Rural Round-up: Maria Bakola on telemedcine in Greece

Maria Bakola of Greece writes about telemedicine in rural and remote areas in Greece from ancient times to today.

Greece, due to the geographical heterogeneity, combines mountain landscapes and lakes, as well as incredible beaches and many islands. Around 80% of the mainland is mountainous and has more than 3000 islands. Only 169 islands are inhabited and most of them have less than 100 residents.

Telemedicine in remote areas is of great importance, since it can provide effective health care to patients, at their place of residence, minimising the expenses and the need to travel for specialty care.

Telemedicine is good for junior doctors and rural GPs because they can communicate and work with experts on complicated cases, and at the same time it is good for the hospitals, because it helps them handle only very serious cases that need hospitalisation.

The ancient communication system in Greece included pigeons that carried messages, Hermes-the messenger to the Gods from ancient mythology and the fryktoriae network. The so called “Fryktories” (from fryktos = torch) were placed on mountain peaks or capes ensuring visual contact over a long distance, taking advantage of the mountain topography and geomorphology of the Aegean islands and designing a system outlining letters using fire.

Last century Prof Skevos Zervos (1875-1966) was a pioneer surgeon in transplants and telemedicine. He developed a system that allowed him to auscultate a patient from a distance, and the data could be transmitted to any place needed in the world. His innovative system was proposed to be used on board of the Greek ships that were travelling from Piraeus to New York, but the system was not used because it could not be afforded at that time.

Since then, and especially the last two decades, many other telemedicine systems and networks have been installed or are under development in Greece. A few of them are: Mermaid (medical emergencies), Nivemes (tele-consultation, videoconferencing), Ambulance (home monitoring, Athens, Nicosia etc.), Sismanogleio (pneumonic, cardiac, urological diseases in Northern Greece and Aegean), Hygeianet (general-Crete), Nika (teledermatology-Chalkis), Hermes (maternity Telemedicine Services- Primary Healthcare Centers of the islands of Naxos and Mykonos), Epirus-Net(general-Tele-diagnosis, Electronic Health care recording), Hector (prehospital Emergency Care-Crete).

Unfortunately, most of these were pilot programs that never had the opportunity to prove their value. It is worth mentioning two efforts that have taken place in recent years.

One is from a private telecommunication company. This telemedicine program is implemented in 100 remote areas throughout Greece. Those living in these areas can visit their GP and do basic preventive medical tests such as ECG, spirometry, oximetry, blood glucose test etc. If the GP decides that he needs an expert opinion, the tests are sent to a private health centre in Athens where they get the answer in the next 24-48 hours.

The second one, under the name “National Telemedicine Network (NTN)” covers the needs of remote areas, in the Aegean islands. It consists of 43 telemedicine units which are installed in primary care health centres of islands (such as Milos, Astypalaia, Ikaria, Kalymnos, Kos, Kastellorizo), in large hospitals of the Health District of Piraeus and Aegean, and in the centre of operations of the Ministry of Health. Each telemedicine unit includes a specially designed chamber, with an ultra-high-definition camera, a screen from which the patient or the doctor can see each other in real-life size, and other medical instruments such as an ultrasound machine, stethoscope etc. The results of the examinations conducted by the doctor / nurse-companion are real-time available to the expert who is involved in the examination from a remote location. In this way access to specialties such as internists, cardiologists, surgeons, psychiatrists, dermatologists etc. is offered to permanent residents as well as tourists in need.

This system was designed for use for both preventive and emergency care, as well for e-learning purposes providing training to medical and nursing staff in real time. I would like to express my sincere gratitude and appreciation to Drs Radeos, Bartzou, Karafotias, and Aggouridakis and Mr Koukoulas for their collaboration and special interest in rural areas and telemedicine in Greece.

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