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Telehealth in the Developing World is a very wide-ranging book, rich in practical experience, which will be of interest both to those who want to learn about the developing world and to those who want to learn from developing countries. It is full of real-life stories. Telemedicine, rightly in my view, is seen as central to the improvement of health and life in developing countries. Much has been said and written about telemedicine and its potential to transform life, but these are still early days. A great deal of what has been written and said has been theoretical. This book reflects the reality.

All the projects described here have been driven by people of vision and passion. All have had to confront the problems of the real world, whether these have been the realities of desperate poverty or the, equally real, obstacles of clinical, technical and governmental politics. All the pioneers have been on journeys of discovery, working out how to be effective in the particular environment where they are operating. Who can fail to be impressed by the Swinfen Charitable Trust and its journey? It has pioneered the use of the simplest of modern electronic technology to ensure that people working in isolation in poor countries can benefit from the opinions of specialists in the richest countries.

Other impressive pioneering work in particular specialities – such as teledermatology, telepaediatrics, telepathology, telepsychiatry and e-mental health – is described here. There are also descriptions of progress in developing countries, such as China, Pakistan, Chechnya and Ecuador, as well as accounts of linking with Italian expatriates and cross-cultural experiences between the USA and Cambodia.

Importantly, these accounts show how telemedicine enables professionals to be put in touch with other professionals. Individual clinicians in remote areas are able to tap into advice from their peers and, very motivationally, to feel part of their profession and of an international group of colleagues. This by-product of telemedicine must not be underestimated. It has sustained human beings when other resources have failed.

Underpinning all this are accounts of public and technical policy that attempt to answer the question of how the enthusiasm of the pioneers can be turned into sustainable mainstream activity. This is, of course, the vital question.

Health care, as we know, is primarily about people-to-people interactions. It is about understanding, diagnosis, physical contact, communication and, ultimately, providing care. All of this is facilitated by the technical processes of imaging, pathological testing, information gathering, research and so forth. The task for every health care system is how to maximize the personal contact at the same time as maximizing the technical input, while all the time operating within a sustainable financial framework.

People working in developing countries have had to think about this task with even more urgency than those of us working in richer countries. They have had to think about how to obtain an expert opinion in remote places, how to support local clinicians who may not have all the skills they need, how to make sure technical information is interpreted wisely in very difficult circumstances and how best to use very scarce resources. Telemedicine offers help in meeting these conflicting needs by improving access to data and to individuals, while driving down the costs of doing so.

We in the developed world have large and industrialized health systems that grow costlier by the day as we absorb new technologies. At some point, as costs and demand both rise, we too will need to learn some of the lessons that our colleagues are learning in Africa, South America and Asia. The pioneers in this book are learning lessons for developing countries. They are learning lessons for us all.

Document(s) 1 of 31