Telemedicine in Nepal

The Journey We have travelled

Dr Udaya Koirala
Associate Professor & Senior Consultant Surgeon
Kathmandu Model Hospital
Deputy Director
Center for Rural Health and Telemedicine, Phect, Nepal
The First Long Range Testing 2002 at Mohare
The First Long Range Wireless Link
May 2002
Mohare Relay Station- Elevation 11,000 ft
Setting connection in remote areas – not easy
Khopra Relay Station in 2004 – Elevation 12,500 ft
TELEMEDICINE https://www.nren.net.np/telemedicine/ NREN website
Tele-medicine, an important component of e-health, is one of the most rewarding and promising achievements of the advances in information
and communication technology. It has unfolded the possibility of narrowing the gap between developed and underdeveloped countries,
between cities and villages and between the ‘haves’ and ‘have nots’. Through making services available to the needy in remotest areas,
telemedicine can reduce mortality, morbidity, expenses, and psychological strains and can be a very useful tool for producing health for the
people at large.
Several efforts have been ongoing in Nepal to provide access on quality health services for rural majority through
Telemedicine. Kathmandu Model Hospital, the medical partner of NREN, with the support of NREN and Nepal
Wireless have initiated a pilot project on 2006, which connects more than 80 Km far rural community hospital
through setting up wireless network.
This is very successful initiatives and it ime tele-consults.
After connection with TEIN3, the telemedicine initiatives has broaden and have established better communication and relation with different
Medical university, Teaching hospitals and the medical persons ahas been replicating in different remote areas of Nepal. Currently we
have connected 10 rural health centers and have been conducting regular virtual classes and real tcross the globe. We are connected to number
of universities in the US, Japan, Korea, Australia and conducting regular session with Kyushu University Hospital Japan, Seoul National
University Bundang Hospital Korea, University of Kansas and the University of New Mexico United States. And also working to develop
regional network among South Asian TEIN3 partners.
Currently we have built active connection among following medical organization of Nepal to enhance telemedicine initiatives:
•Kathmandu Model Hospital, Bagbazar
•Institute of Medicine, Teaching Hospital, Kathmandu
•Dhulikhel Hospital
•Communication Health Education Services by Telehealth(CHEST),
Maharajgunj, Kathmandu
•Gauri Shankar General Hospital, Dolakha
•Manmohan Memorial Community Hospital, Pharping
•Kirtipur Community Hospital
………..2006
• Gaurishankar General
Hospital
• Connected to NREN
backbone through Fiber,
Bandwidth of 10 ~ 20
mbps.
• Kathmandu Model
Hospital work as a Hub
for Telemedicine.
More than 13 remote areas like Trisuli, Jomsom,
Myagdi, Makwanpur, Sidhupalcholk, Kavre,
Achham, Bajura, were connected by 2011.
Telemedicine session between remote health center and Kathmandu Model Hospital
Early Experience with Telemed Gadgets
Feet planted to the earth…….

Want to touch the sky………

Globalization
Was having regular oncology session with Kansas
University, University of New Mexico,
• Having regular video session with Japan, Korea,
Malaysia, Thailand, Philipines, Indonesia, Vietnam,
Singapore, India, Bangladesh etc. through APAN
( Asia Pacific Advanced Network ) Medical
Working Group.
• Live video presentations and live discussions,
different case presentations and tele discussions
have been fruitful to the participating surgeons
Center for Rural Health and Telemedicine,
Phect , Kirtipur
• Having regular inter-hospital sharing with TUTH,
NAMS, Dhulikhel Hospital, Patan Hospital, Possible
Health Bayalpata and Dolakha, Pyuthan district
hospital, Bajura district hospital, Gorkha Ampipal
Hospital, Nangi rural health care center………….
• PRINT EDITION - 2011-01-22 | NATION
• Balm to rural folk: 25 districts get telemedicine services
• - POST REPORT, Kathmandu

