An evaluation of the first year's experience with a low-cost telemedicine link in Bangladesh

In July 1999, the Swinfen Charitable Trust in the UK established a telemedi cine link in Bangladesh, between the Centre for the Rehabilitation of the P aralysed (CRP) in Dhaka and medical consultants abroad. This low-cost telem edicine system used a digital camera to capture still images, which were th en transmitted by email. During the first 12 months, 27 telemedicine referr als were made. The following specialties were consulted: neurology (44%), o rthopaedics (40%), rheumatology (8%), nephrology (4%) and paediatrics (4%). Initial email replies were received at the CRP within a day of referral in 70% of cases and within thee days in 100%, which shows that store-and-forw ard telemedicine can be both fast and reliable. Telemedicine consultation w as complete within three days in 14 cases (52%) and within three weeks in 2 4 cases (89%). Referral was judged to be beneficial in 24 cases (89%), the benefits including establishment of the diagnosis, the provision of reassur ance to the patient and referring doctor, and a change of management. Four patients (15% of the total) and their families were spared the considerable expense and unnecessary stress of travelling abroad for a second opinion, and the savings from this alone outweighed the set-up and running costs in Bangladesh. The latter are limited to an email account with an Internet ser vice provider and the local-rate telephone call charges from the CRP. This successful telemedicine system is a model for further telemedicine projects in the developing world.