Free Rangin...

Today was truly our first “Free Range” opportunity and what a day it was! We went to a brand new CHC (Comprehensive Healthcare Clinic) in the Kama District (VERY impressive 40 bed hospital built for $200,000 – WITH equipment), and a BHC (Basic Healthcare Clinic – no beds, almost “urgent care” like). Hard to describe in words both what we saw, heard, smelled – and the possibilities to truly make a difference. Could have done without riding in the UN ambulance (low profile unmarked Toyotas are really good), but all was safe and good and it did handle the crazy dirt roads to the BHC pretty effortlessly.

Then it was off to the market with Mahrab – total pro at negotiating the colorful busy streets packed with artisan crafts, shoes, food, men, women (most burqa clad), and children – you name it… pretty much there, as we shopped and made arrangements to have new shalwar kamiz’s made. It was so much fun… and almost exactly how I’d imagined it – only better and brighter.

We’re also starting to slowly, but surely (as much as you can in a few days at least), piece together the healthcare “puzzle” here. One of our key theories established prior to our trip was that it would be far better to link Jalalabad with Islamabad/Pindi in Pakistan than to Kabul (both are primarily Pashtun, whereas Kabul is predominantly Dari; many Afghans also seek care in Islamabad; and of course the relationships we established there over the past year as a result of our comms/telemed work there). Theory = PROVED – based on all our meetings and conversations over the past few days.

Over the next couple of days we’ll seek to make the introductions between our new Afghan friends and Dr. Zafar, Dr. Sadia and the rest of the team in Pakistan. Also hoping that we can help to orchestrate reciprocal trips between Jalalabad-Rawalpindi so that a) an operational highly successful telemedicine program can be witnessed by the teams of doctors here, and b) that leveraging the true expertise of Dr. Zafar and Dr. Sadia, a successful regional model can be established. I have a feeling that if all of these incredible people are able to meet, that magic will happen – especially if we can keep the bureaucrats out of it.

Up next… figuring out the best location for the telemed equipment… as of COB today, we are thinking the Fab Lab may be best location until we can arrange a return trip and do a little more training and support. There’s a whole lotta equipment (eagerly accepted) just sitting in boxes, in the basement, etc. of the hospitals here because the support and training infrastructure was not there before well-meaning (blank space - insert name) NGO, government agency, etc. left it. We don’t like repeating the mistakes of others (or our own for that matter)! We also just can’t pack it up now though… as we catalogued everything today on the pool table, we generated more than a little bit of excitement. Beginning to look like that in addition to a spontaneous school, that the Fab Lab may become the next clinic in JBad.

Tomorrow it’s back to the more “established” program, but really hoping not too established, because today was a really great day.

Kabul Happenings - Day 1

A lot can really happen in 24 hours…so far in addition to surviving Kabul traffic (no small feat in of itself) due to local expertise and TRUE driving skill (us Southern Californians can learn a thing or two here!) … we narrowly missed children, bicycles, goats, sheep, and numerous other obstacles on our way around town, we’ve attended meetings and tours of hospitals and a local Rotary meeting...and have successfully made it to our home away from home for the next week in Jalalabad – and ALL our gear made it. But first about Kabul… what an experience in so many ways (broken down cab story upon request). While picking up some satellite gear purchased from Kabul Net, I was left in the car while Ishaq and Pete went to pay, and was immediately surrounded by children. They say they are professional beggars, so I shouldn’t cave and give, but professional or not I can only take so much of “Please Madam, Please Madam, Please” while I type on a blackberry worth more than most of these kids will see in a year. There’s the one precious little boy who kept throwing the Kleenex he was selling through the open window, the one who tapped on the window for a solid 5 minutes then started imitating a chicken and I just couldn’t help laughing, and the two little girls who chased after our car… I guess I’m just going to add that to the budget. Pete’s actually not much better, although his breaking point is the mothers holding their babies in the middle of the road.

Back to the purpose of our trip … get some “ground truth” on the healthcare “system” in Afghanistan and look for opportunities where telemedicine capabilities can be applied and leveraged. After visits to the soon-to-open privately funded Afshar Hospital and Acomet Hospital (affiliated with Kabul University) … the possibilities are endless – they are committed to healthcare, technology, education and building local capability and capacity, and have movers and shakers at the helm to put it mildly. Lot of synergy here and information to report.
Tomorrow, we’re off to meetings in Jalalabad… although on no particular schedule, because that’s the way it works.

One last quick bit… we were most honored on Saturday night to attend the Kabul Rotary Club meeting, where Dost Mohammad won the prestigious Rotary International Paul Harris Award for his dedicated leadership. More on Rotary and the work they’ve been doing here later (we owe all the smooth trip and connections to them for a start). If you’re interested in joining or providing support to the Kabul Rotary Club, contact Dost at domohammad@mtn.com.af.

Pictures: Picking up the sat dish; @ Acomet Hospital with Kathleen Rafiq and Dr. Goforth; @ Afshar Hospital with Dr. Goforth, Dr. Tim Fader and Dr. Nayeem.

What is Telemedicine & Next Up on the "Tour"?

Telemedicine is broadly defined as the use of technology to support the delivery of medical care over geographic distance. The increasing availability of Internet connectivity and portable, low-cost laptops and medical devices make it possible for the developing world to benefit significantly from telemedicine, where it has the potential to increase access to healthcare in rural and remote areas; provide care to mobile or evacuated populations; and increase the efficiency of physicians in urban areas.

In the most common practice model, physicians (or other healthcare providers) carry a compact tele-clinic with them. When they encounter a patient who would benefit from a consultation with remotely located senior or specialist physicians, the tele-clinic equipment is used to collect and transmit relevant clinical information. The foundation of the tele-clinic is a laptop computer; medical devices that may be included in a tele-clinic include EKG, respirometers, and digital cameras equipped for a variety of uses, including ENT and dermatology photographs. Data collected from these devices is automatically included in a referral request, while clear, Web-based interfaces guide physicians in the collection and reporting of other clinical information, such as history and symptoms.

Next stop: Exploring Telemedicine Possibilities in Afghanistan... Estimated date of Arrival - March 28, 2009 (Kabul), March 29 (Jalalabad)...