1. The Healing Touch (Mental Health Programme) Community Based Telemedicine System for Tsunami survivors Oxfam Trust SATHI

2. OXFAM TRUST NGO started during the time of 2nd Word War for relief to war victims NGO started during the time of 2nd Word War for relief to war victims Has the best equipped teams for disaster relief Has the best equipped teams for disaster relief Indian arm only one of 12 International partners in Developing Country Indian arm only one of 12 International partners in Developing Country In disasters previous Indian Experience In disasters previous Indian Experience –Latur Earthquake –Mumbai Riots –Gujarat Earthquake

3. S.A.T.H.I. Society for Administration of Telemedicine and Healthcare Informatics A Resource Organization for Developing Software Developing Software Training of personnel Training of personnel Field Testing Field Testing Project management Project management –Tsunami Relief Standardization Standardization

4. Past Experience of Natural Disasters Latur Latur –Immediate and Intermediate - Poor –Long Term Satisfactory in most aspects -- but PTSD PTSD Suicide rates > 20 times Suicide rates > 20 times Drug Addiction Drug Addiction High Drop Out Rates from School High Drop Out Rates from School Bhuj Bhuj –Immediate Poor, Intermediate Better –Long Term Less than desired Dr. M R Surwade

5. Tsunami Experience Immediate Immediate Intermediate Excellent Intermediate Excellent Long Term ??? Long Term ??? –Alcoholism –PTSD –Panic Reactions

6. Tsunami – the unfinished agenda Survivors are still in grip of fear & shock Survivors are still in grip of fear & shock Anxious & depressed Anxious & depressed Displaced & unemployed Displaced & unemployed Ignorant about tsunami Ignorant about tsunami –What was it? –Will it strike again? –How to be prepared? –How to cope with the after effects? Feeling of helplessness Feeling of helplessness Jan 2005

7. The concerns More people die of after-effects of natural disaster than the disaster itself More people die of after-effects of natural disaster than the disaster itself Mismatch between needs and services Mismatch between needs and services Inadequate no. of mental health specialist Inadequate no. of mental health specialist Increasing trend of psychosocial effects – depression and alcoholism Increasing trend of psychosocial effects – depression and alcoholism Stress and fatigue among relief workers Stress and fatigue among relief workers No community participation No community participation

8. The Telemedicine solution Ensure access to specialists’ services Ensure access to specialists’ services Ensure quality of services Ensure quality of services Enable people Enable people –to articulate their needs –participate in interactive sessions with experts Enable service provider to be need specific Enable service provider to be need specific Strengthen the health care delivery system Strengthen the health care delivery system Increased efficiency of service provider -more coverage Increased efficiency of service provider -more coverage

9. The Healing Touch Project Community based Community based Village level operable Village level operable Integrated with present health system Integrated with present health system –vertically: primary - secondary - tertiary –horizontally: among the networked units Empowering the community Empowering the community Exemplary partnership Exemplary partnership –between Government, NGOs, Community and development support agencies - DISTINCTIVE FEATURES Feb2005

10. The partners Oxfam – Funding and administrative support Oxfam – Funding and administrative support SATHI – Technical support, designing and operationalization of telemedicine system SATHI – Technical support, designing and operationalization of telemedicine system Local NGOs – Implementation and coordination Local NGOs – Implementation and coordination Government of TN Government of TN –Service delivery –Frontline workers –Health subcentres/ PHCs Specialists’ institutions ( SCARF, AIIMS) Specialists’ institutions ( SCARF, AIIMS)

11. Development & operationalization processes Health needs assessment Health needs assessment Designing of telemedicine network Designing of telemedicine network Advocacy & Orientation of all stakeholders Advocacy & Orientation of all stakeholders Capacity building of community mental health team (frontline workers of Government, NGOs and community) Capacity building of community mental health team (frontline workers of Government, NGOs and community) Advocacy and social mobilization of IMA, Indian Association of Psychiatrists) Advocacy and social mobilization of IMA, Indian Association of Psychiatrists) Sensitization of women self help groups Sensitization of women self help groups

12. Facilitating Intervention Counseling ( through Video Conferencing for the victim) in the presence of the health worker The Health Worker may be a victim too Expert Backup Individual and group sessions possible No Travelling Required by the victims Continuous learning (on the job as well as on the spot.) Adaptability to the needs

13. Planned Locations of Centres

14. The Planned Telemedicine Network CHENNAI TELEMEDICINE CENTRE Existing Superspeciality Telemedicine Centres I (AIIMS) Existing Superspeciality Telemedicine Centres II Existing Superspeciality Telemedicine Centres III TMC -1 TMC -5 TMC -6 TMC -7 TMC -8 TMC -2 TMC -3 TMC -4 Local Coordinator First Phase Second Phase

15. Basis of Field Unit Locations Assessment Assessment of situation regarding health needs Availability Availability of personnel to operate and use the systems Linkages Linkages with the Government systems and other health care facilities Support Management Support ISED PEDA FACE

16. Procedures Followed Check Background Check Background –Existing Health System –Of NGO Concept marketing Concept marketing Create MOU Create MOU Install the systems Install the systems Training Training Test Sessions Test Sessions Streamlining Streamlining Create TCS Time Table Create TCS Time Table Feedback Feedback Reporting Mechanisms Reporting Mechanisms

17. Basis of Central Unit Location Availability of Qualified Psychiatrists Willing for Voluntary Work Familiarity with the affected areas – –Physical Proximity – –Language Problems – –Previous Work Done Management Support

