Teleradiology in Pakistan copes with bandwidth, computer literacy problems

Establishing a teleradiology network in the Third World is different from the First World. Critical communication infrastructure components such as cable, DSL, or fiberoptic networks may be scarce commodities in developing areas.

One issue facing a new teleradiology project in Pakistan is low bandwidth, said Dr. Osama Ishtiaq, who administers a medical Web site called TelMedPak based in Islamabad.

Established in April 1998 with the help of physicians and students of Rawalpindi Medical College, TelMedPak is designed to improve health services for rural residents and reduce the isolation of rural practitioners through the use of telemedicine technologies. The site also provides a large database of information to doctors and medical students.

A teleradiology component has recently been added.

Until more adequate resources can be recruited, digital images are being transferred using simple e-mail store/forward technology.

The teleradiology process is being tested on low-bandwidth systems with dial-up Internet access, which is correspondingly slow. Nevertheless, tests involving the transfer of digital images have been successful.

"Case histories, including diagnostic images such as x-rays and CT scans, were sent through the Internet from Gilgit to Islamabad, where our panel of consultants gave their expert advice," Ishtiaq said.

Many rural physicians lack computer expertise. Informatics gets little emphasis in Third World medical curricula.

In some areas, hospitals are in such disrepair the sick are crowded into corridors and the availability of medical supplies is erratic. In these situations, IT infrastructure may be the least of anyone's worries, no matter how obvious its importance.

One development that may help the computer literacy questions is the opening of Pakistan's first healthcare informatics-related school, the Institute of Health Informatics (IHI). It was established last year in Karachi by a private firm called ProtoMed Consultations.

The IHI offers a certificate, diploma, and two-year degree program covering, among other topics, the role of IT in contemporary healthcare management, telemedicine, and advanced informatics.