How have things come this far? No longer ago than last May, a two-day congress was organised on the island of Tilos to which participated the Ministers of Greek Government and Territory, the mayors of all Greek islands, and physicians and managers of major health care facilities. High hopes were raised at the time to install a permanent Telemedicine Station on Tilos to serve as an exemplary telematics methodology for export to similar remote islands and rural areas in Europe. In order to support this initiative, the "Archipelago" project has been submitted to the European Community. However, the initial enthusiasm of the local health providers and population seems to have subsided, leaving the health care management on the island in exactly the same situation as it was before the telemedicine experiment.
The problem of what Dr. Cavina refers to as the "human factors" could not be overcome so far. A hard but clear statement in the July report summarises the current stalemate faced by the Pisa team. "All health care data collected and stored in a database by the Italian team during May 1998, and all rescue protocols, available in the new computer of the Livadia ambulatory, have never been used since nobody is able either to enter them, or to use an e-mail, or to change the written text from the Greek fonts to the English ones." The only remaining alternative would be the temporary continuous presence for at least one year of a native speaking teaching staff with specifically trained telematics experts on Tilos as well as in other remote areas. Ideally, the regional or national establishment of a legitimate training school for practical telemedicine education of instrumentation and methods would solve teaching needs in a wider territorial range.
From May to August, potentials of risk have not once been evaluated though the local care takers could dispose of the laboratory, telematic facilities, and professional consultations, all implemented by the TimTem team. During the Summer, three emergency cases occurred, with one cardiopathic patient and two victims of gastro-duodenal haemorrhages, which were dealt with in the old-fashioned way without utilising the useful resources of the Telemedicine Station. On top of this, Dr. Cavina envisages a number of new risks that are threatening tourist regions such as Tilos. The building of larger roads with no signalling invites drivers to speed up and cause more accidents while the emergence of night clubs will likely stimulate the degree of alcoholism, drugs abuse, violence, and micro-crime. Here, the Telemedicine Station could play an important role of prevention and protection of both the population's and tourists' health.
To achieve an efficient application of telemedicine in remote areas, resident nurses and physicians should be obliged to become familiar with telemedical actions as an integral part of the conventional health care practice. This also goes for temporary substitutes of the resident practitioners and as such calls for a sufficient period of specific training on the spot, to carefully learn how to use telemedicine facilities, how to handle telematic instrumentation, and how to follow special medical protocols. Professor Cavina cherishes little or no illusions at all with regard to the regular use of reference hospitals for telemedicine, of which the rules and planning depend on the central political and administrative institutions. Let's trust there is still any hope and life left for the small and practical planned steps within the TimTem project, which may get a re-boost through Archipelago. For the history of TimTem, we kindly refer to the VMW article Beautiful TimTem baby slow but sure to transform into adult Archipelago project.