18. Training through Telemedicine system Training modules developed Training modules developed –Based on assessed needs –Human Rights perspective –Incorporates WHO guidelines – relief worker and affected people –On the job training and continuous training –Innovative interactive and participatory training methodology –supported by audiovisuals

19. Expected outcomes of pilot A developed operational Model of telemedicine system that A developed operational Model of telemedicine system that –ensures access to needed healthcare services –operable at village level –sustainable Capacity built : Community Health Team, NGOs, specialists institutions Capacity built : Community Health Team, NGOs, specialists institutions Package of Rapidly deployable Telemedicine Unit for disaster response developed and ready. Package of Rapidly deployable Telemedicine Unit for disaster response developed and ready. Mar2005

20. Current Status (May 2006) Funding provided for Three Units only (One in Centre at SCARF + 2 in periphery) Funding provided for Three Units only (One in Centre at SCARF + 2 in periphery) Independent Evaluation completed (Report awaited) Independent Evaluation completed (Report awaited) Over a six month period (from one peripheral centre) Over a six month period (from one peripheral centre) –Over 150 patients examined online –Tele counselling provided for 49 patients –Prevention of two possible suicides –Gradually decreased need felt for Mental Health support

21. Lessons Learnt Community based telemedicine system is Community based telemedicine system is –Sustainable –Excellent force multiplier –Effective facilitating tool for mental health assistance Coordination among multiple partners necessary for operationalization. Coordination among multiple partners necessary for operationalization. Difficulties in ISDN connectivity Difficulties in ISDN connectivity Better awareness about telemedicine needed Better awareness about telemedicine needed

22. Next steps Scaling up programme reach Scaling up programme reach –To address problem adequately –To utilize available expertise in mental health more efficiently Overcome Language barrier Overcome Language barrier –To reach the unreached More effective utilization of systems setup More effective utilization of systems setup Cover more areas Cover more areas Develop rapidly deployable units for disaster management Develop rapidly deployable units for disaster management –Need for Mobile Units

23. Problems faced by us New Technology New Technology Service Taking Too long Service Taking Too long –Connectivity –Identification of Specialists –Identification of Caring Institution –NGO Coordination Funding Funding Language Issues Language Issues

24. Connectivity Problems PSTN Line PSTN Line –Not Enough Bandwidth ISDN Line ISDN Line –Not all exchanges have it –Within 2.5 Kms of Exchange –Immobile Mobile Phone (CDMA /GSM) Mobile Phone (CDMA /GSM) –Service unreliable/ Low Bandwidth VSAT VSAT –Too expensive or only for Govt Internet/ADSL/WiFi Internet/ADSL/WiFi –to be tested Exchange themselves got flooded

25. NGO Coordination Problems Unfamiliarity Unfamiliarity Fixed Mindset Fixed Mindset Looking for Doles Looking for Doles Cross Restrictions Cross Restrictions Unwillingness to spend Unwillingness to spend Flagging off of Interest Flagging off of Interest

26. In Summary Implementing Telemedicine is much more than purchasing / installing Hardware and Software But Attention to detail can bring results

27. Three Phases of Disaster Management (Healthcare) Immediate Immediate –Evacuation/Transfer/Manage Acute Injuries Intermediate Intermediate –Drinking water / Sanitation / Food / Stopping Epidemics Rehabilitation Rehabilitation –Mental Health –Occupational Therapy

28. Acute Stage Management Help in Evacuation Help in Evacuation On Site Injury Care On Site Injury Care Know when and where to shift Know when and where to shift Possible to wheel patient in OT Possible to wheel patient in OT Running and Functional Systems work better in Emergencies Emphasis on Mobile Units Emphasis on Mobile Units Satellite / Mobile connectivity Satellite / Mobile connectivity Pre Trained Staff to be sent with the equipment Pre Trained Staff to be sent with the equipment Would help to have pre-trained local volunteers Would help to have pre-trained local volunteers

29. Intermediate Stage - Epidemiology Data Collection and Disease Surveillance Data Collection and Disease Surveillance Online Mass Training of Health Workers Online Mass Training of Health Workers Program Evaluation Program Evaluation Prevention and control Prevention and control Monitoring Monitoring Improved policy-making Improved policy-making Better Administration Better Administration

30. Suggestions and Planning for future disasters Create Delivery Network Create Delivery Network Pre Response to Trauma Pre Response to Trauma Testing Testing Pre Arrange Funding Pre Arrange Funding –?Sign MOUs Immediately

31. Additional Future Actions - for disaster preparedness Creation of National Population Database Creation of National Population Database –Smart Cards/Key Numbers Driving License?, Election Card?, Social Security Number?, Ration card? Driving License?, Election Card?, Social Security Number?, Ration card? Database of Stakeholders Database of Stakeholders –NGOs / Government / Private Players Database of Health Service Providers Database of Health Service Providers

32. Suggested Future Actions --cont Penetrating IT into Healthcare Penetrating IT into Healthcare –Role of IAMI –Knowledge Kiosks/CSCs Computerization of all Patient records Computerization of all Patient records –Standardization Issues –Data Locations ?Personal ?Personal ?Web server ?Web server Involve Local Hospitals and Medical Professionals in Training and Disaster Planning Involve Local Hospitals and Medical Professionals in Training and Disaster Planning

33. Thank You Acknowledgements SATHI Team OXFAM