Abstract
Over the past 12 months, the global community has seen what has been termed the Arab Spring. People living in the Middle East have risen up and demanded change. And change came! While the debate of what the catalyst is that caused this will rage for the foreseeable future, it is clear that technology and its application can certainly be credited. Nearly a year ago in December 2010, a vegetable vendor sparked a revolution in the North African country of Tunisia after his story was uploaded to Facebook. We now know the semi-peaceful uprisings of the disenfranchised populace in Egypt and other countries in the region were brought about in part by technology and of course the will of the people. The use of social networking tools such as Facebook and the Internet itself are the vary devices that are changing the world. The way we view each other, the way we conduct business, the way we educate, the way we get instantaneous news, and the way we conduct global health are all a result of the advances in technology.
Social networking tools have revolutionized the way people communicate. They have introduced new and profound ways of collecting and sharing data. Other tools such as Web 2.0 and even semantic Web applications (also called Web 3.0) and 3D environments such as Second Life are changing our understanding and utilization of the Web. They allow us to do things we could only imagine a few years ago.
Historically, technology has pushed human development from a societal perspective, and to a degree anthropometrically, to new heights. Fire, the wheel, city states, computing devices, even communications have taken thousands of years to develop, and humankind has changed for the good and the bad because of it. One could argue that the technology Columbus brought to the New World over 500 years ago had a massive negative effect before it ever had a positive effect. Nevertheless, technology continues its unabated march forward. Technology brought about change in Egypt, Libya, and other regions; we shall see how this ultimately turns out!
A personal interaction with a group of colleagues in Moscow, Russia, in 1995 sparked an interesting discussion. Our group was working with a Russian Hospital affiliated with the police, fire services, and Spetsnaz (Russian Special Forces). Our discussion was on the use of technology, specifically Internet-based technologies, and its impact on a population that is in dire straits. A comment that a population with access to healthcare knowledge and expertise would be less inclined to lean toward terrorism was put forward. One of the Russian generals commented that this was the first time he had heard such a revelation. While it was not clear whether that was indeed a truthful statement from him, it indicated that access to information is powerful tool and in everyone's hand it means something good and bad. We need not go far to see the events unfolding in Egypt, Tunisia, Libya, Syria, or other countries in the region to understand the power of social media. We witness first-hand history in the making.
In North Africa and across the region, individuals are speaking up. They are expressing their rights and their interests. The world is no longer one of isolation. It is a diverse and changing environment where the economy and commerce are interrelated and where events that unfold in real-time solicit an immediate response. The advancements in technology have made Earth a smaller blue ball in the void of space. Just imagine using Google Earth to actually see places, buildings, and other things on a map as a photograph and not a road map. It has made all of us aware of the changes in culture, geography, politics, and most importantly to global health. Technology is a social change agent. Technology is what makes us human.
New Approaches/Old Problems
Gunther Eysenbach with the Centre of Global e-Health Innovation at the University of Toronto discussed Medicine 2.0 in the Journal of Medical Internet Research in 2008. The model he presents has a pentagonal theme, one of which is “Social Networking.” The others include “Participation,” “Apomediation,” “Collaboration,” and “Openness.” Social networking is the key to the other four. It enables peering, collaboration, and filtering of information, and thus is an ideal next step in the development of health informatics. Apomediation is a new socio-technological term that characterizes a gatekeeping intermediary that serves as a “network collaborative filtering process.”
The ability to communicate public health information via Morbidity and Mortality reports to the Centers for Disease Control (CDC) or to reports to the World Health Organization (WHO) has been vital to public and global health. Perhaps a new paradigm is developing where technology is feeding information from a variety of expert nodes—nontraditional input points—directly to CDC or WHO. This cutting out the middle man or disintermediation as Eysenbach puts it may lead to more rapid access to knowledge, and therefore, awareness. Combining different technologies such as global positioning satellite (GPS) and Google Maps will help healthcare planners address outbreak of infectious disease.
Consider how information has traditionally been made available to us. Information traveled by horse or by foot or scribed on some form of media for centuries. In the past year, our computers, televisions, and our personal communication devices (smart phones) have relayed events that are occurring in real time. Even if a country shuts off Internet access, as we observed in Egypt, the news still travels at the speed of light! Somehow the word gets out. In the coming years, sociologists, anthropologists, and historians will interpret how or whether social media impacted these uprisings and caused change.
Social media tools for healthcare show great promise; however, there needs to be policies and guidelines in place to support such utilization between physician and patient. A recent letter submitted to the Journal of the American Medical Association (JAMA) indicates that there are potential problems with such tools. More accountability is needed.
In the meantime, we will continue to explore, adapt, and adopt new technologies that will help us ameliorate public and global health issues, and therefore making our lives better.
A New Year Is upon Us
This issue begins our 18th year and it promises to be a great one. By this time next year we will be electing a president, either staying the course or going in different direction. We know that healthcare reform will continue; vendors will continue to develop new devices, applications, and technologies for healthcare delivery; education will continue to evolve; and telemedicine and e-health will continue to grow. Researchers will continue their outstanding work and will submit and we will publish it after vigorous peer review.
In this issue we have a section devoted to Telemedicine in Africa. Maurice Mars brings together an outstanding collection of papers that addresses the application of telemedicine and e-health in sub-Saharan Africa. As a continent with a diverse population and numerous challenges, the application of telemedicine is seen as a highly useful tool.
In addition, there are a number of original research papers that highlight the evidence of the value and utility of telemedicine.
Finally, we acknowledge and thank our reviewers from 2011. We look forward to delivering to you outstanding research and communications about telemedicine in a dynamically changing world.