Reactivating Telemedicine on Tilos leaves TimTem balancing between scepticism and hope

Tilos 09 July 2000It once started off so well, the "Tilos Medicine & Tele-medicine" or TimTem project which aim was to create an export model for telemedicine in remote islands and isolated areas within Europe. A look at the last report of team leader Professor Enrico Cavina tells us that recent developments on the Greek isle of Tilos are far from ideal. Yet, TimTem still remains a case of high interest for other telemedicine workers to learn from. Professor Cavina stays convinced that telemedicine can solve many health-related problems in islands and remote areas on the Mediterranean coasts, provided that careful attention is paid to generating flexible "human factors", such as sufficient training availability and a strong belief in telemedicine, propagated by local physicians and nurses. Only a permanent team of telemedical operators in the area can guarantee the safe functioning of a telemedicine station.

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We left Professor Cavina a year ago in the midst of a deplorable situation, causing great discouragement to his team, but also at a time when the Archipelago project, the successor of the TimTem initiative, had just been submitted to the European Community. Bad luck seems to have followed the University of Pisa project workers ever since. The European Commission has indeed rejected the Archipelago proposal, leaving the TimTem staff without any grants nor support to establish a permanent Telemedicine Station which should be managed for at least one year by one, but preferably two trained operators on Tilos. The second urgent need relates to a permanent Reference Hospital with a regional basis in which an innovative telemedicine approach could be introduced. To this purpose, active support from the Greek National Public Health System is required but here just as anywhere else, policies for decision making are working very slow.

After the Summer of 1999, no precise data on the general health condition of the Tilos islanders nor on the exact number of emergencies was obtained by the TimTem team for eight months. Only 3-4 cases of serious cardiovascular emergency were reported. Several times, occasional military physicians have been substituted to the local physician, due to his political involvement as a mayor on the island. During his periods of absence, at least two to three misuses of transfers by helicopter took place for acute renal disease, and for biliary or renal colic. While private connection with the Greek Telecardiology Centre is still functioning well, the resuscitation devices and defibrillators in the new ambulance remain unused. In the meanwhile, the local population has grown by over 30 percent in one year to about 500 people at present. At the same time, more tourists will be visiting Tilos which brings about major changes in the economical life in the island.

Perhaps, further TimTem project funding should be obtained from private investments. In June 2000, the TimTem workers returned for one week to Tilos to update the computer's station connections. It was found that OTE, the National Telecommunication Company, is able to provide an efficient ISDN link with safe and fast Internet and e-mail possible at 115.200 bps. This positive news may lead to a change in strategy. Telemedicine care on Tilos has a twofold target, the island people and the tourists and travellers. Professor Cavina makes a strong plea in his report to combine these two types of interest and to address the hotels, community tourist co-operative agencies, and the travel agencies to invest in a continuous telematic health support. An installed telemedicine system would enable them to offer better insurance arrangements and safer residence conditions to customers during their holiday.

Consequently, Professor Cavina also hopes to reach the local population by moving the telemedicine availability from the business to the resident people, thus offering benefits in both private and public sectors, as he describes in the report. Enquiries have already been launched last June, both to tourist and local people, to respectively ask their opinion on a regular telemedicine service and the update of the clinical data archive that has been established during 1998-1999. The response was very positive. The mayor-physician on Tilos even expressed his needs for permanent training availability to manage digital images, for consulting performance in dermatology, and telelaboratory facilities. However, there is very little material support to take any of these new steps, since Professor Cavina can only rely on the help of Telemed s.r.l., a new but still very small telemedicine company.

On the TimTem team's side, there is a great willingness to carry out training and long-distance guided management of new generation ultrasound devices for diagnostic teleconsult. The TimTem team also wants to introduce a Basic Trauma Life Support (BTLS) course for local staff and, possibly, for reference hospital teams in Rhodes. Here, a new hospital has just started working with a medium level of activities but still lacking any medical speciality units. In the near future, this clinic will become the telemedicine reference hospital for the area, depending on the growth of a Greek Telemedicine System, that will be self-managed by the regional authorities. Yet, no specific, concrete model for telemedicine application on the field exists. Therefore, the Pisa University is ready to assist with a postgraduate master course, starting next academic year in 2000-2001, to train new professional people in basic telemedicine.

For more details on the current status of the project, you can consult the TimTem home page. For further background information, we also kindly invite you to read the VMW article TimTem on Tilos enjoys no bed of roses, no pleasure cruise... in the October 1999 issue. At the Web site of the University of Pisa, you can consult the information about the new postgraduate Master Course on Basic Telemedicine.


Leslie Versweyveld

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