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From Cambridge to Cambodia: Experience with a telemedicine project in the developing world

Learn about the experience of a telemedicine project in the developing world, focusing on health, education, and economic stability. Explore the impact on the village of Robib and the challenges faced in providing remote healthcare.

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From Cambridge to Cambodia: Experience with a telemedicine project in the developing world

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  1. From Cambridge to Cambodia:Experience with a telemedicine project in the developing world Joseph C. Kvedar, MD Director, Partners Telemedicine Vice Chair, Department of Dermatology Harvard Medical School

  2. www.villageleap.com

  3. Three Components of Development • Health • Education • Economic stability

  4. Snapshot of Robib • Population, 900 • Per capita income, $40/year • With the web site Villageleap.com, villagers have made over $6,000 in ~1 year, selling crafts via e commerce.

  5. Village Leap Project • Individual donor funded schools • Each equipped with a solar panel • 60 complete • 70 planned • At present, only one has Internet connectivity

  6. Telemedicine in Robib • Simple store and forward email solution. • Evolved from the posting of general health questions to specific case presentations. • Nurse from Pnom Penh travels monthly. • Information includes history, nurses PE and some digital images.

  7. Work Flow Boston Robib Pnom Penh

  8. Case Mix • Cardiovascular 8 • Endocrine 5 • Musculoskelatal 4 • Pulmonary 2 • Infectious diseases 2 • Eye 2 • Others (DERM, GI, GU, GYN) 5 • Total 28

  9. Chief complaint: mother says child has mild fever and dry cough since birth • Abdominal distension observed • pulse 145, resp. 40, temp. 37.9, 5 KG • Lungs crackle all lobes, heart normal but tachycardia, abdomen is tender, Positive hepatosplenomegaly, positive bowel sound, skin mild pale

  10. The most likely diagnosis is peripheral neuropathy due to uncontrolled diabetes. Better glucose control with insulin or oral agents has been associated with less neuropathy. Unlikely to reverse the symptoms but better control may prevent worsening. An EMG and NCS would be most definitive in establishing the diagnosis. Infrequently a demyelinating component can be seen which responds to IV gammaglobulins. Patient #1: Som Tol, male, 48 years old Chief complaint: Feel burning on both soles and palms, palpitation, frequency of urination, blurred vision. Last 6 months chest pain. BP: 100/60 Pulse: 104 Resp.: 20 Temp. : 37.0 Past history: not significant Lungs: clear both sides Heart: regular rhythm, no murmur Abdomen: soft, flat, not tender Bowel sound: positive Skin: warm to touch, no edema Limbs: numbness and feel burning in all limbs Urinalysis: Glucose: ++++, Ketone: +, Protein: +

  11. Concerns/next steps • Incomplete medical data • Easy to capture more data • System to implement advice needs thought • Supplies • Human resources • Local expertise

  12. Contributors (incomplete list) • Partners Telemedicine • Kathleen Kelleher, Remote Consultation Coordinator • Countless physicians • Sihanouk Hospital Center for Hope • Graham Gumley, MD • Maetha, RN • Project Villageleap • Bernie Krisher • David Robertson

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