Rift Valley fever patient in Eastern Africa examined by University of Texas Medical Branch experts via real-time, telemedicine connection

Galveston 25 January 2007As a half-dozen University of Texas Medical Branch (UTMB) infectious disease, telemedicine and other experts gathered in the UTMB telemedicine studio early on the morning of January 22, a movie screen before them filled with the larger-than-life image of a bearded, prostrate 50-year-old herdsman in the Masalani Hospital of northeastern Kenya, who at that very moment was battling for his life. The patient had arrived at the regional hospital three days earlier, after experiencing nearly four days of intense fever, severe throbbing headaches, joint pain, nausea, vomiting after eating and weakness so profound he could no longer walk.


Dr. Summerpal Kahlon is a UTMB postdoctoral fellow and resident in the Infectious Disease division of UTMB's Internal Medicine department. He arrived in Kenya last week with the telemedicine equipment that facilitated this real-time consultation and medical examination, and noted that the patient had reported experiencing a number of mosquito bites before coming down with his symptoms. The patient tested negative for malaria, a common disease in that area.

The initial diagnosis by Dr. Kahlon: Rift Valley fever (RVF), an emerging mosquito-borne infection that has been sweeping through northeastern Kenya and the country's coastal areas since torrential rains raked the region last November, killing nearly 30 individuals and displacing more than 20.000 people - all the while providing a watery habitat for the mosquitoes that spread RVF.

Dr. Kahlon's infectious disease mentor, Dr. C.J. Peters, a world-renowned expert in RVF and numerous other infectious and tropical diseases, concurred in the diagnosis. "Dr. Kahlon is taking samples to be sent back to UTMB so we can test them and confirm the patient's diagnosis", Dr. Peters noted.

Two days later, the diagnosis of RVF by Drs. Kahlon and Peters was confirmed by laboratory tests performed by researchers with the United States Centers for Disease Control and Prevention based in Garissa, Kenya. Subsequent reports from Dr. Kahlon to scientists in Galveston indicated that the patient continues to improve and that admissions of suspected cases of RVF to the hospital have decreased.

Dr. Peters said that telemedicine offers great promise toward expanding UTMB's reach and ability to extend aid to those in need. "We were able to talk with the local physician and be sure that they had instituted the proper public health measures", Dr. Peters stated. "He also had some questions for us on what he should be doing to protect his hospital staff - and we were able to advise him on this issue as well." Dr. Peters added that the telemedicine technology was well-received by the local citizens, and he feels this technology provides a possible way to support and aid these populations.

Dr. Stanley M. Lemon, director of UTMB's Institute for Human Infections and Immunity (IHII), called this initial field test of the telemedicine technology "an outstanding start of a novel and unique paradigm", adding: "It has tremendous potential to link expertise here at UTMB embodied in someone like Dr. Peters to the management of a dangerous infectious diseases in the field."

Elaborating, Dr. James LeDuc, director of a new Programme on Global Health within the IHII at UTMB and associate director for programme development for the Galveston National Laboratory, a seven-story biocontainment facility now under construction on the UTMB campus, said the technology provides a "great training opportunity" for UTMB students and postdoctoral fellows in the field and on campus, as well as for indigenous medical personnel. "We consider this to have been a major success and clearly of value to both the physicians on the ground and to our academic colleagues here at UTMB", Dr. LeDuc continued. "Based on this successful demonstration, we will be expanding our technical capabilities and building partnerships with collaborators around the world to expand our abilities to jointly investigate interesting cases in infectious disease and respond to important outbreaks."

As of mid-January, more than 220 suspected cases of RVF, including 82 deaths, had been reported in Kenya's North Eastern Province and Coast Province. Since then, the Kenya Medical Research Institute had confirmed 56 cases and 12 deaths. In the Garissa District in the North Eastern Province, there had been 132 cases and 54 deaths. Another 58 cases and 10 deaths had been reported from the region Dr. Kahlon visited. Undoubtedly there were many more cases that were not reported by the under-supported public health infrastructure.

When the UTMB Electronic Health Network (EHN) received a call for aid from UTMB's infectious disease experts, a portable unit was not readily in stock for deployment. In less than two days, the EHN crew assembled the unit and gave Dr. Kahlon a one-hour crash course on how to operate the equipment.

The capabilities of the technology sent were somewhat less than the latest available today and caused a five- to eight-second delay between the connections. But they were more than enough to enable the physicians and scientists to consult across oceans and continents and to examine the patient closely and listen to his heart sounds.

Dr. Glenn Hammack, who heads the Electronic Health Network, one of the largest operating telemedicine programmes in the world, stated of the project: "We put together what we had, and simply tested the capabilities to see how low the bandwidth could actually be, and still make a connection." The low bandwidth keeps both the cost of the equipment and the charge for satellite connections low.

Dr. Hammack said that although Dr. Kahlon was using generator power and had to climb the roof of the hospital himself to adjust the satellite for a better feed, the technology worked well. "We were able to see the patient, examine him and listen to his heartbeat through the digital stethoscope", Dr. Hammack stated. "We also received good feedback from the infectious disease specialists at UTMB on how we can improve systems for these types of projects."

Dr. Hammack said he couldn't recall another instance of this type of telemedicine connection being done. "It will certainly not be the last", he stated. "The possibilities are endless." The UTMB Electronic Health Network annually conducts more than 60.000 face-to-face physician-to-patient telemedicine visits from Galveston to locations throughout the world.

Leslie Versweyveld

[Medical IT News][Calendar][Virtual Medical Worlds Community][News on Advanced IT]