The Markle Clinic in Ratankiri Province uses an Internet link, transmitted via a dedicated satellite dish donated by Shin Satellite of Thailand, to send and receive e-mail text and images. A nurse from the Sihanouk Hospital Center of Hope visits the Markle clinic once a month for a four-day stay, during which he examines and photographs patients and measures their vital statistics. The resulting report is e-mailed to doctors at both the Sihanouk Hospital Center of Hope and Partners Telemedicine, who collaborate with doctors in Ratanakiri on making a diagnosis and developing a course of treatment. Patients are encouraged to return for follow up telemedicine check-ups as necessary.
The Markle clinic and the American Assistance for Cambodia (AAfC) schools in its region are part of an innovative initiative that cost-effectively extends the reach of the Internet via a wi-fi network. Within Ratanakiri Province, poor roads and distance isolate villages. While it would be prohibitively costly to dedicate satellite dishes to individual villages in this area, or to create a wire-based network among them, they are now being linked to each other and to the Internet wirelessly via a mobile send-and-receive system. Twice a day, one of a small fleet of motorcycles is driven past each of 14 computer-equipped schools and the satellite hub, the Markle Telemedicine Clinic.
Each motorcycle is outfitted with a wireless antenna and a data storage box. As it drives past a school, the motorcycle can transmit e-mails and information from web sites. This mechanism allows people to send e-mail and effectively surf the web in a time-delayed fashion. The schools, in addition to the clinic, are becoming community hubs from which villagers can send and receive questions and information about their personal health, regardless of whether they are able to travel to the Markle clinic, as well as communication on other topics. This so called “Motoman” initiative was designed by the Cambridge, Massachusetts-based firm First Mile Solutions in association with AAfC.
The Markle clinic was established within a regional referral hospital, rather than as a freestanding building or in association with a smaller health center. This arrangement enables the Markle clinic to benefit from the hospital’s facilities and professional staff, and also saved money on construction. As a result of the clinic’s link to the regional hospital, telemedicine staff is able to acquire and e-mail laboratory data, x-rays, and ultrasound images in addition to descriptive text messages and digital photos.
Many patients reported that they had been “satisfied” with their experience at the clinic. In addition, they expressed their willingness to pay for telemedicine consultations in the future—the majority of patients indicated that they would. The median amount suggested by patients was $0.63. While this may sound low relative to outside standards, it is important to consider that the average annual per capita income in Ratanakiri is about $40. According to an informal survey, consultations at public hospitals in Phnom Penh range from $0.50-$1.25, consultations at provincial hospitals are about $0.25, and consultations at district health clinics are about $0.13.