• Jan 21, 2011-

• Prime Minister Madhav Kumar Nepal on Friday formally inaugurated a rural
telemedicine centre and SAARC telemedicine centre at Patan Hospital on Friday. With
this, 25 districts in the country now have telemedicine facility. Also, Nepal is now the
third SAARC country to have this facility .Speaking on the occasion, the prime minister said telemedicine will enhance the
government’s effort to increase health access to people living in rural areas. In Nepal, where the majority of people lives in remote areas and has limited access to roads,
telemedicine is one of the best alternatives to deliver quality services like diagnosis, prescription and counselling by health experts and physicians over telephone.

•The telemedicine service is available in Achham, Bajhang, Bajura,

Darchula, Dolakha, Gorkha, Jajarkot, Khotang, Kalikot, Manang, Mustang,
Rasuwa, Rukum, Sindhuli, Sindhupalchowk, Taplejung, Humla, Jumla,
Rolpa, Pyuthan, Dolpa, Mugu, Okhaldhunga, Sankhuwasabha and
Solukhumbu districts.
• National focal person for telemedicine and director at Logistics Management Division under the Health
Ministry Dr Mingmar Gyelzen Sherpa said, “In remote areas, there is a lack of specialists as many of them are urban centred. The government also has
not been unable to provide adequate facilities and deploy the needed health experts. In this bitter fact, through this facility, the health experts in the urban areas now can
guide to the junior health assistants in the district and provide counselling to the patient and do regular follow up treatment of the patient. The patients do not need to
come to city spending huge amount of money just for follow up treatment or so.

•
Meanwhile, a statement by the Indian Embassy read that the centre has been established with assistance of Rs. 40.88 million from the Government
of India under the SAARC tele-medicine network project which is fully funded by India. “This was part of the assurance conveyed by Dr. Manmohan Singh, Prime Minister of
India, at the 13th SAARC Summit held in Dhaka in 2005. The MoU for the implementation of the project between India and Nepal was signed in June 2009,” read the
statement.
• The centre will also enable the host institution for Continuing Medical Education (CME) services to select hospitals in SAARC countries.
• Published: 22-01-2011 07:57
• The Himalayan Times > Nepal > BPKIHS begins telemedicine service
• BPKIHS begins telemedicine service
• Published: October 06, 2015 12:12 pm On: Nepal

• RASTRIYA SAMACHAR SAMITI

• ITAHARI: BP Koirala Institute of Health Sciences (BPKIHS) has initiated
a telemedicine service to ensure health service access of people of
eastern mountainous districts through hospitals of the region.
• The BPKIHS has completed the preparation to provide specialist
service through internet to different district hospitals and health
centres operating in eastern mountainous districts including
Dhankuta, Udayapur, Siraha and Ilam in the first phase.
• Telemedicine software training in Dhankuta (Nepal)
• Posted on 10/04/2015 by Anish Battharai
• eHealth and Telemedicine Unit of the B. P. Koirala Institute of Health
Sciences (BPKIHS) at Dharan, Nepal organized one day training on “Use
of Telemedicine Software” at Dhankuta Hospital on 4th April 2015. The
main aim of this training was to provide hands on and onsite training
to the front line health care professionals working in the primary
health care centers and district hospitals in the use of telemedicine
software for tele consultation. Twenty three participants from various
health centers from eastern region of Nepal attended the training
program
 Telemedicine In Nepal: Prospects and Challenges
Int'l Conference on ICT for Development & Education, Nov 16-17,2011 Soaltee Crown Plaza Hotel, Kathmandu

