Dr' Mohammad Ali Malik

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Project Hope Telemedical Linkage between
District and Teaching Hospitals in Sind.

• Dr. Mohammad Ali Malik
• Jinnah Postgraduate Medical Centre
• Karachi, Pakistan.

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Pakistan Geography, Demographics andHealth
Scenario
Total area (803,940 sq km)Population (2006
est.) 165,830,560 (growth rate 2.01 about 60
population is ruralPopulation density per sq
mi551 (asymmetric spread)Basic Health
UnitTehsil Heath UnitTalqa Hospital District
Health UnitTertiary HospitalNo of Doctors
128,.000No of Specialist 18,500Distribution
uneven
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Table of Contents

• Telemedicine an Hope
• History of Telemedicine in Pakistan/Sindh
• Network
• Sites
• Connectivity/Communication
• Infrastructure
• Technical Facilities
• Method Adopted
• Project Management
• Sources/Progress of TM
• Future of Telemedicine

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Telemedicine an Hope

• Telemedicine projects are meant to assist the
  government in Transforming delivery of healthcare
  services and making them available at the
  door-steps of common man, through the use of
  information and communicating technology as a
  solution. The project proposed with the objective
  to provide people lining in rural,. Remote areas
  of Pakistan. By consultation, advice and
  treatment form specialist doctors based in urban
  center hospitals, through Tele-Diagnosis/Consultat
  ion and Tele-Treatment.

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History of Telemedicine in Pakistan/Sindh

• Initiative of Telemedicine in Pakistan
• The concept introduced by NGOs as a partners in
  local hospitals.
• To expend healthcare in rural/remote area
  government focused on Telemedicine in year 2000.
• In commencement store and forward system applied
  
• On availability of multiple sources of bandwidth
  including national satllite the Ministry of IT
  interest started in 2005.
• At moment Pakistan is conducting Telemedicine via
  satllite as wall as landline (ISDN BRI)
• In Sindh pilot project launched in 31st April
  2005 with collaboration of Sindh Government,
  Engro Chemical. Under the chairmanship of Prof.
  Rashid Jooma head of Neurosurgery JPMC Karachi at
  present DG Health Islamabad Pakistan.

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Network

• PAKSAT HealthNET
• Sites PAKSAT HealthNET is designed as a pilot
  project has infrastructure linking three urban
  hospitals with twelve hospitals in rural/remote
  areas.
• Number of rural sites are covered in each
  province under this project are as follows
• Sindh (JPMC)
• Shikarpur, Gambat, Jacobabad, Mithi
• Punjab I (Holy Family Rawlapindi)
• Attock, Khoshab, D.G Khan Pindigheb
• Punjab 2 (Meo Hospital Lahore)
• Jhang, Gujrat, Sahiwal Rajanpur

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Technical Facilities
Holy Family Hospital Rawalpindi
1- D.G. Khan 2- Pindi Gheb 3- Attock 4-Khushab
1- Sahiwal 2- Rajanpur 3- Jhang 4- Gujrat 1-
Mithi 2- Jacoabad 3- Shikarpur 4- Gambat
Holy Family Hospital Rawalpindi
Mayo Hospital Lahore
Mayo Hospital Lahore
Jinnah Hospital Karachi
Jinnah Hospital Karachi
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3070 Divide
70 Rural Area
















30 Urban Area






Majority of the population without health
services
Concentrated
Healthcare
Resources


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Connectivity/Communication Sindh

• JPMC as a Hub is connected with referral spokes
  by PakSAT 1 ku band
• Landline ISDN BRI

• 4 spokes are connected by PakSAT connectivity
  like Jacobabad, Shikarpur, Gambat, Mithi
• Rest 4 are on ISDN BRI line like Ghotki,
  Mirpurkhas, Sanghar Shadadpur
• 512 kbps full duplex data connectivity being
  provided between Hub Remotes.
• PakSAT bandwidth offering by Ministry of
  Information Technology services free of coast
  for all 4 spokes

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HUB
First Telemedicine Pilot Project For Sindh on
Internet
Telemedicine Center Jinnah Post Medical Center
Karachi (JPMC)
Internet
Spoke 01
Spoke 02
Telemedicine Referral Unit District Headquarter
Hospital Shikarpur (DHQHS)
Telemedicine Referral Unit Gambat Institute of
Medical Sciences (GIMS)
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• Ranking of
• Sindh District

