This is a personal “From the Field” story by Direct Relief Employee Mat Maccalla.
I went to southern India to visit a hospital that was using a telemedicine van that Direct Relief International had bought for them. Recently there had been an international conference about the van put on by the United Nations and the Indian Space and Research Organization, and I was going to see the van for myself. While I was there, however, I heard of something perhaps even more impressive: a miracle that was about to happen near to where I was. Just a few days ago, on January 14, as it does every year, the miracle occurred—at least that’s what thousands of Hindu Indians who witnessed the miracle from high atop Mount Sabarimala will tell you.
For many weeks now, spiritual devotees have been making their way from all over India and all over the world, to reach Mount Sabarimala, the eternal dwelling place of the Hindu Lord Ayyappa. And far below the peaks of the divine mountain and its Hindu Shrine, at its base camp in Pampa, in what could perhaps be called a perfect paradox between religion and science, faith and reason, stands a fully functional telemedicine van, outfitted with the most high-tech bio-medical equipment on the market—the same one that I had now traveled half-way across India to see.
Located in the southwestern-most state of Kerala, 400 kilometers from the coastal city of Cochin, Mount Sabarimala (‘mala’ meaning mountain), is visited each year by tens, if not hundreds of thousands of devoted worshipers, some of whom make the trip a yearly sacrifice. They come to celebrate, pay their respect to, and worship Lord Ayyappan, a Hindu symbol of religious unity and communal harmony. Most of the last part of the journey is undertaken on foot, and many walk for days on end to reach this sacred place. In order to participate in this ceremony, pilgrims must fast for 41 days, and are not permitted liquor, tobacco or sexual relations.
The only complaint that I’ve heard made about the experience is that injuries and illness are a fairly common occurrence along the path. Which makes sense, when one takes into account the fact that there are countless thousands of people, walking long distances in unpredictable weather over rough, rural and wild terrain with animals and sickness hiding in every corner. One example of the dangers involved occurred just a few years back, when so many people had jammed their way onto a hillside that the hill collapsed, killing a large number of people.
But what is there to do when the mountain is so far from any form of health care? Bring the doctors to the pilgrims, says Dr. Kumara Menon, who is the telemedicine director at AIMS Hospital in Cochin, Kerala. The Amrita Institute of Medical Sciences and Research Center (AIMS) is a multi-specialty, charitable, non-profit medical center that provides healthcare services to thousands of low-income and indigent patients. The 800-bed facility was established in 1998, and has already treated tens of thousands of inpatients and hundreds of thousands of outpatients. The hospital also runs half a dozen educational programs and medical universities. Beyond their on-site activities, however, AIMS is perhaps better known for their free or low-cost community-based health programs, medical outreach camps, health awareness campaigns, and other services provided to people living in remote areas throughout the state.
Another example of their service is evidenced by their response to the tragic effects of the tsunami that devastated much of Kerala State’s coast. Immediately thereafter, AIMS deployed teams of medical personnel and ambulances to the hardest hit coastal areas in Kerala and its neighboring state of Tamil Nadu. Numerous medical camps were quickly set up and free services were given to tens of thousands of tsunami survivors. Those that needed additional treatment were transported back to AIMS or to other local hospitals.
Unfortunately, the medical directors at AIMS still faced problems: they realized that temporary camps were only able to provide so much care; some cases were difficult, if not impossible to treat at the camps without more advanced equipment or specialists; and other, even more remote places, were still not receiving any health care services. But they had an idea.
If they had a telemedicine van that was able to move amongst the camps as well as travel to the more remote areas where camps had not been established, they would be able to improve their services and increase the number of patients they could treat. “Telemedicine” means using satellites and internet technology to send and receive data from a more rural site to a more sophisticated hospital. There, experts and specialists stationed at the hospitals who could otherwise not help or advise patients, are able to be of service to them. Utilizing telemedicine, patients—regardless of where they are—can be ‘seen’ by doctors at the AIMS hospital, diagnosed, and treated on site, or can be transported back to the AIMS hospital to be given more advanced care.