• Presented by Er. Krishna Pandey, IT Consultant, HLCIT

• The medical field is also not untouched with the growing edge of
technology. Telemedicine is the virtual presence of the doctor to
nearby patient. With the help of Telemedicine the people in rural
area now get treatment by the medical personnel from any part of
the world.
• With Telemedicine, medicine is not just a capsule or syrup but the
suitable way of treatment at right time. Patient from Jumla (Karnali)
can be treated by doctors at distant place like Kathmandu, Pokhara,
Butwal and also from the other country as per our access.
 K. Dremstrup, S. Rees, M.Ø. Jensen (Eds.): 15th NBC on
Biomedical Engineering & Medical Physics, IFMBE Proceedings
34, pp. 117–120, 2011.
www.springerlink.com
•
Temp: 21°c (70°f)
Wind: E at 4 mph (6 kmph)
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• 3-9 February 2017 #844

• Nation

• Long-distance medicine
• Lack of Internet access and low bandwidth slows spread of telemedicine in Nepal’s remote areas
• Sonia Awale
• 0Share
• Sonia Awale
• ON CAMERA: Surgeon Udaya Koirala (at right) with colleagues at Kathmandu Model Hospital consults with Health Assistant Tilak Chhantyal in Myagdi through Skype this week about a
patient.

• It is 9am at Kathmandu Model Hospital. But instead of donning his

surgical gown and going into the operation theatre, surgeon Udaya Koirala
enters a room with a large computer monitor for his regular Skype call to
Shikha Health Post in Myagdi district, 250km away . Health Assistant Tilak Chhantyal comes online from Shikha
through an intermittent video, and the two greet each other with “Namaskar”. There are two patients today: A man whose wife is pregnant because his vasectomy malfunctioned and needs
to be re-sutured, and the other is a burn patient.
• Koirala and his team examine the patients, and he suggests treatment. On other mornings, the cases have been much more life-threatening, but the spread of Internet connectivity is allowing
many lives to be saved through telemedicine in a country where rural medical care is sparse.
• “With real time video conferencing we are examining patients directly. We can see their condition and make a diagnosis,” Koirala says, adding that in most cases the patient doesn’t need to go
to a city hospital and can be treated by the health assistant.
Telemedicine in Nepal: A Pilot Project
Mohan Raj Pradhan
Pages 180-183 | Published online: 20 May 2016
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https://doi.org/10.1080/01296612.2005.11726794

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abstract

This paper details a study designed

to assess whether telemedicine based on store and
forward technology is sufficient for the diagnosis of cases sent from remote rural
areas in the fields of dermatology, radiology and pathology . The findings show that
there was no difference between the results obtained by diagnosis using images
compared to using conventional methods of diagnosis.
Additional information
Author information
Mohan Raj Pradhan

Dr Mohan Raj Pradhan is the CEO of HealthNet Nepal.

HTTPS://WWW.INDIEGOGO.COM/PROJECTS/TELEMEDICINE-IN-NEPAL#/
Telemedicine in Nepal
We provide healthcare to the people living in the remote parts of Nepal with the use of
Telemedicine technology. This projects saves hundreds of lives.
PROJECT OWNER
Prabhat Adhikari
Kathmandu, Nepal
1 Campaign

$285 USD raised by 7 backers

6% of $5,000

Nepal is a beautiful country situated in the foothills of the Himalayas, and boasts eight of the tallest mountains in the world,
including the Mt Everest. 80 % of its population live in the mountains. There are more than 24 % of the population who earn
less than a dollar per day. Many of these poor and innocent people die even before seeing a medicine.Delivering even the
basic health care to these people has so far been impossible. So, we came up with an idea of using technology to reach out to
these poor people.

We formed a team of volunteers (doctors, engineers, MBAs and various

other fields) and launched a telemedicine clinic in Kalikot, one of the
remote villages of the country. This pilot project has so far been highly
successful, so want to set up some more clinics in the surrounding villages.
We have registered a not-for-profit organization in Nepal; and we have our own website under the name of Nepal Youth
Initiative, which can be seen in this link below.

