An international telehealth symposium was conducted between healthcare institutions in Hawaii and Thailand using a combination of Asynchronous Transfer Mode, and Internet2 connectivity. Military and civilian experts exchanged information on the acute and rehabilitative care of landmine victims in Southeast Asia. Videoconferencing can promote civil-military cooperation in healthcare fields that have multiple international stakeholders

Berg, Benjamin W.

Chitpatima, Suwicha T

Hudson, Donald H

Soh, Eugene K

Vincent, Dale S

eVols at University of Hawaii at Manoa

An International Landmine TelehealthSymposium between Hawaii andThailand using an lnternet2and Multi-protocol VideoconferencingBridgeGrant Support: Pacific Teiehealthand Techn0oay Ho and the Freeman FounoafionDsclaimer: The vews expressedin this manuscript are those ofthe authors and do not reflect theclime OOff or oos1cn of crcDeoartment of the Arrry. Deoarhwent of Ddense. or the U SGovernment.- Department of Medicine, TripierArmy Medical Center. Honolulu,H:i96859:E.KS.. D,S,V,B.W.Sf.uauanc amPacific Teiehealth and Technolcy Huf Honolulu. HI (D,H.HfCcrrespcndence to:CPT Eugene K. Sch MDMCHK-DDIT:pier Array Mec’icai CenterHawaii 96859-5003Ph: 80S433-5720Abstractbetween heal/incare instituirons in? franca/i and J7nahland usinq a comb/nat/on of Asyncinroncnus TransferAn/ode .a rv3 lntenrnet2 cunnectr’v/tv Mil.itarv arid c!vi/—‘an eeoc’ ‘s ewr’anquo :e?o”avcn on ne aca no ariarenac:/iia i. n-c care or i.anorm;• roe yin tn-rae inA5 V’ocOOOri creel rig c ‘ore vU larvcon‘peration in healthcare fiolds that have mult4ole,nrerrnato’na! star cnneoersIntroductionLandmines are a major public health problem inThailand. The 2001 Landmine Impact Surs er foundthat landmines along the Cambodia. Laos. Burma.and Malar sia borders affected 531 Thai communitiesin 27 provinces. According to the Survey, 346 newIandmine casualties ss crc recorded heiss ccii June 1 OHSand Mar’ 21)01This telehealth symposium enabled landmme experts from Thai Non-Governmental Organizations(NGOs’t. the Rural Thai Armx RTA a Hass aucharitable service oroanization (Shriners Hospital forChildren. and the US. military to exchange intorma—tion on the acute and rehabilitative care of landminevictims in Thailand.\\e has c pres ouslx reported successful. regularlyconducted s ideoconferenceson healthcare topics risingeitherdirzital telephone OISDN)orlnternet2 eonnectivitra between two tertiary care hospitals in I lawan andThailand. Expandmo on tbs model. ‘ye conductedthe landmine svmpoium between three sitec, twoinstitutions in Hawaii and one in Thailand, using aconrbinat ion of ISDN. Asynchronous Trans/dr ModeAT\’l’i, and lntcrnet2 connectivit uver an electronrchridoe.Methods4 thrce—huur seminar \sas conducted 2’ .lLilv 21(1)4 at1601 i Honolulu and I (000 25 JuL 2(304 i Bangkok),There is crc tinee participat no sites The Thai laneyideoconterencjng site was Phranii’nokutklao Medical Center (PMK), a 000-bed tertiar care hospitalin Bangkok operated 1w the Royal Thai Army thattreats cii ilians. and milita re personnel There were twoparticipating sites in Honolulu: TriplerArmv MedicalCenter(TAMC). a242-hedtertiary careeenterdrr I-USmilitary personnel and their fdniilies: and Shriner’sHospital br Children t SHC a free 40—bed suroreaiand rehabilitatis e orthopedic hospital.The three participating sites utilized two differingforms of connectivity and a multi—protocol video—conference bridge to enable sites to interconnect.Tis o sites TAMC and PMK I utilized InternationalTelecommunications Union standard 11323 s ideoconferencing us’- ing Internet protocol (IP’) over thelnternet2 netisork to connect to the brds’e. These tvsites utilited Tandbern videoeoriterence equipiiient.The third site (SI IC) utilized a private AIM circuitcarrying 1-1323 [P to conned to the bridge, and alsoused Tandbers equipment.The des ice enabling these disparate systems tocommunicate is called a multi -protocol videoeonterence bridee, and is operated by the State of HawaiiTelehealth Access Network and Ii’ ‘used on the UI—icampus. The hridoe naintai es 11320 ISDN ito the public switched telephone sn-stem. 1-1323 lPrports’ to the public in.ternet and internet’.2. as well ar:ATM poils to pm ate crcut. The hridrre translatesan incoming 1-1320 pn tocoi nto an oute’ i/n” I-l32.and vi,cwversa, enabling the hitter/ag systei’ns tocommunicate The hiidtnec.an he.con’figuredfor”Confictions Presence” where all sites hear all partic’ipantr.and ‘see all participants in a sitscicl!i Hills in- nodSqunes/: tor “Vriice Actiyatn’d” sn-here all sites hearall participants anc’ see on.ly the. activel spe.a.k’ing site.;and f/rn “Central Control” is here the hrtdoe operatormakcs determination’ ot’ 1m-itcarr-and-sccssvhatbr the duration of a videoconfcrence.294All lectures were presented in English. ‘s ith supporting Pms erPointslides. Thai \GOexperts discu’.sed the landmine prohlem: mine riskeducation: mohileprostheticclmics: inanufactureofpmsthetics usinglocal materials: research on social issues; and victim assistance. ARoyal Thai Army physician discussed acute resuscitation and victimtransport in Thailand, and three US. military healiheare providersdiscussed Blast Resuscitation and \ ctim Assistance BRAVA) programs in Sri Lanka and \ ietnam. At the conclusion offhe procrciin.l\rtic ipants anonvmouslc ucd a wirelessAudienee Response Sc stemto rate the technical arid educational quality of the ideoconterunceon a 9-point Likert scale i awful, 9=excellentResultsSeventy-one people participated in the seminar. If) in Thailand and5 in Honolulu. There were attendees fom ten countries, includingThatland and fec CS. -\total of I—I different \GOs ss el-c representedat the conference. In [lass al, nine 5 of the attendees represented\GOs i(15’ ss crc members of the Royal Tha Arms or ti-icmtl:tart. and 14 If-c \ere non-\O ct\ bans In Thailand. ten93ff) of the attendees represented NUOs and si\ 37ff) attendeessve.re either ir.i tl.w. Roa.i Thai Arm or the •U.S. mii.i.tary. Nearlyhalf of the attendee.s were physicians, with a higher pe.rcentage07%) in Hass au than ri Thailand 3 1 C). Attendees a-greed thatas sientlican; trainnc value in the- conference mean (vP.Nt — 1 I O,i i 0 “IF) t “mcl ideci mean lv I 9 SI) I 37. rre$3 was good at :disireslost scitind or S ideo.DiscussionThe United State.t.i has a long history of participating in dem.iningartivi.t.ies: in Thailand. In 2002-3. US. humanitarian deminingassistance- totaled over 55(10,000, including 5650,001) Corn theS rate Depart nte nt br ibm M no Act 6 ln Center activities, and theeruai nder al located for I_ - S - miii tars er’conne I to ci ndnct two in—train-the-trainer mine awai’cness scion, This was the 1laudmine ss mpos um coi td acted sl nlt I taneous is in 1 hal land andthe U-S. using. vide.oconberene.tng.Most inte.i-national distanc.e learning ii.litiatives h.ave. occ.urredtn academic se.ttings. rtvo-sva irttr.rae.t.ive. video and internetcourse for uures between the Universirs of North Carolina and theDc Prefecture Collece of \ursne in Japan has been describedl-kblad ct at rcccntlc reported a pilot tudc with Swedish medicaltucIcnts, n o hich teachers 1rpm the C 5, -5us1ralta, and Ss edena:’ed tdeoeluteteucluo to P500 fec uiedicat students in refugee-mental heaiti%In ourexpcrie.nce. NGO work.ers are u.ncommonly used as’ teachersin undc.rgradu.ate or grad.u ate. medical education tra i nine prograrm:.Trehan or al reported that medical students from Northwesternnis ersuts routinely bras el to Cental .-\merica to work in ruralhealth clinics staffed nuatuls bc NG0-. with the coal of exposinethe students to a different set of medi5al and public health is’ncsthan tOes o aid tvpiealls encounter in the 175,Our previous interncr2 vudeoconierences has e been conductedpoint-to-point between PMK and TA DC. In the current model.tii.e use cf the bridge a.t the lJnive.rt..rity of Hawaii allowed an audience from a non-Internet2 site to participate. One disadvantage ofusuitC the hruds’c was the loss of the capability to show speaker andl-DsverPoint content simulttuleousls, a suhoptinial situation whenmans participrmis speak English as a second language. ‘Though itwas possible to switch video input from “talking head” camera todirect input of PowerPoint slides, the resolution and scan conversionresulted in reduced legibility of images and small typeface on thePowerPoint material.The bridge aIlo’ ed tile collaboration beiss ecu lnternet2. ATM.and ISD\—enahled sitcs. hut a ness eropen—source software ensemblecalled tile Access Grid - permits more robust eroup-to-croup interaction to take place over a distributed nerss ork such as Internet2,The simultaneous inultipoini—to—mulupoint capability oil tile AccessGrid has the potential to overcome many limitations of traditionalv ideoconferencing.ConclusionThe landnine symposium derrmnstrated that s deoconterencingtechnology can he used topromotecisI-inulitary dialog tora healthcare roblem that is typIcally enconntei’ed only in the des elopIngworld. but that lids relevcinc e to takeholder’ in des eloped coLintricsas ss cii, Videoconlereneing is an effective nrcthd for members ofthe international medical community to link geographically remoteteachers and learners svith common educatonal goals. The highbandss idth capahilits of the Internet2 permits high qualits point—to—noints ideocoritcrcncng, and ness Access Cirid soss are oilers thepossibulits- of expandinc the International telchcalth consersation tomultplc sites that are all interacting at the sane timeAcknowledgementsh utbor wu o thank he e undl gJ for hel spe 1 ce recorduna ripe turn Dr Bore 0 rn of wait Tel he Ith Ace1 o k Mt h I o P1 of h ci e I H awh In ft Unu 1 utH wa So t a u of oP he Teu h Ith ndTe note y Hw, Honol Ik5 B, k and a Naict-ar Kaew0n o’ g o ff . e P1 gkalk ac M°d a7no’ 8angkc Jam L-rdre gf “a’ S ‘a 0o o5a - cr ffvldren Honeff-cr ThdcJ Bems ao blato- cobt Edo’ be’ ‘‘ ac”; fl-i Stsr° HA ristaro,., Ths-siOReferencesI I II‘‘—It295

An international landmine telehealth symposium between Hawaii and Thailand using an Internet2 and multi-protocol videoconferencing bridge.

http://evols.library.manoa.hawaii.edu/bitstream/10524/53512/1/2004-10p294-295.pdf

An international landmine telehealth symposium between Hawaii and Thailand using an Internet2 and multi-protocol videoconferencing bridge.

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eVols at University of Hawaii at Manoa