The geographical nature of the Philippines with 7,107 islands and over 1,400 municipalities makes health care delivery in the country challenging. While the deployment of Doctors-to-the-Barrios (DttB) to Geographically Isolated and Disadvantaged Areas (GIDA) have helped ease this problem, a fraction of medical cases that DttBs attend to in their health units still require the expertise of clinical specialists who hardly reach these areas.

These problems are slowly addressed by telemedicine. As defined by the World Medical Association, “Telemedicine is the practice of medicine over a distance, in which interventions, diagnostic and treatment decisions and recommendations are based on data, documents and other information transmitted through telecommunication system.” With the aid of ICTs, (Information and Communications Technology), DttBs in the country are connected with clinical specialist which allows medical referrals 24/7, more resources efficiently used and most importantly, more lives saved.

Since 2007, the University of the Philippines Manila National Telehealth Center (UPM-NTHC) has been supporting Doctors to the Barrios (DTTBs) and Municipal Health Officers (MHOs) through the use of eMail and SMS based Telemedicine.

When a remote doctor encounters a client with complicated case, the primary care physician easily consults a clinical specialist by sending an SMS (short messaging service) or eMail to NTHC. NTHC forwards the telerefral to appropriate clinical specialists based in the Philippine General Hospital. The clinical specialist, in turn, sends his expert opinion to NTHC, which is forwarded to the remote doctor. These technologies became available through freely available softwares like FrontlineSMS and iPath, for SMS and eMail referrals respectively.

Since October 2007, a total of 1,768 tele-consultations have been facilitated by the National Telehealth Center. These were sent by over 200 remote doctors from all over the country – as far as Batanes to Tawi-Tawi.

Recent analysis of the telereferrals revealed the following statistics (see chart below)

• Most of the telereferrals are sent via SMS (87%), while (13%) are sent via Email.
•  When telereferralsare sent via SMS, information needs of referring physicians are directed to Case Management (53%). When sent via eMail, information needs are directed towards Diagnosis (53%).
•  43% of the SMS telereferrals have been responded to by the domain experts within 15 minutes. 48% of eMail telereferrals were answered within 48 hours.
•  The most frequent specializations utilized were Internal Medicine (26%), Pediatrics (20%), Obstetrics and Gynecology (11%) and Radiology (10%).
•  The remaining percentages include General Health Information Inquiries (9%), Dermatology (7%), Surgery (7%), Medico-legal (3%), ECG readings (3%),  Ophthalmology (3%) and lastly Psychiatry (1%) and ORL (1%).

Being the only doctor in a remote island can be a real challenge. There is often a lack of various resources needed to support medical management and travel to tertiary hospitals can be very expensive and risky for the client. By connecting these primary care physicians to the clinical specialists of PGH, they are able to bring forth expert clinical decisions and provide better patient intervention.

 “Very useful bcoz i trust the source, it is relevant, applicable, it provides resources that answer [1] s0me of my needs even though i did n0t request for these. Pr0mpt en0ugh. The waiting tym is reas0nable for pxs. Helpful bcoz it helps me better d way i do my work” -Looc, Occidental Mindoro

“Usefulness: Very useful to us dttbs esp those in remote areas where net access aren’t that gud. Promptness: Responses r readily sent so mgmt is not compromised. Helpfulness: Very helpful since its jst a txt away and pxs are then quickly managed.” -Agutaya, Palawan

“No comment just want to say it is very helpful , informative on bulletine recived and great help financially for patient no longer need to travel for further evaluation or opinion . Thank you very much and more power” – Jovellar, Albay

“It serves as a big help for us, especially in emergency cases. We felt we’re not alone. Thank you very much!” -Pilar, Abra

Itbayat: Nearer to Taiwan than Manila

Manila, Philippines – JBV, a typical 7 year-old boy attending his grade school never imagined that he will be able to smile differently.  From Itbayat, a municipality in the northernmost island of the Philippines in the province of the Batanes, he was born with a Complete Cleft Lip and and Palate.  Several years ago, the parents of this child flew to the City of Manila several times for his operation but never became successful due to operation clearance hindrances.  But through the use of an off-the-shelf videoconferencing software, the patient and the otorhinolaryngologist were able to meet and evaluate the case, and the patient was cleared for surgery.
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