 Blog author, Dr. K Ganapathay is a Past President of the Telemedicine Society of India, Neurological Society of India & Indian Society for Stereotactic & Functional Neurosurgery. Emeritus Professor, Tamilnadu Dr MGR Medical University, he has 43 YEARS of clinical experience. He is on the Board of Directors of Apollo Telemedicine Networking Foundation and Apollo Telehealth Services – the largest and oldest multi specialty telehealth network in South Asia, an Advisory Board member of InnovaSpace, and recognised as a staunch advocate par excellence in promoting telehealth. For more details see www.kganapathy.com. I am thankful to Prof. Thais Russomano, Space doctor, for rekindling my dormant interest in outer space. 11 years ago I started taking my grandson to the terrace in my house and repeatedly showed him the moon and said "I want you to work there as a doctor". Who knows? This may actually happen in my life time.
As a 'Made in India', totally indigenous product, who has worked only in India, I am absolutely thrilled to learn about INDIA’S FIRST MANNED SPACE MISSION - Gaganyaan, scheduled for launch in December 2021.  GSLV Mk III Lift Off Image: ISRO The mission, which was announced by Prime Minister Narendra Modi in his Independence Day speech, is set to be a turning point in space history, as it will make India one of only four countries in the world, after Russia, USA and China, to launch a manned space flight. The plan involves sending three Indians into space for 5 to 7 days on a Low-Earth-Orbit mission (altitude of 300-400 km). At 27,000 km/h, a spacecraft completes an orbit around the Earth every 90 minutes. Costing within 1.5 billion US$, this 40-month project will employ 15,000 individuals, including 13,000 from industries and 1,000 from academic institutes – and of course, Indians!! Vyomanuts (Indian astronauts) for this mission are likely to be selected from 200 shortlisted Indian Air Force pilots, with just 4 being selected and trained. The best among the superhuman test pilots will get the golden ticket. On the seventh day after launch, the crew module will re-orient and separate itself from the service module, landing on Earth within 36 minutes, in the Arabian Sea, close to Ahmedabad.  Crew module splash down Image: ISRO One of the six largest space agencies in the world with the largest fleet of communication (INSAT) and remote sensing (IRS) satellites, ISRO has already developed most of the technologies required for manned flight. In 2018, it performed a Crew Module Atmospheric Re-entry Experiment and Pad Abort Test for the mission, while the Defence Food Research Laboratory (DFRL) has already worked on producing space food, and has been conducting trials on astronaut G-suits Most governments are averse to taking risks. It is a sign of the times that a popular government, in an emerging economy is willing to invest effort, time and money in what would, as a knee jerk response by many, be considered “preposterous”. One has to have the foresight that early investments in space would indeed be a differentiator. There are incredible resources out there. The moon has sufficient helium to power the entire globe. We will soon have an energy crisis and we are depleting all of our resources here on Earth. Whoever controls the valuable resources found in space will perhaps control the world. Unless goals are set, we will never get there. As the late chairman of ISRO Prof. U R Rao once remarked “...a government’s approach is to avoid all failures, but sometimes we need failures to push the boundaries”. Space law (spearheaded by the US) at present mandates that the natural resources found in space can be owned but not the place itself — like catching fish at sea. This has encouraged the pursuit of space business and millions of dollars have come in from private players. Today, if one finds a rock with valuable materials (precious metals like gold/platinum), it is yours. India is indeed a paradox. We have centres of excellence better than the best. We no longer talk of achieving world class, and indeed, in several disciplines, the world talks of achieving India class! It is true that we have a long long way to go. Internationally, an income of less than $1.90 per day per head of purchasing power parity is defined as extreme poverty. By this estimate, about 12% to 15% of 1.3 million Indians are extremely poor. Are we justified in denying millions of people good drinking water to satisfy an “ego trip”? In my view the answer is a resounding Yes. How else would you explain a billion plus mobile phones in the country. We are in a stage of transition. As Lloyd C Douglas remarked “this too will pass”. The future is always ahead of schedule. The Gaganyaan mission when (not if !) successfully executed will have untold spin-offs impossible to quantitatively qualify. It will show every one of us, that the ISRO culture of meritocracy can be imbibed by everyone, that minute attention to the nitty gritty in everyday life is doable, that failure is not an option.  Image: Canadian Space Agency Manned space missions do pose health risks pre-, during and post-flight for crew members onboard a spacecraft or station. There are communication challenges for medical doctors monitoring them from the ground. Physical and mental changes related to adaptation to the space environment need to be monitored in real-time. Changes in clinical parameters and management of unexpected medical emergencies need to be addressed and prepared for. Removing the effect of Earth's gravitational force alters all organic functioning. Space motion sickness, characterised by impairment of performance, nausea, vomiting and a diffuse malaise, occurs in astronauts and lasts for the first 72 hours of a space mission. Normal process of bone formation and resorption is disturbed. All of these aspects still require further study and understanding, and perhaps the Gaganyaan mission can also inspire and motivate Indian researchers to address these issues. For the last few years in all my talks I have been mentioning that India no longer follows the West. We no longer piggy back. We don’t even leap frog. After all how much can a frog leap! We pole vault!! A few years ago, President Obama warned American doctors that if they “don’t wake up” more Americans will start going to India for health care because it is cheap there. Indian doctors protested. They said in one voice “Mr. President, they don’t come to India to save a few thousand dollars. They come to India because our outcomes are as good as any of your hospitals. We are inexpensive not cheap!!  Just one more comment of interest...
Dr. K. Sivan, Chairman ISRO, within hours of the Prime Minister’s announcement, disclosed the appointment of Dr. Lalithambika as the first Director of ISRO’s Human Space Programme. Going by the number of women in top positions at ISRO, it is obvious that, if there is gender discrimination at all, it is of the reverse type!! Speaks volumes that Indian women are second to none .
