The ten sites are spread across California as far south as Pauma Valley in San Diego County and as far north as Ft. Bidwell in Modoc County. A number of sites are so isolated that weather and road conditions often effect access to services, such as overnight mail. Combined, all ten sites service more than thirty distinct American Indian Tribes.
"Diabetes is a disease of civilisation which slowly poisons all organ systems and eventually results in disproportionate disability in American Indians", commented Dr. Linda Aranaydo, M.D., Advisory Committee member to the Grant Programme. "It is appropriate that modern telemedicine technology will now be used to prevent blindness and vision impairment in diabetic American Indians."
Funded by a $1.2 million, two-year grant from The California Endowment, the state's largest health foundation, the California Telehealth & Telemedicine Center will be able to offer a second funding cycle for other interested Indian health programmes. The request for proposals for the second cycle will be released in June 2001. The ten funded Indian Health Programmes will be trained on the technology beginning in March, whereas the equipment will be installed in April 2001.
Among the selected projects is the Chapa-De Indian Health Programme at Placer. It will provide a comprehensive wrap around service focused on case management, designed to substantially reduce the level of diabetic related blindness in the patient population. Teleophthalmology will be utilised to increase the diabetic patients compliance rate with receiving annual retinal screens from 52 to 89 percent. If retinal screening indicates retinopathy and the need for follow-up treatment, patients will be referred.
The Feather River Tribal Health project in Butte intends to improve patients' quality of life by offering early and on-going retinopathy screenings in-house. The Indian Health Council (IHC) Inc. will establish a Diabetic Ophthalmology Centre at a rural north San Diego County clinic to provide high-risk as well as diagnosed diabetic clients from 9 area reservations and out-of-area tribes with remote retinopathy screening. The Karuk Tribe will install a centre for tele-ophthalmology in the rural isolated community of Orleans, which will try to reach 100 percent of the diabetic clients with retinal screenings annually.
The Riverside-San Bernardino County Indian Health project aims to increase the awareness of the diabetic complications through education. Therefore, it will add a tele-ophthalmology based retinopathy-screening component to the existing diabetes prevention and outreach programme. The Round Valley Indian Health Center in Mendocino will link the local point-of-service site via state-of-the-art telemedicine retinopathy equipment to the provider and will also implement a mobile retinopathy-screening programme to serve the other American Indian communities in Mendocino and adjacent Lake Counties.
The Shingle Springs Tribal Health Programme will use advanced technologies in order to maximise the number of patient consultations for speciality eye care services. The Toiyabe Tele-ophthalmology Service at Inyo/Mono will be carried out in concert with the present diabetic team that has been in place since 1992. The project has on-site Internet and frame relay capabilities as well as a systems administrator with lengthy involvement in telehealth. A culturally sensitive marketing of the service via monthly diabetic clinics will be a benefit to compliance.
The United Indian Health Services project is designed to provide increased retinopathy screening to the American Indian community in northwestern California. A collaboration will be established with local ophthalmologists who will also provide follow-up services. Warner Mountain Indian Health in Modoc has received the tenth minigrant to train staff, install and provide all of the tribal members and the surrounding community with access to the most up to date retinal screening device available within a 250-mile radius. More information about the California Endowment grant is available in the VMW November 2000 article Telemedicine grant offers diabetic Indians opportunity to receive annual eye screening.