Telemedicine in French Guiana

Remote medical consulting or telemedicine

Since 2000, CNES, MEDES (for MEDEcine Spatiale – Space medicine) and the Centre Hospitalier Andrée Rosemon de Cayenne (CHC) have been working together on the contribution of Space systems to public health matters in French Guiana.
French Guiana is leading the field in experiments with new communication technologies applied to public health. It is now possible for doctors to diagnose and care for patients at a distance thanks to satellite communications by using the CNES portable telemedicine station.
12 sites in French Guiana (11 isolated sites and one ambulatory care centre in Cayenne prison) have been equipped with a portable station enabling doctors to diagnose pathologies relating to cytology, dermatology and also cardiology (by means of electrocardiograms).
These sites were equipped through a partnership with the Regional Council, MEDES, the Andrée Rosemon de Cayenne hospital, CNES and the Ministry of Health.

At the current time, it is possible for doctors to diagnose six pathologies in the fields of dermatology, cardiology, parasitology, obstetrics, ophthalmology and haematology.

What does remote medical consulting involve?

Remote medical consulting involves a medical diagnosis and implementation of therapy at a distance, most often for an isolated site – whether this be a fixed site (a region which is naturally isolated or cut-off following a natural disaster, or an off-shore oil rig; etc.) or a mobile site (shipping, air transport, civil or military ground expeditions, migrating population flows, etc.).
This activity may under certain circumstances be implemented by non-medical personnel (paramedics, health officers, crew members, etc.) since the nearest medical expertise in these cases is at a distance of several hundred or several thousand kilometres.
This is why MEDES, at CNES’ request, developed a portable telemedicine station to take advantage of new satellite telecommunication services (Inmarsat, Globalstar, etc.). The system currently being developed is a prototype for a medical teleassistance station which can be adapted for different operational uses in particular for certain specific fields of medicine (cardiology, perinatology, biology, imaging, etc.). The principle consists in improving the collection and transmission of objective medical data via satellite to a medical regulating and expertise centre.

The technical characteristics of the basic model (weighing about seven kilograms with dimensions of 47 x 38.7 x 17.5 cm) are :

• a digital Electrocardiograph (ECG) recorder,
• a digital camera which can be adapted to a microscope for a remote diagnosis for anatomy/ cytology or for reading a haematology slide,
• an automatic blood pressure cuff,
• a pulse oxygen meter, an infrared sensor thermometer, a glycaemia sensor,
• a portable PC coupled with an Inmarsat transmitter, a GSM telephone and a GPS.

This generic technique may be adapted according to the requirements expressed by users and in accordance with available telecommunications systems. These requirements might be a static image station (for pathological anatomical sections or endoscopy images) and/or dynamic images (echocardiography, perinatology, remote monitoring of high-risk pregnancies), a biology/biochemical station, an electrophysiology station (for ECG, EMG, EEG).

To meet the requests of the user community CNES helped implement some of the operational and technical validations on isolated sites before undertaking full scale clinical validation phases :

• with the Centre de Consultations Médicales Maritime at the Toulouse University teaching hospital and in the framework of maritime medical assistance (transporting of passengers between mainland France and Corsica),
• with the medical department of the Polar Institute and the French Navy for providing medical assistance during summer exploration in the Antarctica which lasted several months; during this time various station components were tested for their robustness,
• in cooperation with Médecins du Monde, for use in a context of remote microscope diagnosis from an isolated site in Cambodia communicating with different expertise centres in France,
• with the Centre Hospitalier de Cayenne and the Samu 973 (emergency first aid), as part of medical support for isolated areas in the Amazon forest.

The remote consulting system in French Guiana was found by its users to be useful both in medical terms and technical terms (between 97% and 100% depending on the instruments). Data confidentiality is guaranteed to 99% by the network set up and validated by the national commission for information technology and civil liberties (CNIL).

In 2006, the telemedicine unit continues to be structured around two main themes : teleconsultation and teleepidemiology, the telecontultation progressing significantly. Teleepidemiology includes statistical collection of health centers, the collection syndromic in connection with the DSDS (Direction Départementale de la Santé et des Affaires sociales) and the National Institute of Health Watch, and the ability to trigger epidemiological alerts. Apart from these two issues, electronic mails are still widely used, particularly among isolated sites and logistics service health centers. Finally the bridge with versatile laboratories and parasitology/mycology allows health centers to receive the results of exams in an automated way.

Perspectives include extending the device to areas close to the shoreline to ensure a more consistent network (Kaw, Cacao, Régina, Roura, Tonnegrande, Iracoubo, Organabo, Javouhey and Awala Yalimapo). Other applications are also being considered such as anatomy/cytology, pharmaceutics, etc. Another project under study is the creation of a secured web site for sending files to specialists a long way away, outside of the French West Indies and French Guiana.

On the regional level, the project managers believe that cooperation with neighbouring countries and the Caribbean may be developed and would enable activities to be created. The fact that French Guiana has become a ‘showcase’ for telemedicine means that it might be possible to sell the system to our neighbours and to develop service activities around it, particularly for maintaining and operating the tools being used.
With this in mind, Guyane Technopole, by showing and promoting this technology in its engineering missions for innovating projects (market surveys, etc.) has, with backing from CNES, undertaken to support private initiatives in these areas.
In this respect promising contacts have been made with Brazil.

A few figures in 2006

The bridge with laboratories : novelty introduced in 2006.

The bridge with versatile mycology and parasitology laboratories which allows health centers to receive the results of biological hematology, biochemistry and parasitology tests, through their telemedicine e-mails. For technical reasons, the results of bacteriology and serology are not transferred. This feature is an enormous improvement over the previous situation.