Docs in a Box

Virtual Hospitals Bring Healthcare to Remote Communities

September 07, 1999

Carlos has been unable to eat for three days. There is no doctor in his remote Central American village, so his mother takes him to a tractor-trailer at the edge of town and where a local nurse lays him on a bed before a video camera. Thirty miles away in a large urban hospital, a doctor says, "Say ahhh," and the nurse moves the camera closer to Carlos' open mouth. The doctor recognizes the symptoms of a bacterial infection and the nurse uploads data from a sample of Carlos' blood to confirm the diagnosis.

As far-fetched as this scenario sounds, researchers at Strong Memorial Hospital of the University of Rochester with engineers from MIT and leaders from the Costa Rican Foundation for Sustainable Development have already begun implementing a system that brings impoverished communities access to doctors via ultra-fast internet satellite links. Timothy Dye, Ph.D., of the University of Rochester is making sure that this modern technology, called LINCOS for "Little Intelligent Communities," meets the needs of these remote villages. "You can develop the niftiest technological gadget in the world to improve health, but if it's not made in a way that people will use it - it doesn't help them at all," he explains.

The first system is already in operation in a remote village in Costa Rica. Like the 29 systems to follow, it's built from a decommissioned truck trailer, which was outfitted with computers, satellite equipment, and a mini-medical lab, and airlifted to the village. Inside, local health care workers can connect to medical databases on the Internet, talk with people from other LINCOS communities, or help a doctor in a distant city diagnose a patient.

The ability to diagnose from a distance, known as "telemedicine," has been used by doctors for years in the form of emailed sonograms or online medical databases. But now, researchers are bringing that technology to villages throughout the world, allowing doctors to assist several communities at once - even communities where they might never visit in person. Using telemedicine, doctors can separate those patients who need only a simple remedy from those who need to travel to a city hospital, and be ready to act when the patient arrives.

"This is ushering in a whole new way of practicing medicine," says Dye. "These systems are inexpensive, efficient, and can make a real difference in the well-being of people in places where there has never been any kind of acceptable health care."

Even before the LINCOS system was built in Costa Rica, University of Rochester researchers were talking with the local schools and citizen groups to see if LINCOS could really aid any of the community's concerns. Teachers and principals were quick to embrace the chance to gather new learning tools from the internet to replace antiquated books, and many people welcomed the chance to participate in the distance learning programs LINCOS would make possible

Dye and Alex Pentland of MIT are now looking into the feasibility of having the local health care workers carry small palm-sized computers that stay in radio contact with the local LINCOS station. With such a system, the health care workers could consult vast medical libraries while right in a patient's home.

"Health care workers once gathered tons of detailed information on paper, but it was of little use because there was no way to look at all the data as a whole," explains Dye. "By automating health data, they can now track outbreaks or family diseases, and have a very accurate sense of the big picture. They or a doctor a thousand miles away can spot a trend before it erupts as an epidemic."

The LINCOS system is part of the Center for Future Health recently launched by the University of Rochester and MIT to create new portable technologies to prevent disease before it strikes. Researchers are hoping to place dozens of these boxes in rural or remote areas of the U.S., as well as throughout Central America. The systems are designed with off-the-shelf technology that can be easily maintained or customized for each village's needs. For instance, a farming community may need the mini-lab to process soil samples, while another might use it for water testing.

The LINCOS system is also outfitted with six public-access computers and a telephone, allowing villagers to keep in touch with people they might not have been able to otherwise - including people in other LINCOS-equipped villages. Surprisingly, the idea of computers and the Internet is not completely foreign to villagers since most have access to a television and are aware of the "wired world."

"Knowing about the Internet and email isn't the problem," one villager told the Rochester team. It's the lack of access that's the problem.

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