patient; otherwise, the patients saw regular staff. Using a computer to communicate with the patients allowed them to assess many more patients than if they had seen them in the flesh.

TeleSehat – front desk

The Holy Family pilot telecenter allowed TeleSehat to test the response from the patients and the doctors, and to gain vital feedback for the improvement/refinement of services. After receiving encouraging feedback from patients, TeleSehat was able to improve its services through trial and error at the pilot telecenter.

The second pilot telecenter, in the much smaller city of Gujar Khan (in the Rawalpindi District in Punjab), functions around the clock. Here, each patient’s vitals are taken at the telecenter, then fed into tele-diagnostic software, after which, each patient can discuss his/her ailments virtually with a doctor sitting about 30 miles away in Ahmed Medical Complex – Holy Family Hospital’s partner hospital.

Overall, the patients’ response has exceeded the TeleSehat team’s expectations.

“Imagine a person who has to travel every month from Skardu [a town in Baltistan] to Islamabad [the capital] with her mother for her mother’s monthly check-up at Shifa Hospital Islamabad,” explains TeleSehat’s Malik. “Her monthly expense, including airfare, doctor’s fee, accommodation, food and local traveling costs, is more than PKR 25,000 per visit including the traveling and stay time.”

Malik also notes that in many of these remote regions the number of “quack doctors” outweighs the number of good, genuine doctors.

Challenges to implementation

One obstacle the pilots have had to confront is the patients’ discomfort with a virtual doctor. Initially, the patients were apprehensive about consulting a new doctor instead of a trusted family doctor. In addition, a virtual medical check-up made the patients uneasy and dubious about the diagnosis. Could it work?

The concept was too new for these patients. To increase the public’s comfort level with distance medicine, TeleSehat initiated a marketing campaign in which free medical camps were set up in certain spots within the villages. The campaign also included telemedicine demonstrations at homes and schools, among other locations.

Perhaps the biggest challenge facing TeleSehat is the lack of availability of broadband Internet in many of Pakistan’s remotest areas. Malik describes the Internet access as the lynchpin of the telemedicine model.

“Bandwidth is one variable without which this whole solution is not at all workable,” says Malik. “To resolve this issue we have geared up the software solution to get accommodated in either broadband DSL, fiber, wireless or GPRS options. In addition we are also in negotiations with satellite Internet service providers to develop a low-cost package to enable TeleSehat to take this service to the remotest corners of Pakistan.”

Plans for expansion

Two months ago, TeleSehat joined forces with Shifa International Hospital as a “TeleHealthCare Solution” partner. Under this agreement they have to establish three centers in Skardu, Ghance and Astore in the remote Gilgit-Baltistan province.

“So far the set-up has been deployed at Skardu and Ghance whereas Astore shall be completed in another two weeks,” reports Malik. “Services have commenced at the Skardu site and we have over 50 patients so far who have had consultations with doctors sitting at Shifa International Hospital in Islamabad.”

In addition to the Gilgit-Baltistan sites, three more sites are planned to open in November in Faisalabad, PWD Colony Rawalpindi and Mirpur (AJK).

Interestingly, Malik also mentions that Shifa has approved to link its central doctor pool with a local hospital in Kabul, Afghanistan. “This site shall be deployed by mid-December, 2011. The most important aspect of our working relationship with Shifa is the establishment of central doctor pool. Having this as our major strength, deploying sites in various remote areas is not an issue anymore.”
For the future, TeleSehat also hopes to launch telemedicine services in underserved urban areas.

The author would like to thank Bilal Farooq and Syed Zahoor Hassan at the Lahore University of Management Sciences (LUMS) for access to their case study on TeleSehat and their valuable contribution towards this article.

Some images courtesy of Bilal Farooq.

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