Selnow's Address to the ITN Organizational Meeting

Gary Selnow's Comments
Children's National Medical Center
ITN Organizational Meeting
September 25, 2008

Most everyone here today has conducted medical education programs outside the United States; some of you have shared medical knowledge in developing countries; some have worked in the World Health Organization's Band 1 & 2 countries—the poorest of the poor. And some have ventured into conflict-infected countries where hostility smothers outside assistance. Sadly, those regions of poverty, isolation, and conflict also suffer the greatest need for medical knowledge. This is where we propose to focus the efforts of the International Telemedicine Network—on the countries in greatest need—where delivering services is most difficult.

Information Technology—or IT—lies at the heart of the program we propose. IT has many virtues and offers many options. The options, we'll discuss in a minute; the virtues are clear: IT saves time and money. Before breakfast, an educator in the United States can talk with doctors 10,000 miles away, then go to the office for a full day's work. Compare that to the travel time, displacement and financial costs of weeks on the road. We can involve thousands of medical educators for a fraction of the time and expense it would cost to send teams abroad. And, of course, it is pure "green" because we move electrons, not people, and that gives us a small carbon footprint.

We'll look at IT in a minute, but first let's consider why people here may be interested in assisting isolated medical communities.

Is it for the money? Raise your hand if your work on medical education in a third-world country has made you rich . . . . So, that can't be it. You work in these places—and you are here today—because you believe that sharing medical expertise will improve the practice of medicine in places left behind. And, these efforts, in turn, will extend life and improve the quality of life. These are valuable and noble goals. Goals as achievable through electronic means as they are in person—at least most of the time.

Moreover, for the physicians in the room, you may work in these places because you are drawn to the brotherhood of healers. Without a doubt, yours is a noble fraternity. By its very nature, it is also integrative, involving networks of professionals whose research and experiences collectively form the body of knowledge about healing. Collaboration is key. Why? Because good doctoring requires good collaboration. The medical profession everywhere benefits when you reach out to colleagues tucked away in tough places, anywhere.

Now, that brings us to what IT can do. For example, it can provide live video conferences in which we communicate face-to-face, real-time with doctors abroad. With considerable success, we have done that with medical schools in Iraq and elsewhere. It also can provide a forum for patient consultation. We've done that, too, right here from Children's Hospital when Dr. Craig Sable assisted with young patients in Baghdad.

We also can demonstrate and observe surgeries and other procedures with running commentary for real-time instruction. In times of public health emergency, we can bring in experts, as we did recently for a cholera outbreak in Kirkuk. We can digitally record these sessions, and archive and index them for access by others who could not attend the live presentation. Similarly, we can archive thousands of Grand Rounds, lectures, and training program videos to provide physicians in distant regions a direct connection to some of the finest medical instruction anywhere. They can access this material 24/7 and do that in their own hospitals and medical schools.

By way of an information gateway under development by our partners at the MITRE Corporation, we can supply disenfranchised medical communities with world-class, bio-medical libraries containing thousands of journal titles, textbooks and monographs. Communication real-time, communication recorded—in video and print—interactive tutorials, individual and group study; the resources we can provide will open the world to medical communities, now closed off. Medical educators, practitioners and students, now off the grid, can join a global medical community, once far beyond their reach.

So, what is this day all about? First, we should settle on a statement of mission about providing medical education and information in places now closed off. Second we need to sketch out operational details of an IT-based, medical education program that addresses our mission. We'll also look at how we assess a country's needs and evaluate program outcomes. We'll take a sneak peak at the developing gateway; and critically important, we'll discuss funding for this work.

Let me close with an important thought about the image of the U.S. abroad. While the benefits of our work for the study and practice of good medicine stand on their own, and the enrichment of medical collaborations—the brotherhood—cannot be denied, we should also recognize the value of this work to the world view of the United States. Far from waving the flag, I'm simply recognizing that a group of U.S. nonprofits and educational institutions, lending a hand where it is most desperately needed, can help restore some of the image that has chipped away.

With two quotations, let me end this talk so we can begin our work. The first is a challenge accepted by all of you who reach out to the world's poorest. You are already living the words of Gandhi who said, "Be the change that you want to see in the world." And the other is from the great philosopher, Yogi Berra, who said, "I want to thank you for making this day necessary."

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