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Hub with Referral Units
Shikarpur June 2005 Gimbat
June 2005 Jacobabad
June 2006 Ghotki June
2006 Mirpur Khas July 2006 Sanghar
February 2007 Shahdadpur
February 2007 Mithi
January 2008
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Technical Facilities Hub/Sites

• Sites

• Hub

• TM software for database of Patients
• Digital ECG Machine
• Digital stethoscope
• Compaq video Otoscope
• Digital Camera
• X-ray scanner
• High Defination Video conference equipment
  (Router, Pollycom cameras VSX 7000, LCD Screen
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• ISDN lines linking sites

• Server Dell PowerEdge 2950
• Desktop computer Dell Core Duel Intel R
• TM software for database of Patients
• Digital ECG Machine
• Digital stethoscope
• Compaq video Otoscope
• Digital Camera
• X-ray scanner
• High Definition Video conference equipment
  (Router, Pollycom cameras VSX 7000, LCD Screen
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• ISDN lines linking sites

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In telemedicine, information moves rather than
the patient
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Video conference between Hub and referral spoke
Prof. Rashid Jooma
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1st Referral spoke Shikarpur
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Referral Connectivity
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Regular Consultant forVideo Conference

• Medicine Prof. Muneer Ahmed
• Dr. Qurban Sheikh
• Dr. Kirpal Das
  Makheja
• Dermatology Prof. Azam Samdani
• Dr. Nadeem Ahmed
• Dr. Samira Rizwan
• Dr. Sobia Liaquat
• Neuro Medicine Dr. Shaukat Ali
• Dr. Khalid Sher
• Dr. Santosh Kumar
• Epilepsy Dr. Fozia Siddiqui
• Pediatric Prof. Zeenat Essani
• Prof. Afroz Ramzan
• Prof. Abdul Ghaffar Nagi

Gynae Obst. Dr. Razia Kirojo Dr. Haleema
Dr. Pakeeza Chest Medicine Dr. Nasir
Hussain Psychiatry Dr. Iqbal Afridi Neuro
Surgery Prof. Rashid Jooma Dr. Sattar
Hashim Nephrology Dr. Manohar Lal Dr. Manan
Juneju Dr. Kaneez Zehra
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Total Numbers of Patient, 2005 to2007
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Dermatology

Dermatology
6000
5200
4500
4000
3500
3000
2500
2100
Dermatology
2000
1500
1000
500
25
0
2005
2006
2007
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Medicine
Medicine
1400
1230
1200
1000
800
Medicine
600
580
400
200
13
0
2005
2006
2007
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Neurology
Neurology
600
488
500
400
300
200
97
100
8
0
2005
2006
2007
25
Pediatric
Paeds
400
339
300
250
200
150
100
74
35
50
0
2005
2006
2007
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TELEMEDICINE CENTRE,JPMC. NUMBER OF PATIENTS
JAN TO DEC 2007
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Referred case from spoke to tertiary hospital
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Achievement
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Project Management
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Future plan TelemedicineSindh Province
Sub Hub NAWABSHAH Kandyaro Now Shero
Feroz Sakrand Moro JAMSHORO Dado Sehwan Umerkot B
adin LARAKANA Shahdadkot Now Dero Rato Dero Dokri
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CME
Prof. Elahi Bux Soomro HOD, Medicine, Civil
Hospital, Karachi. Prof. Zeent Essani
Ex. Director, NICH Prof. Muneer Ahmed HOD,
Medicine, JPMC Dr. Waqaruddin Ahmed
PMRC Dr. Asghar Channa Deptt of
Surgery Dr. Ahmed Usman Deptt. Of
Dr. Rizwan Memon L.N.H Dr. Azam
Shafquat NICVD Dr. Huma Qurashi
PMRC
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Major Achievements through Telemedicine

• Teleconsultation
• Bridging the gap between highly  trained
  healthcare
• providers and patients local healthcare
  providers
• CME
• By educating the physicians at the spokes in
  remote
• areas raising their level of competence
  expertise
• allowing them to provide healthcare services at a
  
• better level than before.

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Conclusion

• Telemedicine holds an exciting promise of
  improving healthcare in lesser developed medical
  systems by linking outlying and referral centers
  in a network of information flow directed to
  enhanced service provision to the patient and
  continuing education for the physician.