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.
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.
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.
The 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.