TELEMEDICINE IN DEVELOPING COUNTRIES and TURKISH NATIONAL TELEMEDICINE PROJECT

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1 TELEMEDICINE IN DEVELOPING COUNTRIES and TURKISH NATIONAL TELEMEDICINE PROJECT Prof. Cavit AVCI Istanbul University, Continuing Medical Education and Research Center-ISTEM, TURKEY TELEMEDİCİNE IN DEVELOPING COUNTRIES Telemedicine can be an effective tool in the search for solutions to general problems encountered in the health system and medical education in developing countries. Medical schools, educational centers and specialists are not distributed homogenously within the land of these developing countries; but usually condensed in certain wealth and land of these developing attractive areas. Hence, people living far from these certain areas can not take advantage of these high quality health services. Therefore, common and general problems of the developing countries in this issue are: - Disequilibrium of the distribution of qualified health services by means of geography and demography. - Poor people who live in rural areas can not benefit from the qualified health services unlike rich people who live in wealthy areas. Telemedicine can partially solve the problem of this disequilibrium in the distribution of health services, which is a common problem of developing countries. Because a connection between health centers which are of poor quality in the rural areas and of high qualtiy in wealthy areas, Telemedicine can help people who are unable to reach these centers due to economic and social reasons, to access the same quality health services at least partially. There are unfortunately some problems in achieving to these theoritical solutions. - Telecommunication systems which constitute the backbone of Telemedicine, are expensive for developing countries, which already have economic problems. - Difficulty of persuading the specialists who have to adapt to this new system and new technology. - Bureaucracy

2 It is a difficult and time consuming practice for developing countries to solve these problems. Therefore international organizations in which developed countries have effective memberships regarding Telemedicine, have to make serious plans and programs in order to start Telemedicine in developing countries at once. It should be noted that there is a widening gap between the health services in the developed, developing and undeveloped countries even now. It is recognised that Telemedicine, which is a very important technological advancement, is spreading rapidly and easily in developed countries which have high economic standards, but this is slow and difficult to achieve in countries with economic problems. But, regarding theorotical expectations, Telemedicine is very important in developing countries, and may be even more important than it is in others. If adequate measurements regarding ever spreading Telemedicine, are not taken or they are postponed, the gap in health services between the countries and people continue to widen. This would be a shame for the human generation heading for a global world. Conclusion -Telemedicine which brings a new dimension to medical education and health services, is an important feature. - Telemedicine needs an expensive and high level technological background, and complex organization - Telemedicine can supply many benefits to developing countries regarding its advantages. It can be partially helpful in maintaining a fair distribution of health services, instead of economical and geographical difficulties. - Telemedicine tends to spread faster in developed countries. - Although it is more necessary and more effective in establishing a balanced distribution of health services in developing countries, Telemedicine is spreading slowly because of some certain difficulties. - If measures are not taken by developed countries and concerned international associations, the gap of health services between developed and developing countries will widen, further and will not be easy to close in the future.

3 As an Example of Developing Countries NATIONAL TELEMEDICINE PROJECT IN TURKEY ( PROJECTS OF ISTANBUL UNIVERSITY-ISTEM ) TURKEY is a large country located between Europe, Black see and Asia with a rooted history and a population of 73 million people living on an area of app sq km. It is a developing country and a candidate member of European Union. Almost half of the population of the country live in big cities whilst the other half live in rural areas. Nearly all well-equipped hospitals are located in big cities, the same situation counts for medical specialists (doctors, dentists, nurses etc.) as well Turkey currently has 31 thousand 978 general practitioners, 58 thousand 258 specialists and 20 thousand 975 residents. The total number of doctors is 111,211. The number of medical schools reached 74. Turkey is divided into 7 geographical regions. Wealthy cities in Marmara, Ege and the Mediterranean coasts have higher population and social facilities. Since the weather and social conditions are less attractive in Eastern and South Eastern parts of Turkey, the population is lower. Turkey is an example of a developing country with an irregular distribution of population. Although the area is large, cities are usually located irregularly with respect to differences of socio-economic and geographical aspects. Parallel to population differences, there also exists a dıfference ın the dıstrıbutıon of specıalısts. The difference in distribution of specialists, hospitals and well equipped centers between the regions due to these socio-economic and geographical aspects, should be noted. In the light of this argument; Telemedıcıne that would be realızed ın Turkey, ıs expected to supply ımportant benefıts. With this objective Natıonal Telemedıcıne Project has been started under the leadership of University of İstanbul which is the oldest institution in Turkey. The project has 3 phases : FIRST PHASE: The first Telemedicine practices have been accomplished between two medical faculties of İstanbul University (Capa and Cerrahpasa) with radio-link & ISDN lines since Later: To expand the radio-link & ISDN lines and include 14 educational hospitals in Telemedicine applications.. Simultaneously: To connect to European countries and others with ISDN lines, internet, Satellite etc and to organize common Telemedicine applications.

4 SECOND PHASE: To connect the Medical Faculties and major Educational Hospitals in different parts of Turkey, to the center in Istanbul. Hence, to involve these centers in Telemedicine and its applications. LAST PHASE: To facilitate every hospital in Turkey (including the ones in Eastern and Southeastern Turkey, medical centers, individual doctors ) connecting in an adequate way to National Telemedicine System, and help everyone to use. In order to reach this phase, it is expected ; - To acquire experience during the previous phases - To familiriaze and adapt doctors, medical authorities and users to the system - To persuade the authorities and institutes which will provide the financial and technological facilities of the benefits and profitability of the system and make it possible to spread the system - To utilize today s technology of audio-visual telecommunication facilities (ISDN, ınternet, satellıtes etc), and to make it cheaper, widespread and easy to achieve ISTEM (Istanbul University, Continuing Medical Education and Research Center) established a Tele-education and Telementoring Network that linked some national and international remote hospitals with the Istanbul University.

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