Nepal Youth Initiative

• We are starting telemedicine in Dhading, Bajura,
Sindhupalchok. Join us in the exciting ventures of
modern medical telecommunication technologies. We
need funds and volunteer doctors for this project. See
how you can help make this world a better place.
• And very soon, we are going to set up Teleclinics in
remote area of Dolpa, Humla and the earthquake
hit areas of Dhading and Rasuwa.
Telematics and Informatics
Volume 34, Issue 7, November 2017, Pages 1166-1176

Exploring the role of telemedicine in improving access to

healthcare services by women and girls in rural Nepal
Author links open overlay panel
RajanParajuliPhilippeDoneys
Show more
https://doi.org/10.1016/j.tele.2017.05.006Get rights and content
Highlights
•Even if unintended, telemedicine reduces gender-based barriers to access healthcare.
•Telemedicine circumvents gendered travel restrictions and decreases travel time.
•Telemedicine cuts expenses by lowering treatment costs and improving referral systems.
•Mobile phones offer anonymity that enables sexual and reproductive health discussions.
 Mobile Phone Support for Rural Health Workers in
Nepal through ‘Celemedicine
• ’ Joanna Morrison,1 Naba Raj Shrestha,1 Bruce Hayes,1 Mark Zimmerman1 1 Nick Simons Institute, Sanepa,
Lalitpur, Nepal.
• ABSTRACT
• Globally, there is a shortage of health workers in rural areas. Effective health systems
depend on having sufficient, accessible health workers with the right skills. In countries
like Nepal, highly skilled health workers often prefer to work overseas or in urban centres,
and therefore, in the short term, it may be pragmatic to focus on ensuring support and
skills development of mid level or paramedical health workers. Information technology
has the potential to support these health workers. We describe a pilot intervention
undertaken in Gulmi District, whereby all mid level health workers in the district have
been provided with a free phone number to call three General Practitioner Doctors
(GPs) in the District Hospital. The intervention aims to increase appropriate referral, and
increase connectivity between the District centre and peripheral health facilities. We hope
that our intervention will provide support to rural health workers, and, if implemented as
part of a package of interventions, may increase retention. We present some initial
findings from discussions with health workers and analysis of call-log data, and describe
our next phase evaluation and possible scale-up.
 Scope and challenges of telemedicine in Nepal: a look towards future
Article with 116 ReadsSource: OAICite this publication
Rudeep Piya
Abstract
Telemedicine is not a new technology today, but it is a novel approach for many developing countries, and in fact, it may have
more profound impact on these countries than developed nations due to unmet demands for health and unprecedented health
related challenges. In the health context of Nepal, telemedicine is rising and currently being implemented, though on a pilot scale
– most of them by private health institutions. The main purpose of this study is to explore the practicability of telemedicine
application in Nepal, with particular reference to challenges and scope regarding its implementation and use. In this study, a
qualitative research method was used. As such, interpretive research approach was employed in order to explain the phenomenon
of interest. Multiple data collection tools were used to investigate and find possible explanations to the research questions
considered. The empirical data gathered from the study were analyzed using the theories of Information Infrastructures (II) and
Actor-Network Theory (ANT) from the information systems field. The notion of II is used to establish telemedicine as an
infrastructural tool while ANT is used to describe the interaction and negotiation processes among diverse actors identified during
the study. From the empirical findings, issues related to funding, sustainability, technical acquisition, low resources and
underdeveloped infrastructures were found to be major challenges to ICT growth. Important findings related ICT infrastructure
and its sustainable development are discuses and implications are given with particular reference to telemedicine .
Finally,
it is concluded that funding and sustainability are the core issues, including
other sociological and political issues, for telemedicine development in the
context of Nepal, and hence calls for more research in this area. Key words: Actor-
Network Theory, Challenges, Developing Countries, ICT, Information Infrastructures, Nepal, Sustainability, Telemedicine Nå

Scope and challenges of telemedicine in Nepal: a look towards.... Available from:

https://www.researchgate.net/publication/45181396_Scope_and_challenges_of_telemedicine_in_Nepal_a_look_towards_future
[accessed May 30 2018].
A recent overview of telemedicine technologies by two
experienced telemedicine researchers argued that

"most failures of telemedicine programs are associated with

the human aspects of implementing telemedicine" (Allen
and Perednia, 1996, p. 22).

