SIM Quarterly [Columns, Issue 1]

The British Healthcare Internet Association had a very enjoyable launch at Healthcare Computing 97 held at Harrogate, UK in March 1997. We had a meagre stand filled with information leaflets, however, the real work was done by cruising the exhibition halls and talking with everybody. We also had an un-official meeting place at the 'Quacks' site, but please don't tell the organisers!

At the evening reception, short presentations were given to a packed room. Later, we had a very delicious and loud dinner at the Drum and Monkey. I heartly recommend it for fish lovers.

BHIA and SIM courting

It is very encouraging for all those who are passionate about advancing the Internet in medicine and health care to know that members of the BHIA Council joined SIM and likewise, members of SIM Executive Committee joined BHIA. The two organisations continue to input into each others deliberations through the mailing lists. This can only be good for both organisations and will help further the mission of excellence in health care through Internet technologies.

MEDNET 97

BHIA is very pleased to announce that it officially supports and endorses MEDNET 97. A number of people from BHIA will be making presentation submissions to the Editor for inclusion in the programme of the World Conference. Ahmad Risk has volunteered to help with the Internet café, provided that he and Harold can explore the Brighton gourmet scene together!

InfoFest 97

Talking of MEDNET, BHIA are exploring the possibility of holding a 'Festival of Information' (InfoFest) in December 1997. The 'Fest' will focus on short talks, workshops and hands on sessions as well as table top exhibits and demonstrations from the smaller suppliers including products ancillary to the Internet like digital cameras, modems, voice recognition, etc. The event will be more of a grassroots celebration of information technology and the Internet. We also hope to offer launch pads for innovation in 'show and tell' type presentations.

The dark side of the Internet

We, at BHIA, like you in SIM and many other organisations are very concerned about issues of quality standards for medical Web content. There are no easy solutions to the problems of 'bad' medical sites. However, it is only with the corraling of like minded people from a wide section, both nationally and internationally, in a sincere efforts to attempt to set quality standards that we can succeed in helping the new media deliver what anyone could only dream of few short years ago.

This international collaboration of governmental and non-governmental organisations and individuals is crucial to our mission. To that end, I shall be attending an inaugural conference of the USA Medical Webmasters to be held in Washington DC on 10 and 11 June. The conference aims to discuss issues of medical Web publishing standards, regulation on the Net, and the next steps for the American Medical Webmasters that include the possibility of forming an organisation of their own and exploration of avenues for international collaboration. I shall be presenting the view from Europe which includes discussion of the Health on the Net Foundation's Code of Conduct, BHIA's own 'Quality Marking for Medical Web Publishing', and sharing with our American colleagues the experiences and knowledge gained from the formation of BHIA. I look forward to reporting on the conference in this column soon.

Current BHIA projects

Current BHIA projects include:

A study of issues surrounding GP (family physician) connectivity to the Internet.
Experiments with a Web-based 'work space' for group and collabortive working.
Preparation for MEDNET 97 and InfoFest 97.
Collaboration with the UK NHS Telecomm Branch in the study of general practice requirements for connection to, and use of, NHSnet.
Probably the first ever book review by an online community of Bruce McKenzie's excellent book Medicine and the Internet. Incidentally, the book has gained the official endorsement of BHIA as a valuable resource and a thumping good read!

Well, that's all for now folks, hope to see you again in Issue 2 of the SIM Quarterly.

Details on all of the above projects are at the BHIA Web site:

<URL:http://www.bhia.org/>

You can obtain further information on these and other topics, and about the BHIA by writing to me at info@bhia.org or risk@cybermedic.org.

Ahmad Risk MB BCh
British Healthcare Internet Association
General practitioner
Reigate, UK

MEDINET

A non-profit health professional network in Bangladesh.

Introduction

A physician's up-to-date medical knowledge is essential for the effective treatment of his or her patients. Developing countries cannot support training for large numbers of physicians on recent developments, nor can they afford sufficient books and journals. Whereas the BMA Library in London subscribes to around 700 journals [1], the library of Dhaka Medical College (the premier medical school in Bangladesh) may irregularly subscribe to only 1 or 2 current medical journals. This situation denies the poorer patients in developing countries the benefits of modern medicine.

The advent of Internet kindles hope of bridging the wide information gap between North and South created over the past several decades. Nothing in human history has had greater potential to make more information more readily available to more people at low cost. However, Bangladesh - like many other developing countries - is still not in a position to utilize this benefit due to a serious weakness in it's telecommunications infrastructure. Here, even the higher educational institutions lack Internet access. Most Government medical schools have only one (or no) computer; none have full online access to Internet resources.

To alleviate this information poverty amongst health professionals in Bangladesh - at least in part - a non-profit project, MEDINET (Medical Network), was initiated to provide locally-appropriate solutions for electronic exchange and Internet access.

