Abstract
There is considerable talk about medical diplomacy with regard to telemedicine. Dr John Howe, CEO of Project Hope, spoke on the subject in the annual Kenneth Bird address at the American Telemedicine Association (ATA) annual meeting in May 2010. Project Hope has certainly been a wonderful gift from the United States to developing nations, bringing medical training, collegiality, medical care, and resources to locations around the world. This charity has represented a confluence of public, industrial, and governmental resources throughout its history. The charity has honorably received gifts from individuals, corporations, and governmental agencies, and applied them to international need, in concert with massive volunteer efforts by medical personnel and others to staff the enterprise over the past 50 years.
In his remarks, Dr Howe emphasized that in its role of medical diplomacy, Project Hope is entering its third phase, which will include increasing reliance upon and propagation of telemedicine to alleviate world suffering. U.S. medical volunteers are out in the world in legions, with sponsorship from our professional societies. It is considered routine that medical people will find a way to join in relief efforts such as those in Haiti or in programs of sustained assistance as with Project Hope or Orbis in ophthalmology, Interplast and Project Smile in plastic surgery, and a score of other splendid conduits of care to medically underserved areas.
Nurses, administrators, and students clamor to join in the effort to bring the benefits of advanced medicine to areas in need because of strife, disaster, or poverty. Telemedicine can allow us to get there without even leaving our practice environment as consultants in such enterprises as the Swinfen Trust or iCONS where consultants volunteer to respond to health questions from around the globe. Our faculty members of the universities are always on the move to other countries to give lectures, teach, and advise on matters of health and human biology.
It is very gratifying that telemedicine would be considered a tool for diplomacy in that such a designation indicates the general applicability of telemedicine in crossing borders without losing value. Telemedicine allows us to embrace a very distant place, remote and underserved, with our best efforts, competence, caring, and concern. Telemedicine embodies attainment in technology and the promise of better health through better access. It is very appealing to an area of need that high technology can whisk into your remote town or hospital and join it in virtual community with the very best hospitals elsewhere. Telemedicine has such a sound general worth that it can be added to the list of activities and services that could be sent abroad to influence the minds and hearts of other peoples. It has the same qualities of apolitical and self-evident goodness as food, music, theater, dance, and general culture that can be recognized as beneficial without questions as to motive or intent. Who can argue against the merits of telemedicine, the dispatch of surplus grain to the needy, the building of schools, provision of clean water, immunization to spare the lives of little children, exchange programs of scholars, and heartfelt efforts to build understanding and a sense of oneness among nations separated by great distance and perhaps a chasm of economic attainment?
Is it not marvelous that the national resources of great nations might be applied in bringing the gifts of telemedicine to bear in distant countries? The U.S. military is without question interested in telemedicine as a tool of diplomacy, as is the United States Agency for International Development (USAID). Tommy Thompson, former Secretary of Health and Human Services in the Bush administration, believed he coined the term medical diplomacy, and strongly urged provision of funds to put federal dollars into vigorous programs to send U.S. medicine abroad to those places that were in line for the best diplomatic efforts. Is that the intent of medical diplomacy? Diplomacy is defined as the art and practice of conducting negotiations among nations. Is medicine a comfortable pawn in the field of international negotiations? Let us pause for a brief caveat.
We have seen U.S. programs such as Food for Peace in the 1960s and Atoms for Peace in the 1950s. We have seen many splendid programs by the most sincere of American people determined to win over the hearts and minds of others to a particular view of world peace. How often have those efforts deteriorated into disillusionment, animosity, and a general distrust abroad of the original intent? Cynics would say that increasing food output leads to population pressure and the consequent Malthusian alternatives of war and pestilence (but at least without hunger). Ditto for immunizations. Importation of free food leads to a collapse of the local agricultural economy, and Atoms for Peace might invite diversion of radioactive materials for sinister purposes. Building schools might violate local practices of religious teaching, and offering education to the best in another country might lead to a brain drain as those young people afire with the possibilities of Western academics and economics abandon their homeland for brighter prospects. And how many times has yesterday's darling of obsequious international overture become the bete noire of tomorrow's newspaper? Well perhaps only cynics would see things in such a way.
There is a finite danger that telemedicine could be seen as largely a high technology tool for national diplomacy. That is a pity. Telemedicine is a concept, an approach, a tool kit for humanity in general. It is not national or even regional. It is international by nature, recognizing no boundaries, political or otherwise. It is a lingua franca among the practitioners of medicine that has no accent, no particular face, no costume or limiting custom. Telemedicine is not of a place but in fact a manifestation of response to human medical need in cyberspace. Telemedicine is a domain of human endeavor not limited by geography. It is not comfortably applied only to those places that are deemed most appropriate to advance a national diplomatic agenda. Conversely, could telemedicine really be denied to those large swaths of humanity that are not in today's national interest or are hostile to its priorities? That does not seem right.
It is wonderful that telemedicine might play a role in medical diplomacy. There is no moral dilemma here. Telemedicine can be supported and sent anywhere with the clear identification of the donor nation. That, in and of itself, is not a problem for telemedicine. There is no morality or nationhood in a 1,000-calorie food pack or a performance of the New York Philharmonic. However, food should never be the weapon of intimidation, and music should never deliver a message of propaganda. Telemedicine is an absolute good, like nutrition or a crisp, refreshing musical passage. Telemedicine can be used but not owned. The effort to bring the benefits of electronic health to the world should be and in fact are far greater than the diplomatic efforts of a single nation. Medical diplomacy with incorporation of telemedicine is in fact good news. Medicine is not going to change, and any mechanism that can support the natural inclination of U.S. medical personnel to reach their colleagues abroad is welcome. Any device that allows medical personnel to work in tandem with their peers abroad toward the objective of human healing is just fine. Medical diplomacy is not the destiny or destination of telemedicine. However, if medical diplomacy can become the tool of telemedicine, that is all for the better.