Ecuador is an ideal location for conducting test beds in telemedicine and telementoring to explore how nascent technologies can be integrated into medicine in remote and extreme places. Beginning in May 1999, MITAC developed a project in Ecuador to demonstrate that telemedicine was a cost-effective way to pre-operatively evaluate patients in remote villages. The project has expanded to include telementoring of medical or surgical consultations to very remote areas where a general practitioner or a layperson might be the only healthcare provider. Through lessons learned and experience, project objectives have expanded to include examination of the prospects for
1) continuation of telemedicine as a pre- and post-operative tool;
2) expansion of telemedicine beyond surgery so that medical advice could be provided from larger medical centers to remote villages;
3) development of an electronic medical record so that transmission of information would be easier;
4) development and implementation of an electronic database to expand knowledge of indigenous medicines and treatments;
5) train our partners at the Fundacion Cinterandes in Cuenca and other Ecuadorian groups to become self-sufficient with regard to teleconferencing and transferring data to and from remote areas of Ecuador; and
6) evaluation of high frequency radio as a mode of transmitting medical data.


During the past two years, several successful trips to Ecuador have taken place to advance the project objectives. Teams of medical and technical personnel have completed many objectives, including: electronic transmission of preoperative patient data; installation of Electronic Medical Record (EMR) in Ecuador and training of collaborators in entering, exporting, and importing data; transmission of text files (10kb) from remote villages to larger cities using high frequency radio; transmission of EMR-exported data file from Taisha to Macas using high frequency radio, radio modem and software; transmission of data from Macas to Cuenca via Internet; and a telesurgery conference, Cuenca to Richmond -- transmission of live hernia surgery from a mobile surgical truck with images from laparoscopic camera held by alpha-port, while surgeons in Richmond identified key structures. MITAC's industrial affiliate, Televital has been a key partner in accomplishing MITAC's plans and objectives in Ecuador.

As an extension of previous work with telesurgical monitoring of both laparascopic and open surgery, the project in Ecuador has extended MITAC's capabilities to include the monitoring of basic physiologic parameters during surgery. In much the same way that surgical consultation has been enabled by use of the RDTU, anesthesia consultation is now available for remote situations. During the December 2001 trip to Ecuador, surgery was performed in the Cinterandes Foundation Mobile Surgical Facility in Sucúa. The surgery, an open cholecystectomy, saw the first known transmission of real-time physiologic parameters for distant anesthetic monitoring. Dr. Lynne Gehr, a faculty anesthesiologist at MCV/VCU monitored the transmitted data in the MITAC laboratory, while Dr. Patricio Escandon, a member of the faculty of Yale University's Anesthesiology Department, was the local attending anesthesiologist. Much of the clinical data transmission was made possible and more effective by MITAC partner Televital's telemedicine software.