Blog written by Prof. Dr. Thais Russomano, InnovaSpace Co-Founder & CEO
Telemedicine is a rapidly emerging and growing area of health assistance, research, and education that uses information and communications technologies to provide remote assistance to communities that currently lack specialist healthcare, or access to any form of medical assistance. Imagine living hundreds of miles from specialist doctors, such as cardiologists, dermatologists, and radiologists, to name but a few. This very situation occurs in many thousands of places all over the world; it is a huge problem that can impact very negatively on people's lives. In such circumstances, telemedicine is a potentially powerful tool that can not only improve the quality of healthcare, but also help in reducing the costs of healthcare delivery. While travelling in India at the end of 2017 and visiting the Apollo Hospital in Chennai, I came across a classic example of a place where telemedicine fits in perfectly - an extremely remote area high in the Himalayas.
At an altitude of around 13,500 feet sits the world's highest altitude Telemedicine Centre, implemented by Apollo Telehealth Services. This outstanding telemedicine program was established by Apollo under the directorship of Dr. K Ganapathy (President, Apollo Telemedicine Networking Foundation; Director of Apollo Telehealth Services; and InnovaSpace Advisory Board member), and aims to make quality healthcare accessible to the unreached populations of the towns of Keylong and Kaza, both in the Himalayan state of Himachal Pradesh, and with a total population of around seven thousand people.
The main health services provided are the delivery of medical assistance in emergencies, and primary and specialist tele-consultations. As of the 14th December 2017, a total of 9,389 consultations between the two remote towns and the Apollo Hospitals in Chennai had taken place (666 emergencies; 8723 outpatient consults). One such emergency involved local farmer Ram Singh who began to feel short of breath one day while out tending his cows. Fortunately for him he was able to attend the Apollo Telehealth service in Keylong and was treated remotely by a cardiac specialist in Chennai. Thankfully Mr Singh survived his heart attack and is able to tell his story in the above video, which makes him a classic example of how telemedicine can save lives!
 Blog written by Anna E. Schmaus-Klughammer, Director, Klughammer GmbH Mongolia is a huge country, being four times bigger than Germany, with nomadic cattle ranchers (herders) making up a large part of the Mongolian rural population. Due to the vast distances between cities, these populations living and working in the remote desolate regions of the country have very limited access to specialist doctors and hospitals, and the rural-based doctors work in isolation and are often left to make their own decisions in difficult cases. Although a hospital is located in each of the 21 provinces (Aimags) of Mongolia, each Aimag is three to four times the size of Switzerland, meaning that, in general, a journey of several hundred kilometres is required to reach it. Mongolia's desolate landscape and vast open spaces
Upon arrival at a hospital, the facilities encountered are fairly limited and the health care professionals often inexperienced, as it is state policy to send young doctors to the provinces. This situation can leave the medical professionals handicapped when faced with complex cases; with no specialist doctors to consult, patients are frequently referred on to hospitals in the major cities. This in itself is a problematic and costly procedure due to the great distances involved, let alone the additional difficulties faced when travelling whilst sick. As an example, the city of Ölgii, which is the major city of the Bayan-Ölgii Aimag in the extreme west of Mongolia, is 1636 kilometers from Ulaanbaatar, Mongolia’s capital city. Logistically, therefore, a journey between these two cities will take 3-4 days and will frequently involve travelling on overcrowded buses driven on unpaved roads. Camels, yaks and the herders live in desolate regions
In such an environment the use of telehealth and telemedicine can bring enormous benefits in terms of widening access to care and to expert medical opinion, and by overcoming the isolation of patients and health professionals. In this respect, in 2009, the German company Klughammer GmbH implemented a web-based telemedicine network in Mongolia in order to help Mongolian doctors access diagnoses and make clinical decisions. The project, funded by the Swiss Development Corporation (SDC), LuxDev/UNFPA, and the Millennium Challenge Account - MCA (USA), focused on mother & newborn health care, newborn hip screening, tumour detection, and cervical and breast cancer investigation.  Health professionals were trained to use the medical devices/telemedicine platforms All 21 provincial hospitals were connected via an interactive Internet platform to hospitals in Ulaanbaatar, with the Mongolian University of Health Services, National Center for Mother and Child Health of Mongolia, and National Cancer Center of Mongolia all being a part of this telemedicine network. Klughammer supplied, assembled and installed all the hardware and software required, such as computers, monitors, apparatus for transmitting patient image or laboratory results, and microscopes and radiology equipment, as well as providing staff training in the use of these. A web-based Electronic Health Records system, called CampusMedicus, was also introduced. This important healthcare IT application permits the secure storage of patient data, medical history, laboratory test results, and radiology and histopathology images. Each patient record allows case discussions to take place between doctors at a local, national and international level, giving access to expert medical opinion and enabling conference calls, for example to discuss patient tumour cases, among others. Medical staff in a provincial hospital using the Klughammer telemedicine platformThe practicalities of such a system have enormous potential to make a real difference to the lives of patients and doctors in remote regions such as Mongolia. It provides the opportunity for medical staff in the remote provinces to upload patient exams onto the platform, like tumour tissue microscope images, X-ray images of fractures, and ultrasound images from pregnant women, which can be securely stored and forwarded to specialist hospitals. Medical experts in the capital city Ulaanbaatar can then study these images and give their opinion for each patient case, adding it to the telemedicine platform, which operates in real-time. Access to the platform can also be made available to international specialists when needed. Since 2009, this ongoing project has led to the review of approximately 50,000 patient dossiers, leading to a decrease in the number of patients referred to Ulaanbaatar, and therefore improving the service provided to patients, speeding up diagnoses, and enabling large savings to be made in terms of time and money.
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