In February, we left Professor Cavina and his team from the Post-graduate School of Emergency Surgery at the University of Pisa in the midst of a difficult to solve funding problem. In fact, the "Tilos Medicine & Tele-medicine" (Tim-Tem) project workers were trying very hard to raise money for the installation of a permanent Telemedicine Station in the Greek island of Tilos to export it as a model for telemedicine services in rural and isolated areas. In the meanwhile, the mayor and physician of the island has succeeded in making the Aegean Ministry sensitive to the specific health care delivery issues in Tilos. As a result, the Tim-Tem team has now acquired the necessary funds for the station's immediate and full implementation. During the Easter holidays, the project people carried out a new on-field verification. Professor Enrico Cavina informed the VMW Magazine about the recent findings.
The fickle sea transport and weather conditions seem to form an insular constancy throughout the winter and springtime. The population, on the other hand, shows a permanent variability. Some two hundred younger people who have spent the winter in Athens or Rhodos return to Tilos for the Easter holidays. A strong activity is deployed by building traders personnel to fix all lodging facilities before the start of the tourist season. Due to the recent crisis in the Balkans, Tilos will soon face a substantial increase of the military population. All these non-resident people have not been involved in the Tim-Tem clinical mapping, performed in May 1998.
Among the islanders who were integrated in the health care files at the time, the project team identified a number of patients with pathologies at risk of worsening. This group has been submitted to a complete check-up. As such, two patients have experienced good, functional and objective outcomes. After an initial tele-consultation session, the first one received a hip prosthesis in a surgical intervention, performed at Rhodos in January 1999, whereas the second underwent aneurysmectomy after an ultrasonography tele-diagnosis. At present, a tele-consultation has to shed light on a very particular case of a patient suffering from ocular pathology, irregular aphthae to the oral cavity, and glossitis. A rheumatologist, working in the Tim-Tem team on the island, has diagnosed the endemic syndrome of Behcet, but the experts at the Pisa University still have to confirm this analysis.
A preventive action has been launched to trace down families at genetic risk. The team also tries to identify sporadic endocrinopathies, people with Down's syndrome, and malformations. In the light of epidemiological prediction and prevention, the road from Livadia over Megalochorio to S. Antonio currently is being transformed into a larger and more comfortable motorway. Speeding tourists are the cause of an increase in severe car accidents. In the Easter week, the Tim-Tem team witnessed one such case, in which the passengers luckily were not heavily injured. They were transported with the regular boat service to Rhodos Hospital and were discharged after 24 hours.
As for the telecommunications equipment, the team has obtained a spare basic computer instrumentation with accessories after the problems which occurred with a damaged modem, due to an unexpected breakdown in the electric circuit at the beginning of the year. On April 1st, a computer virus entered the reference station at the Surgery Department of Pisa University by a cryptic transmission via e-mail. Although it was immediately identified and destroyed, there was a temporary delay in the e-mail transmission between Pisa and Tilos. The incident has once again proven the urgent need for both ISDN and satellite systems to enable videoconference and interactive e-mail facilities. For "wireless" communication in difficult first aid field circumstances, the new Nokia 9110 GSM pays excellent services with regard to e-mail, fax, and image transmission communications from digital as well as infrared camera. In normal cases, the phone still remains a most reliable tool, which is commonly used by the doctor and people on the island.
The Tim-Tem team on Tilos now has the permanent disposal of two Pentium 2 computers with a fully equipped hardware and software 300MHg capacity. The machines support the use of video-camera, modem, printers, Internet, fax, and connections with photographic and medical instrumentation, such as ultrasound, radioscopy devices, and so on. A third computer is on its way. As a result, teleconsulting can be organized for dermatology, proctology and for image transmissions of teeth and oral cavity, the external part of the eye, and for reproduction of fixed X-ray and ultrasound images. At the moment, three digital cameras are available as well as portable electrocardiographs for tele-diagnosis with both the remote Centro Diagnostico Milano and a Centre for Cardiology in Athens. The team has also installed a temporary portable lab for hemato-chemical exams with modulated reactants in order to be used in direct connection with the computer for telematic or printed transmission of the results.
The most spectacular accomplishment however constitutes the supply by the Regional Health Care Administration of all the devices and equipment for the permanent Telemedicine Station. As such, the island of Tilos may expect the arrival of an ultrasonograph for "dynamic" images' transmission, and a portable radioscopy device with digital Dicom 3.0 output. This can be used by not-trained personnel to transfer images of a high quality definition. In addition, the Aegean Ministry has granted a sophisticated ambulance with complete resuscitation equipment. A specific training programme with tele-updating has already been planned for the doctor, nurses, and volunteers to experiment the telematic monitoring of vital parameters.
The Telemedicine Station will be implemented at Livadia ambulatory, where there is also a small room for hospitalization and ambulatory-like treatment. At present, the ISDN connection is being built, allowing videoconferencing to take place for tele-psychiatry and for patients in need of pharmaco-therapy monitoring. Currently, a study is being undertaken to investigate both the feasibility and financial management of a satellite system for emergencies. As far as the daily operability of the Telemedicine Station is concerned, there is a need for profound analysis of all the human factors involved. In any case, the islanders are very much aware of the organizational problems due to the actions of their mayor and doctor towards the Aegean Ministry.
Professor Cavina and his team expect to soon achieve some practical results with regard to the further development of the Tim-Tem project. In May, the mayor of Tilos has organized a meeting on the island in the presence of the responsible Greek Health Authorities to discuss the ongoing and future work within Tim-Tem. Plans have been unfolded to export and reproduce the Telemedicine Station model to other Greek islands, as well as to the centre and north of Europe in the regions of the Capraia Island and the Tuscany Archipelago in Italy, and the Western islands of Scotland. The Tim-Tem methodology will be summarized in a European project proposal, focusing on the citizens and their health. For more details, you can consult the Tim-Tem home page or read the VMW article Tim-Tem team requires urgent funding to build regular Telemedicine Station on Tilos in the March 1999 issue.