Abstract
Recently the American Telemedicine Association (ATA) held its midyear meeting in Anchorage, Alaska. For those of us who had never been to Alaska, it was an adventure both from observing firsthand the natural beauty of the wilderness and the presentation and exchange of ideas on telemedicine during the meeting.
One can clearly see how remote Alaska is. Those who live there most likely appreciate this remoteness. It is a long way to anywhere! The striking landscape and the myriad of nature's beauty unfold at every turn. The vistas and wildlife abound on a road system that is highly efficient and with hardly any traffic. While traveling by car to the north, from Anchorage to Wasilla or Fairbanks, or to the south to Seward on the coast, you only see a very small portion of this glorious state. The majority of the state, and therefore its population, are not accessible by car. Only snow machines or small airplanes can reach the vast remoteness that is Alaska.
While nature can be deceiving, people must carefully gauge what action they might take. For instance, mudflats are not consistent with muddy ground. They may look that way, but clearly they are more like quicksand. People have met their demise by not paying attention or planning ahead. Additionally, on a hike to a glacier, while exciting and worthwhile, you must pay attention to signage that clearly states “if you are attacked by a black bear—fight back”; “if you are attacked by a Grizzly bear, play dead”; and “if the Grizzly starts to eat you—fight back.” This point is illustrated to enforce the concept of being prepared and having an awareness of one's surroundings. Healthcare in Alaska is the same way. More on that later!
The ATA midyear meeting typically provides a venue and opportunity for the U.S. Army's Telemedicine and Advanced Technology Research Center (TATRC) to conduct discipline-specific workshops or seminars. This year was no exception. Given the remoteness of Alaska and the remoteness of Hawaii, it was appropriate to discuss challenges in the delivery of healthcare across this large expanse of water and geography—the Pacific Rim. The U.S. military has men and women deployed across this area in support of its national interest. Addressing healthcare in this setting is quite challenging, and telemedicine and e-health are significant tools in the delivery system.
TATRC, in partnership with the ATA, developed a workshop entitled, “Challenges, Solutions, and Best Practices in Telemental Health Service Delivery Across the Pacific Rim.” This workshop was held in conjunction with the ATA's meeting. This one-day workshop was organized with the hope of accessing the current state of maturity of emerging applications of telemental health across this diverse geographical expanse. While the Department of Defense (DoD) is focused on the health and safety of its deployed forces, it has an interest in gaining a better understanding of what others are doing so that perhaps it can enhance its own capabilities to address its growing concerns of traumatic brain injuries, post traumatic stress disorder, suicide, etc. The format of the workshop included four panels with membership from DoD, Hawaii, Alaska, and government/academia. A formal report is being prepared with an executive summary to appear in this journal early next year.
The ATA midyear meeting itself provided an outstanding program. Two highlights were the speakers on the first day. Dr. Stewart Ferguson (President-elect of the ATA) and Mr. Martin Buser (four-time Iditarod champion) provided outstanding examples of the remoteness that is Alaska. Dr. Ferguson discussed the application of telemedicine and how his personal experiences of mountain climbing were an excellent analogy. Mr. Buser presented his firsthand experience of trekking across the wilderness of Alaska's interior in the 1,049 mile Iditarod race. Each of these individuals aptly illustrated the need for communication, planning, strength, and endurance to complete their activities. While telemedicine isn't really a climb to the top of Denali or a race across snow-covered Alaska, it is nevertheless challenging. Without the proper tools, planning, and communications, it will be significantly more challenging to achieve what you have set out to achieve.
The application of telemedicine in Alaska and the lessons learned in this frozen tundra help us all understand how we can enhance our telemedicine activities, regardless of our location. While we often think about remoteness as a geographical barrier covering a great distance, someone commented during the ATA meeting that remote can also mean under the Brooklyn Bridge—not underwater, of course, but those who live in close proximity. It was pointed out that access for these individuals is quite challenging due to traffic and getting to their doctors.
Recently, we participated in the grand opening of a telemedicine center in Tirana, Albania. This United States Agency for International Development (USAID)-funded activity established a national center in the capital, Tirana, and five other cities throughout the country. This grand opening included the Prime Minister of Albania, the U.S. Ambassador, and the Albanian Minister of Health. The rest of us either participated in person or by video teleconference. The importance of this event is that telemedicine has been embraced by the highest levels of government and is now part of the healthcare system of that country. This effort is part of the International Virtual e-Hospital, which is headquartered in Anchorage, Alaska.
This issue brings to your attention a number of issues related to remoteness, disaster response, devices, clinical applications, economic issues regarding costs, and the potential of mobile solutions in a developing world. These papers reinforce the concepts of remoteness and the characteristics that have made the applications in unique settings successful.
Alaska was a reminder of how telemedicine has been applied for a number of decades across the vast frozen tundra. The challenges Alaska faces are not unique to Alaska alone but shared by all of us wherever we are. Telemedicine could be considered a state of mind. If we put our minds together, we can achieve the unimaginable.