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