Intended for healthcare professionals

Rapid response to:


Use of telemedicine will double in next decade, report predicts

BMJ 2010; 340 doi: (Published 23 March 2010) Cite this as: BMJ 2010;340:c1634

Rapid Response:

Telemedicine offers transnational burn patient care to Sao Tome

Zarocostas indicates an ever-expanding area of healthcare services (1). Such new trends, however, should be considered seriously toward the needs of those in developing countries, as well as those countries that have developed them.

The utility and efficacy of telemedicine have been debated for years (2-7). Making telemedicine available to serve those with limited resources is a key global health concern (3). Taipei Medical University's medical mission provides an example of telemedicine linking one of the world's most remote locations with a team of experts.

In late December 2009, the medical mission began its work in the remote island country of Sao Tome & Principe. This former Portuguese colony is hundreds of miles from mainland West Africa. Medical resources in the host country are scarce, so most burn patients must recover without inpatient care if they survive infection. In early 2010 more than 10 patients with major burns were admitted to Sao Tome's central hospitals. Several of them died of infection and others faced problems later on.

Three children were brought to our mission in late March due to significant burns on the torsos, faces, limbs and inguinal regions suffered weeks earlier. Digital images of the children's burns were sent by e-mail to the University Hospital in Taipei. A follow-up Skype videoconference through rented satellite link in Taiwan's Sao Tome embassy provided a barely real-time but conventional telemedicine consultation to evaluate burn severity.

Due to inadequate bandwidth, the close-up images' resolution was not sufficient to determine hypertrophic scar thickness, but the plastic surgeon in Taiwan identified that contracture had resulted in limited limb range of motion (ROM).

The decision was made to transfer the patients to Taiwan for post-burn reconstruction before irreversible body disfigurement and permanent functional loss. Unfortunately, one patient died of infection before transfer. The other two boys did well on the flights and were with their family members. After transposition flap surgery, skin grafting and rehabilitation both children regained good function and movement.

Burn reconstruction requires long-term planning and years of follow-up to reach optimal outcomes, especially for growing pediatric patients, in the Wan Fang Hospital affiliated with the University. Functional evaluation after their return to Sao Tome is planned through web videoconferencing. The medical mission also seeks to reduce burn injuries by developing preventive programs for use in the islands later this year.

Telemedicine's capacities and utility in burn cases have been noted (8-10). In this case, telemedicine and subsequent transfer out of country were indispensable in saving the patients' lives. Despite limitations in the accuracy of triage done via virtual devices, the ROM assessment was close to the previous evaluation using telecommunication. This proves telemedicine can play a valuable role in triage and planning for burn treatment referrals.

Besides the medical professionals involved in the children's reconstruction therapy, the larger university community is campaigning for donations to cover the children's health costs. Telemedicine has brought together medical experts and concerned citizens across the globe to help two badly burned children recover and move freely again.


1. John Zarocostas, Use of telemedicine will double in next decade, report predicts BMJ 2010; 340:c1634.

2. Rinde E, Balteskard L. Is there a future for telemedicine? Lancet 2002; 359: 1957-8.

3. Larkin M. Telemedicine finds its place in the real world. Lancet 1997; 350: 646.

4. Brown SW. Will teleneurology hit the big time? Lancet Neurology 2004; 3: 517–8.

5. Hazin R, Qaddoumi I. Teleoncology: current and future applications for improving cancer care globally. Lancet Oncology 2010; 11: 204–10.

6. Audebert H. Telestroke: effective networking. Lancet Neurology 2006; 5:279–82.

7. Solberg KE. Telemedicine set to grow in India over the next 5 years. Lancet 2008; 371: 17–8.

8. Saffle JR. Telemedicine for acute burn treatment: the time has come. Journal of Telemedicine and Telecare 2006; 12:1-3.

9. Turk E, M.H.M.F., Karakayali H, Kut A, Basaran O. Use of telemedicine in decision-making and burn follow-up: Initial experience from two burn units. Burns 2007; 33, Sup. 1, S51-S52.

10. Wallace DL, Smith RW, Pickford MA. A cohort study of acute plastic surgery trauma and burn referrals using telemedicine. Journal of Telemedicine and Telecare, 2007; 13:282-7.

Competing interests: None declared

Competing interests: No competing interests

26 July 2010
Professor, Dean for International Affairs, Taipei Medical University
Chiehfeng Cliff CHEN, Jan-chan John LIN, Min-Hui Marc HSU, and Yu-Tai CHANG
11300, 250 Wushin Str., Taipei, TAIWAN