Similarly, in its site visits, meetings, and other activities,

the committee heard repeatedly about the human factors
that appear to underlie the rejection or limited acceptance
of telecommunications and information technologies by
otherwise interested clinicians and administrators.
J Nepal Health Res Counc. 2015 May-Aug;13(30):149-53.
Opportunities and Challenges of a Rural-telemedicine Program in Nepal.
Bhatta R1, Aryal K1, Ellingsen G1.
Author information
Abstract
BACKGROUND:
Telemedicine services are considered essential for improving the accessibility, quality and efficiency of the healthcare services in developing
countries. With these expectations, government of Nepal has implemented a rural-telemedicine program in thirty peripheral district hospitals
to improve the accessibility of specialist health services. Telemedicine can be appropriate to the nation like Nepal with low physician/patient
ratio. However the acceptability of telemedicine can be a delayed process, where the healthcare modalities are not well internalized.
Similarly, the peoples who are involved in the program play a key role for making it efficient and effective. Hence, assessing the
opportunities and challenges is important to address needs and better implement the program.
METHODS:
This study has used an interpretive case study approach to explore the opportunities and challenges of the program. Fifteen stakeholders
were interviewed from central level and program sites namely Darchula, Sindhupalchowk and from Patan
hospital. Discussions at peripheral sites with stakeholders were recorded and intensive notes were taken.
RESULTS:
The findings suggested that the rural-telemedicine programme does offer some benefits, however there are still many challenges associated
with the implementation of program. These challenges include infrastructure problems, lack of human resources, competence and financing.
CONCLUSIONS:
Overall attitude of the stakeholders involved in delivering telemedicine services was
favorable however several loopholes were reported in the existing system. Hence it shows
sufficient potentialities of rural- telemedicine to improve the health care delivery in rural
and inaccessible areas.
KEYWORDS:
Challenges; local practice; nepal; opportunities and limitation; rural-telemedicine.
PMID: 26744201
 Remote perception

• “All the three application of telemedicine

program are regularly used at
Sindhupalchowk, however videoconferencing
is most effective for getting medical support
and treating the patient”
 District Hopital Team

• positively perceived
– rural-telemedicine service has supported patients to get
appropriate care and consultations especially to those
patients who cannot afford to travel to get the specialist
services.

• additional burden of work

Fear from Paramedics and nursing staff

• good computer skill, knowledge in medical

terminologies and reasonably good English
are necessary to use the existing technology
for proper communication with specialist.
• “…due to the irregular supply of electricity
and slow internet service, it is difficult to send
emails. This is even worse during
videoconference consultations due to
frequent disconnection, blurry images and
unclear sound”
 Obstacles
• ? lack of technical expertise,
• ? efficient infrastructure
• ? Trained human resource
• ? supporting environment.

– It takes several weeks or even month to maintain

the equipment and software if they stop
functioning.
• Respondent at Patan hospital said that health
workers try to avoid their responsibilities due
to the lack of confidence, knowledge and skill
to use the available technology in the delivery
of health services
• Lack of governmental coordination has also affected overall
management of the rural-telemedicine program.
• Due to the unstable political situation and frequent change of
government, the policy related with the health care delivery
system is fragile. Respondents at Patan hospital discussed that;
rural-telemedicine program is started in large scale without
proper plans and resources. So it is challenging to function the
program.
• Study finding also showed the controversial opinion among
the authorities involved at the central level and the team
working at the district hospitals. The district team blamed the
central authorities for their poor management and not taking
the program activities seriously. However, the district teams
were blamed for not showing their active involvement.
First National Telemedicine Workshop 2016
2nd National Telemedicine Workshop 2019
• Thank you for your
patience listening……