Bringing telemedicine to developing countries, i.e. to all those nations with a low standard of living, a poor industrial base, and an almost non-existent income level, means not only equipping countries with advanced technologies, but also fostering a more capillary and efficient dissemination of health services.
This is the aim that the UN and WHO have set themselves, recognising the crucial importance of technologies in the medical sector in the most economically disadvantaged areas.
In this scenario, we speak of global health, an approach that aims to give full meaning to health as a fundamental and inalienable human right for everyone in the world.
To explore the topic in greater depth with a focus on international cooperation, we met Michelangelo Bartolo, director of telemedicine services for the Lazio Region and lecturer at the Rome Business School’s Master in eHealth Management who told us:
“When we talk about telemedicine in the context of international cooperation, we must distinguish between two different areas: technology and health.
On the technology side, it is necessary, for a precise analysis, to be clear in which country or city we are going to install the telemedicine service.
Until a few years ago, the problem of connectivity was an obstacle not to be underestimated. Today, all the coasts of Africa are wrapped in fibre optic cables that manage to bring good connectivity, unthinkable a few years ago.
I remember that I saw the first wireless in my life in Maputo, Mozambique, precisely because in many countries of sub-Saharan Africa there has been a technological leap from analogue, i.e. the telephone, to digital, with the Internet connection. Today, in these territories, broadband connectivity makes it possible to send traces of electroencephalograms that weigh more than 100 Mb in Italy in order to benefit from the reporting and opinion of neurologists whose diagnostic accuracy is often unthinkable in those latitudes.
The decision to spread the use of asynchronous teleconsultations, i.e. those that do not require the simultaneous presence of the requesting and referring doctor, was a winning choice for international cooperation.
It is the achievement of an important milestone that makes it possible to overcome all the difficulties connected with satellite connectivity, which was an obligatory choice until a few years ago, and which, among other things, was very expensive and sometimes malfunctioning, depending also on weather conditions’.
Health cooperation is an extremely important topic within the international community, and alongside traditional players such as international and intergovernmental organisations, a significant role is also played by non-governmental organisations.
The Sustainable Development Goals (SDGs) of the United Nations, approved in 2015 as part of the 2030 Agenda for Sustainable Development, represent the international community’s commitment to achieving a better and more sustainable future for all. The SDGs mark a historic step because they aim at the composition of a single Agenda to integrate economic and social development goals with environmental sustainability and protection of the health of all people.
“In the aspect of health protection, International Organisations play a fundamental, undoubtedly decisive role.
For developing countries or countries in difficulty, also because of conflicts, telemedicine is very important because it is able to extend the right to health to a wider segment of the population, which sometimes lives in territories far from capitals or large urban centres.
Moreover, these countries must be helped not only by financing the structures – which are inexistent or dilapidated – but above all by training doctors and nurses, because the adaptation of professionalism remains one of the most important assets in the health sphere.
Training must not be episodic, and it must be based on local contexts. There is no point in explaining how to refer Angiotac if there is no such equipment. Training must start from local needs and possibilities. This is also why, in order to be able to request teleconsultations correctly, it is necessary to give the local doctor all the tools to be able to transcribe the patient’s basic data. This is why courses in medical semeiotics are also held: they teach how to examine patients, what manoeuvres to do to explore the nervous system, the heart and so on; an attitude that is sometimes too neglected even in industrialised countries. That is why I like to emphasise that in order to use the new technological tools well, we need to go back to the basics of the medical examination: a good anamnesis, a good examination, and help to study and understand the pathologies we are facing. Training that can also be carried out remotely.
Moreover, I like to remember, that in every response to a teleconsultation, in addition to giving diagnostic and therapeutic indications, there is always a small amount of training. Those who respond sometimes attach scientific publications concerning that particular pathology and it is a way of professionally developing the local interlocutor’.
The Covid 19 health emergency has forced an acceleration in the use of telemedicine applications in Italy, as well as all over the world, which before 2019 was just over 10%.
Many of these initiatives came about precisely in order to guarantee continuity of care both for Covid patients managed at home and for those chronic patients or patients on follow-up pathways who needed to maintain contact with their doctor.
“In Italy, telemedicine is a service that has been known for over 30 years but for too long has been left to the initiative of individuals. I started working on telemedicine in 2006 with a project of the Lazio Region in which the San Giovanni Hospital in Rome where I worked was involved, one of the few hospitals where there is a department dedicated to telemedicine services that are now spreading rapidly.
Today, the situation has changed radically: the pathway has undergone a marked increase with the health emergency and has continued with the funding provided by the National Rebirth and Resilience Plan for digital health, which amounts to almost EUR 2.5 billion, of which about EUR 1 billion is earmarked for telemedicine.
This is a great opportunity to modernise all Italian healthcare facilities and infrastructural and technological platforms with a view to global integration with the NHS. It is clear that in our country there are virtuous regions such as Lombardy, Emilia Romagna, Tuscany, Lazio, and Apulia and territories that are less so. I would not simplify further by saying that the North has a different speed compared to the rest of the boot, but uniformity throughout the country is a challenge to be overcome. The ‘National Guidelines in Telemedicine sanctioned in the State-Regions Conference’ are very important in this pathway, as they represent the tool that can lead to a territorial balance, thus overcoming the weakness of the system, which will have to be less and less hospital-centric. From this point of view, it is worth emphasising the difference between interoperability and cooperability. The first concerns technology, which must conform to precise standards that ensure that each application can dialogue with other applications; the second concerns individuals, or rather the willingness of people to cooperate: here the human factor, empathy and emotional intelligence are central.”
“When I speak of Best Practice in the field of International Cooperation, I like to bring the example of the Global Health Telemedicine platform, the non-profit organisation that was created from the experience of the Dream programme of the Community of Sant’Egidio, which operates in 47 countries with treatment centres and teleconsultation services, for example in refugee camps in Greece and even in Madagascar. It is a platform that has provided over 30,000 teleconsultations covering 31 medical specialities in just a few years.
Paradoxically, it is sometimes easier to operate in developing countries because there are few digital services there and they are more ready to accept new technological proposals.
Born in Rome, he is a doctor specialising in angiology. Since 2001, he has been one of the creators of the DREAM programme of the Sant’Egidio community for the prevention and treatment of AIDS and chronic pathologies, in various countries of Sub-Saharan Africa and in 2002 he began working in telemedicine with developing countries, carrying out missions in several African countries.
Since 2013, he is founder and secretary general of Global Health Telemedicine, a non-profit organisation that promotes multi-specialist teleconsultation services for developing countries; to date, he has opened 47 telemedicine centres in 20 countries, 31 specialist branches, and more than 20,000 teleconsultations. Since 2020, during the lock down for the Covid emergency, it has modified the multidisciplinary teleconsultation platform created for international cooperation by creating with the Community of Sant’Egidio and Global Health Telemedicine a tele-consultation service for Italians who could not access health services. Since 31 September 2021, he has been a member of the Agenas “telemedicine” working group for the definition of the guidelines for the digital model for the implementation of home care (mission 6, component 1, of the PNRR).
As of 1 March 2022, he will direct territorial and hospital telemedicine for the Lazio Region
He teaches telemedicine at the Rome Business School.