Having worked with Direct Relief in the past, and having just received from them a huge amount of supplies, medicine and relief immediately after the tsunami, AIMS thought of asking Direct Relief for help and support in their project. Prior to their request to Direct Relief, AIMS had already received a commitment for a portable satellite link from the Indian Space Research Organization (ISRO), which is the rough equivalent to NASA in the United States. Because AIMS proved that they had the technical capabilities to handle the project, and had proven their dedication to service based on their work before and after the tsunami, Direct Relief agreed to fund the project. Shortly thereafter, the fully-functional telemedicine van was in operation, equipped with general diagnostic supplies, an X-ray, a lab, as well as endoscopy, cardiac and ophthalmic equipment, not to mention the ISRO satellite.
When I visited AIMS hospital in early January 2007, the tsunami was two years in the past, and much of the physical injuries and suffering had thankfully ended. As I arrived at the hospital, they at first appeared very apologetic, and I immediately assumed the worst. Luckily, I soon surmised that they were apologizing that the van was not at the hospital, and thus I was unable to see it firsthand. I, on the other hand, was thrilled that it was not at the hospital, because it presented proof that it was out working as intended.
“Where is it?” I inquired. “Glad you asked”, they replied. They then asked me to follow them, as a patient had just entered the van, and they wanted me to witness the consultation between a doctor at the hospital and the doctor in the van. Up the stairs in the hospital’s beautiful, cylindrical main building, we came to a small, white door. Inside was a massive wide-screen TV, computers, cameras, a sound system, a couch and two reclining chairs. This was not an entertainment room, but instead the main center for telemedicine conferencing. And there, on the TV screen, was the patient, wearing the same traditional outfit that I had seen a hundred others wearing earlier in the day. As I was driving to the hospital, I saw many pilgrims as they walked along the road on their way to Mount Sabarimala. Now, one had made it to its base camp, but something had gone wrong. Luckily for him, that is also where the tele-medicine van had been sent.
I quickly learned that this traveler had been bitten by a snake as he ambled, barefoot, in the grass. His heart rate was irregular, and the doctor in the telemedicine van at the base of the mountain was unsure how to diagnose the problem. Over the computer screen came digital photos of the bite and real-time EKG heart monitoring that were sent by satellite from the van. In addition there was video and audio that Dr. Kumar, who I was with, used to see and talk to the patient and the other doctor in the van. I was amazed at the clarity of the video and that the information was being seen at both locations simultaneously. My only problem was that I couldn’t understand the language being spoken.
More interesting than my own amazement, however, is the long list of others who have been amazed at this van. A few months back, the United Nations, in coordination with ISRO, sponsored a conference at the AIMS medical campus, specifically to talk about the van. As it is the first of its kind in India, and was so unique in the world, and has performed so successfully, the UN was interested in learning more about it, as they were toying with the idea of utilizing the same technology in Afghanistan.
At another event I was attending a few days earlier on the Andaman and Nicobar Islands to commemorate the second anniversary of the Asian Tsunami, I was on stage sitting next to Mr. M. Shashidhar Reddy, who is a member of the national disaster management authority in New Delhi. As we were chatting about other international programs designed at preventing and reacting to natural disasters, he mentioned his desire to see more mobile tele-medicine being used throughout India, and said that the program in Cochin was a good example of the system he would like to see used more.
Additionally, just before I arrived at AIMS hospital, another group of visitors arrived to take a look at the van and learn more about it. This group was from National Geographic, and they had come to document and record a special program for National Geographic about the van.
It seems in the end, that the Direct Relief funded telemedicine van has been a success, and hopefully it will be the forbearer of more technology like it to come. And, even though I was not able to see the van in person to verify its capabilities, I was able to experience it through the miracle of modern science and technology. Now, if only I could figure out a way to experience that other miracle that was occurring on the mountaintop, high above the van…