Students Bring Health Care to Underserved Patients

Their telemedicine system won the 2011 IEEE Student Humanitarian Supreme Prize

13 January 2012

In remote areas, access to a medical specialist usually means waiting months for an appointment and traveling hundreds of kilometers. For example, in northern Brazil, the country’s least inhabited area, a sick person on Marajó Island must travel anywhere from 12 to 24 hours by boat to Belém, the capital of Pará State, to find the nearest hospital. Regular checkups are practically impossible.

The problem can be especially acute for an expectant mother, who should get four periodic ultrasounds to determine the health of her fetus during her pregnancy, according to the World Health Organization.

A group of IEEE student members from the Federal University of Rio Grande do Sul, in Porto Alegre, Brazil, developed a telemedicine system that can help. With the system, which is outfitted with a video camera and microphone, physicians at remote health centers perform examinations that are guided by specialists at distant hospitals. The specialists analyze the results—in real-time—as video and audio of the procedure is sent using a broadband-over-power-line (BPL), satellite, or Internet connection.

The system was used in a 2010 pilot program in which technicians performed free ultrasounds for hundreds of pregnant women in Restinga, the poorest district of Porto Alegre and also evaluated the system for use in three remote villages in 2009 in Brazil’s Amazon region.

The students who developed the PoaS@úde Telemedicine Project won the 2011 IEEE Student Humanitarian Supreme Prize of US $10 000 in the annual IEEE Presidents’ Change the World Competition. The name of the project comes from “POA,” an acronym for Porto Alegre, and “Saúde,” the Portugese word for “health.” The contest recognizes students who develop unique solutions using engineering, science, computing, and leadership skills. The IEEE student members—project leader Alécio Binotto, Flavio Avila, Mateus Bisotto, Diego Bonesso, and Alexandro Bordignon—received their award at the IEEE Honors Ceremony in San Francisco in September.

The telemedicine system in Porto Alegre relies on several components: a portable ultrasound machine at the remote clinic, a BPL network the students set up between the clinic and a hospital, video cameras and microphones at each examination room, and computers to compress and decompress the video and audio sent and received.

A technician at the remote clinic performs an exam while a specialist in the hospital watches the procedure and views the ultrasound images, providing guidance via the audio link and a remote pointer and helping determine the health of the fetus. There’s a delay of about 300 milliseconds in receiving the video and audio at the hospital because of the time needed to compress and decompress the data. But the delay is minute enough for the specialist to accurately analyze the fetus’s heartbeat and lungs, and check other vital signs.

The video below (in Portuguese), taken at one of the clinics testing the system, demonstrates how it operates.

PoaS@úde evolved from a telemedicine project that Binotto worked on with the Fraunhofer IGD Institute, in Germany. Financed by the European Commission, it was to be tested in Brazil.

“However, that telemedicine model did not fit Brazil’s needs,” Binotto says. “The real need was a real-time system with remote guidance that could be applied to the prenatal care of pregnant women in poor districts—which would lead to more usability and impact.” Binotto spoke with his advisor, Carlos Eduardo Pereira, who asked him to design the system’s software. “It was then developed by some colleagues who worked with another professor at UFRGS, Valter Roesler,” Binotto explains. “That led to the PoaS@úde Project.”

Pereira, Roesler, and another professor, Cirano Iochpe, got the support of the Porto Alegre city government for the system. They received assistance from the power company CEEE, as well as ,the Porto Alegre Health Ministry, the Department of Data Processing and Informatics and other sources.

The four communities chosen for the pilot program were truly in need of help, according to the students. In poor Porto Alegre villages, more than 60 percent of pregnant women miss regular doctor’s visits and ultrasounds because they can’t get transportation to the hospital. And it typically takes five months to secure an appointment with an obstetrician. Conditions are even worse in the Amazon region villages of Gurupá, Breves, and Portel, where the lack of regular doctor visits leads to the death of many pregnant women, according to Binotto.

“I think it is unacceptable that in the 21st Century—despite having informatics, engineering, medicine, and other developed disciplines—people are dying just because they have no access to basic health care,” Binotto says. “I believe that our telemedicine project is a very cost-effective way to offer good quality medical procedures to poor people in remote areas. Additionally, it is in accordance with two of the Millennium Goals of the United Nations: improve maternal health and reduce child mortality.”

Testing of the system in the Amazon villages ended prematurely because of a lack of funding for maintaining the satellite network. But the results of the students’ telemedicine project in Restinga were promising. The system decreased the wait time for ultrasounds to one month. And the percentage of women who did not have an ultrasound exam went down to about 10 percent from 60 percent during the project.

The system might even have saved some lives. Fourteen of the women examined had fetuses with developmental problems. Because this was detected early, the doctors were able to steer them toward the proper care, which could mean taking medication or going for more testing. According to the Brazilian government, about 70 percent of birth-related deaths could be avoided if women received better prenatal care.

In fact, the project was so successful that it has become a permanent fixture at four remote health clinics in Porto Alegre, the students say. Each center is staffed by a technician trained to use the system.

And the students have since created a start-up, i9access, at their university that provides commercial support and investigates ways to further the technology. They’re researching how to apply the communications system to other medical tests, including electrocardiograms, and even to assist in surgical procedures together with the Projects in Audio and Video Research Group at their school.

“Receiving the IEEE Student Humanitarian Supreme Prize has motivated us even more to continue our research,” Binotto says.

If you’re involved in a humanitarian project, consider entering it in this year’s IEEE Presidents’ Change the World Competition. You have until 31 January to submit your project.

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