Sunday, 9 August 2015

Telehealth - Necessity or Convenience?

For 30 years I’ve had rheumatoid arthritis so I’ve had more experience with the health care system than I ever imagined when I was a teenager. In many ways I’ve been fortunate – Toronto is a large urban center with many doctors and we have a single payer health care system in Canada. There are places in the world where I’d be bankrupt by now because of the medications, operations and treatments I’ve needed. 

So far my personal experience of telehealth has been only in distance education. At St Michael’s Hospital Dr Rachel Shupak has a program called Rx For Education for inflammatory arthritis patients.  The  Ontario Telehealth Network (OTN) broadcasts the sessions to rural communities. At Baycrest Health Sciences recently I saw the same thing. Their classrooms broadcast educational materials often and easily through the OTN.
As a frequent patient I have often wished for a remote experience of healthcare but for me at it would be a convenience, not a necessity. It would have been a huge help to my father in law as he cared for my frail Mother in law as they both aged. How can you drop a frail elderly person at the door and then leave them there while you park?

Access to care is not the same everywhere even in Canada. My friend in Timmins is on a year long waiting list for mental health care. It would be great if there were a quicker solution.

My next mental picture of telehealth features my friend Camea May. She lives in the Appalachian mountains and recently sent me a picture of herself, standing beside a telehealth robot.  She had such a badly broken leg that a distant expert was consulted on her care.

Camea and her new friend

Before the Global Telehealth2015 conference I read about the use of telehealth in countries where doctors are scarce and care is basic, where there is trauma or PTSD, and where it is almost impossible to offer care to people with mental health issues. This is where you see the true value of telehealth,  – where the need is great and the medical resources are scarce. It can make a very large difference in countries with few medical resources.

A few months ago social media led me to an online talk at the UK/Ireland Cochrane Conference. A friend (Marie Ennis O'Connor @JBBC) directed me to her own presentation but I watched the speaker before her first. His name is Athula Sumathipala and he put the healthcare situation into a global perspective with one sentence:

He said " 89% of the annual global expenditure on health is spent on 16% of the world's population that bears 7% of the global disease burden". He calls it a sad reality and a bitter truth. As far as research dollars are concerned, only 10% of research dollars are spent on studying the developing world's health problems. This is called the 10/90 divide.

So when I say autoimmune arthritis does not get enough research dollars, I am not considering global realities. 

Ideas and concepts now spread at the speed of social media. Discussions are no longer confined to one geographic area. With webinars and livestream conferences we can learn about global issues from people like Athula Sumathipala and Vikram Patel, to name only two. With tweetchats I can have good friends in countries I will probably never see. Listening to them talk about issues in their countries makes me aware of the differences and difficulties in other parts of the world on a more personal level.

I hope that the connections we make through social media will help us address inequities and ethical issues, and that the novel solutions and ideas we learn will spread and lead to progress in health equity in other parts of the world.

This is more than just fairness - it is an ethical issue, and global capitalism makes this hard to change.

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