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A Non-profit Health Professional Network in Bangladesh             
Introduction | How the idea came | Things were not easy | Structure of MEDINET | Success of MEDINET | Future goals | Conclusion | References               

Bangladesh like other developing countries cannot support training for large numbers of physicians on recent developments, nor can they afford sufficient books and journals. Whereas the BMA Library in London subscribes to around 700 journals [1], the library of Dhaka Medical College (the premier medical school in Bangladesh) may irregularly subscribe to only 1 or 2 current medical journals. Thus, the poorer patients in developing countries are deprived from the benefits of modern medicine. 
The advent of Internet kindles hope to make more information more readily available to more people at low cost. However, Bangladesh is still not in a position to utilize this benefit due to a serious weakness in it's telecommunications infrastructure. Here, even the higher educational institutions lack Internet access. Most Government medical schools have only one (or no) computer; none have full online access to Internet. 
To alleviate this information poverty amongst health professionals in Bangladesh - at least in part - we initiated a non-profit project, MEDINET (Medical Network), to provide locally-appropriate solutions for electronic exchange and Internet access. 

How the idea came 
I had opportunity to work directly with computers since 1989 in a philanthropic organization and I developed a natural weakness towards the benefits of computers. I subscribed to a commercial e-mail bulletin-board service in 1994 at the first opportunity. I was looking for ways that e-mail might be used to make current medical information available in my country. I established the Medical Information Group with a few of my enthusiastic students. We held 3 live demos of Internet with collaboration from Ford Foundation in                  October 1995. The demos were held at 3 of the most important health institutions in the country. All events were largely attended by professionals in various capacities, which inspired us to develop the concept of MEDINET.

Things were not so easy 
We started communicating immediately for software and hardware support and soon received a shareware bulletin board software, and the offer of hardware from a local organization. Due to political unrest in the country during that time we could not make effective liaison. Thus, we started service using a 486sx Compaq notebook computer which was being used in a research project. But, after a short time, the notebook computer was taken back permanently. The local organization did not keep its commitment. However, a                  diagnostic company provided another computer and we resumed service. 
After a few weeks the diagnostic company also took the computer back. It claimed to run MEDINET as a commercial profitable company. We rejected the proposal. We then invested in a computer ourselves. Membership campaigns were conducted via press releases in local newspapers, letters to potential clients, and by undertaking other promotional activities. Enhancing computer and Internet literacy was deemed necessary, and we launched a comprehensive computer course for medical students, doctors and                  teachers. With all these efforts, MEDINET began to progress steadily, adding new users and resources.

 Structure of MEDINET 
MEDINET has a LINUX-based Internet host. It connects to the Internet hourly via a dial-up UUCP account with a local commercial Internet service provider. MEDINET stores information in several areas, enabling users to share information, messages, electronic books, articles, journals, newsletters, and software, etc. We regularly procure and update valuable information from Internet, viz. ProMed, EDrug, MedPulse, Medscape, and SIM, etc. Users are assisted to retrieve medical journals. We encourage users to prepare and read messages offline, which ensures efficient use of limited telephone lines and enable them to getting connected to MEDINET without much awaiting.
Success of MEDINET 
Currently the MEDINET network includes many individual users, organizational users and several distribution centers. Remote subscribers use store-and-forward technology to receive/send information in one or two dial up connections per day. MEDINET provides a public Internet service at Dhaka Medical College. Information is displayed in a suitable place for public viewing in some institutes where we could not establish a formal MEDINET connection. Bicycle messengers or couriers are used to carry messages to and from                  distribution centers. Individual users render services to their friends and colleagues. 
This unique system has created a backbone for the distribution of national public health information, and hundreds of professionals and medical students not owning personal computers or telephones are able to benefit. Our computer course has so far trained few hundred doctors and medical students in 6 essential computer applications.
Future goals 
In the absence of other non-profit, academic, professional, or Government networks, several commercial online access providers are aggressively trying to capture the market. They are attracting users looking for entertainment, online chat, etc. It has become difficult for MEDINET to co-exist with this competition, with it's less glamorous 'offline' Internet service. 
MEDINET believes it would be more competitive if it offered a live service (rather than relying on intermittent connections and offline reading). However, because the cost of Internet access is a factor,                  MEDINET's current system may provide the most economical form of access nationwide. To enable users to maintain personal e-mail accounts and local discussion groups, we plan at least one sub-host server in each medical college. We are also offering free connections to the Computer Training Centers in districts and rural towns for distribution of health information. MEDINET introduced free medical advice for patients through consultations with it's physician members, and also other physicians on the Internet.
'While the lucky few million in the rich world amuse themselves in cyberspace, half the human race has never made a telephone call.' [2]. Those in the world's rich northern countries can happily chat among themselves by post, telephone, fax, and e-mail, but very few doctors in the poorer countries of the south can join in. MEDINET is less glamorous, but it is a locally appropriate, simple and inexpensive system which combines the power of information technology with a traditional information distribution system. Experience suggests that glamour often defeats values and rich traditions. Unless we improve the quality of our service MEDINET's future may be at risk. An estimated amount of US$14 250 is required transform MEDINET to a fully online network. We need more computers to provide sub-host servers and extend our training capacity. All MEDINET workers provide voluntary services, but for obvious reasons, they are not in a position to financially contribute. May the world's population come forward to support MEDINET's noble goals. Despite all the constraints, MEDINET may serve as a model for other regions with limited Internet access.
1. Groves T. Information sharing: getting journals and books to developing countries. BMJ 1996;307:1015-7. 
2. Anon. Tele-haves and have-nots. Economist 1996 May 18:19-20.