The origin of MEDINET

Working directly with computers since 1989 in a philanthropic organization, I developed a natural weakness towards the benefits of computers, and began subscribing to the locally available computer magazines to track developments. I subscribed to a commercial e-mail bulletin-board service in 1994 at the first opportunity. I was looking for ways that e-mail might be used to make current medical information available in my country. I established the Medical Information Group with a few of my enthusiastic students. It was witness to a live demonstration on the Internet organized by Ford Foundation in October 1995. Mr. Andrew Robinson, an Internet activist gave the demonstration. We subsequently held 3 other demonstrations with assistance of Mr. Andrew, at 3 of the most important health institutions in the country. All events were largely attended by professionals in various capacities, which inspired us to develop the concept of MEDINET.

Constraints

We started communicating initially for software and hardware support, with shareware bulletin board software, and the offer of hardware from a local organization. At that time Bangladesh was experiencing political unrest and effective liaison was impossible. Thus, we started service using a 486sx Compaq notebook computer which was being used in a research project. In May and June 1996 I attended a network course under Internet Society scholarship. I returned home to find that the notebook computer had been taken back permanently; the local organization did not keep its commitment. However, a diagnostic company provided another computer and we resumed service.

After a few weeks the diagnostic company claimed MEDINET was a commercial venture and took the computer back when we declined to give them a share of the 'profit'. We then invested in a computer ourselves. Membership campaigns were conducted via press releases in local newspapers, letters to potential clients, and by undertaking other promotional activities. Enhancing computer and Internet literacy was deemed necessary, and we launched a comprehensive computer course for medical students, doctors and teachers. With all these efforts, MEDINET began to progress steadily, adding new users and resources.

Structure of MEDINET

MEDINET has an AMD 586-based Internet host with 2 digital phone lines. It connects to the Internet hourly via a dial-up UUCP account with a local commercial Internet service provider. MEDINET stores information in several conferences, enabling users to share information, messages, electronic books, articles, journals, newsletters, and software, etc. We regularly procure and update valuable information from Internet, viz. HealthNet news, ProMed, EDrug, ProCarre, MedPulse, Medscape, and SIM, etc. Users are assisted to retrieve medical journals. We encourage users to prepare and read messages offline, which reduces the cost of long-distance telephone calls (local calls are billed per call) and does not tie up the system, allowing access to other users.

Success of MEDINET

Currently the MEDINET network includes 60 individual users, 17 organizational users, and 6 distribution centers. Remote subscribers use store-and-forward technology to receive/send information in one or two dial up connections per day. MEDINET provides a public Internet service at Dhaka Medical College. Information is displayed in a suitable place for public viewing in some institutes where we could not establish a formal MEDINET connection. Bicycle messengers or couriers are used to carry messages to and from distribution centers. Individual users render services to their friends and colleagues.

This unique system has created a backbone for the distribution of national public health information, and hundreds of professionals and medical students not owning personal computers or telephones are able to benefit. Our computer course has so far trained 200 doctors and medical students in 6 essential computer applications.

Future goals

In the absence of other non-profit, academic, professional, or Government networks, 6 commercial online access providers are aggressively trying to capture the market. They are attracting users looking for entertainment, online chat, etc. It has become difficult for MEDINET to co-exist with this competition, with it's less glamorous 'offline' Internet service.

MEDINET believes it would be more competitive if it offered a live service (rather than relying on intermittent connections and offline reading). However, because the cost of Internet access is a factor, MEDINET's current system may provide the most economical form of access nationwide. To enable users to maintain personal e-mail accounts and local discussion groups, we plan at least one sub-host server in each medical college. We are also offering free connections to the Computer Training Centers in districts and rural towns for distribution of health information at reasonable prices. MEDINET plans to introduce free medical advice for patients through consultations with it's physician members, and also other physicians on the Internet.

Conclusion

'While the lucky few million in the rich world amuse themselves in cyberspace, half the human race has never made a telephone call.' [2]. Those in the world's rich northern countries can happily chat among themselves by post, telephone, fax, and e-mail, but very few doctors in the poorer countries of the south can join in. MEDINET is less glamorous, but it is a locally appropriate, simple and inexpensive system which combines the power of information technology with a traditional information distribution system. Experience suggests that glamour often defeats values and rich traditions. Unless we improve the quality of our service MEDINET's future may be at risk. An estimated amount of US$14 250 is required transform MEDINET to a fully online network. We need more computers to provide sub-host servers and extend our training capacity. All MEDINET workers provide voluntary services, but for obvious reasons, they are not in a position to financially contribute. May the world's population come forward to support MEDINET's noble goals. Despite all the constraints, MEDINET may serve as a model for other regions with limited Internet access.

References

1 Groves T. Information sharing: getting journals and books to developing countries. BMJ 1996;307:1015-7.

2 Anon. Tele-haves and have-nots. Economist 1996 May 18:19-20.

Abul Kalam Azad MBBS MPhil
President, Medical Information Group and Associate Professor, Dept. of Biochemistry
Dhaka Medical College
Dhaka, Bangladesh

Society for the Internet in Medicine

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Copyright © 1997 Society for the Internet in Medicine. All rights reserved.
Date: June 1, 1997
Document URL: http://www.cybertas.demon.co.uk/simq/issue1/columns.html