Telemedicine: Its possibilities, problems, solutions (Part 1)


Telemedicine: Its possibilities, problems, solutions (Part 1)


Sunday, July 26, 2020

Print this page Email A Friend!

In 1978, all countries of the United Nations gathered for a meeting in the city of Alma Atta in Kazakhstan, a republic of the former Soviet Union. This meeting was an international forum to discuss the question, how could the world community provide basic primary health care services for its citizens?

To understand the importance of the practice of telemedicine to Jamaica and the world it is important to briefly reflect on its historical precursor — primary health care (PHC) from which many lessons were learned.

Every country was mandated to prepare a country report on primary health care for presentation to the conference. This document was submitted to the World Health Organization (WHO) regional body which, in Jamaica's case, was Pan American Health Organization (PAHO) /WHO.

The Title of our document was “Primary Health Care, Jamaican perspective”.

The document contained several papers, three of which were prepared by myself, at the time parliamentary secretary and leader of the delegation. The papers were:

1. Jamaica's PHC philosophy and policy;

2. PHC organisational and implementation strategy; and

3. The critical role of community participation in primary health care services in Jamaica.

The late Dr Christine Moodie, head of the PHC Unit, prepared the final paper on the framework on Jamaica's PHC National Plan and Implementation Programme. The other two members of the four-member delegation were Dr Pat Anderson from the Planning Institute of Jamaica and the late Ms Zenia Ellington, a senior administrative director in the Ministry of Health & Environmental Control.

The Jamaica delegation brought over 20 cartons of the document to the conference which disappeared before the first session. The buzz was that the document represented the essence of the thinking of the conference's leadership at that time.

To our surprise Jamaica's head of delegation was nominated and selected unanimously by the plenary session to be a member of the prestigious committee charged with drafting the final conference declaration.

The final draft declaration was referred to as the “Alma Atta Declaration” and was unanimously accepted by the conference as “Basic Primary Health Care for ALL, by the year 2000”.

The declaration was embraced with enthusiasm and unanimous acclaim by the large global delegations present. We all left the conference feeling that universal affordable health care, which had eluded humankind since the existence on the planet, was then a real possibility for all the peoples of the world, and that this would become a reality in just 22 years' time.

As history demonstrated, this dream has not yet become a reality, even after 41 years. The global vision has become an unfulfilled dream. However, present circumstances coupled with the convergence of the rapid advances in human development, as manifested by the global Fourth Industrial Revolution, are presenting very important dividends which, if given back to the people, may convert a hope becoming the real possibility of universal health care for all citizens.

In this regard, the lesson of COVID-19 pandemic is instructive, because it has taught the world, indeed all the so-called economic gurus at home and abroad, that public health and the national economy are both equal sides of the same coin. That they are organically linked with inextricable mutual consequences and outcomes.

Jamaica was taught this lesson as far back as 1983 when the International Monetary Fund (IMF) convinced our powers that be in the Government and the private sector in 1979 to drastically cut back on primary health care in order to rebuild the economy. This fallacy being the theory that one must at first correct the economic malady after which the public health system may be addressed. Public health specialists always defended the position of the inextricable link between the two development categories that they are mutually reinforcing in their development agendas and must be addressed simultaneously.

This lesson was taught in 1980 to 1983 when the full impact of the IMF programme began its underdevelopment of the public health sector. Jamaica closed two nursing schools, laid off over 2,000 community health aids who were serving the poor and the elderly, we cut back drastically on the training of public health nurses and public health inspectors, not to mention health education and nutrition education officers who were critical in our community participation for health activities and the recognition and treatment of malnourished children in poor communities.

This ill-advised global economistic IMF prescription resulted in a deterioration in the quality and scope and content of our community public health services. It exacerbated these conditions, manifested by rising infant mortality rates and rates of malnutrition, lowering of immunisation rates, deterioration in public health hygiene to the extent that we had an outbreak in the Cornwall region of poliomyelitis — a disease which had been eradicated in Jamaica over 31 years before.

A massive islandwide polio immunisation programme was introduced and stopped the outbreak from becoming an epidemic, which would have led to the inevitable crippling of our struggling tourism industry at the time.

This lesson of the inextricable link between public health and the national economic development was never learnt by our armchair economists at home and abroad. Our global and national historical records have given massive amounts of data to demonstrate this reality, including examples of the annihilation of civilisations by devastating pandemics throughout the history of mankind. COVID-19 is merely the present-day evidence of this reality which has now forced mankind to take the science of public health seriously or face the inevitable consequences of an intractable economic crisis.

Having acquired a body of knowledge from past and present scientific evidence, including those derived from 19 years of applied telemedicine research and development, one is convinced that there are technology dividends at this time which give us great confidence to overcome a number of existential health challenges suffered by vulnerable populations in Jamaica and the Caribbean. We must begin to focus on what it is that we are prepared to do in the post-COVID-19 health development space to build a more resilient health development capacity in preparation for the challenges of the future.

The advances in contemporary information and communication technologies, including artificial intelligent systems, coupled with the efficiencies from the Internet of things which are the derivatives of the Fourth Industrial Revolution, give us confidence — a confidence grounded in both the present and future of real and tangible outcomes for the achievement of universal affordable health care for all in Jamaica today. This possibility is more real today than any other time in the history of our country.

The role of telemedicine and the justification for its introduction in Jamaica as part of the solution to address these challenges is the second part of this presentation. Remote health care delivery systems are one of the outcomes of the changing health care delivery methods during this COVID-19 pandemic and the method is here to stay.

Telemedicine is certainly the technology with the potential to enable universal affordable access to health care.

Part 2 will answer the questions as to how will our doctors and their patients be able to deliver and receive high quality, confidential and privacy protected telemedicine services in Jamaica and the Caribbean.

— Dr Winston G Mendes Davidson is professor of public health & health technology, former head, School of Public Health & Health Technology at the University of Technology, Jamaica, and pioneer in telemedicine development in Jamaica and the Caribbean

Now you can read the Jamaica Observer ePaper anytime, anywhere. The Jamaica Observer ePaper is available to you at home or at work, and is the same edition as the printed copy available at




1. We welcome reader comments on the top stories of the day. Some comments may be republished on the website or in the newspaper � email addresses will not be published.

2. Please understand that comments are moderated and it is not always possible to publish all that have been submitted. We will, however, try to publish comments that are representative of all received.

3. We ask that comments are civil and free of libellous or hateful material. Also please stick to the topic under discussion.

4. Please do not write in block capitals since this makes your comment hard to read.

5. Please don't use the comments to advertise. However, our advertising department can be more than accommodating if emailed:

6. If readers wish to report offensive comments, suggest a correction or share a story then please email:

7. Lastly, read our Terms and Conditions and Privacy Policy

comments powered by Disqus



Today's Cartoon

Click image to view full size editorial cartoon