Kilimanjaro Hospital Video Linked to Northumbria Healthcare

OR Networks was approached by the charitable link team from Northumbria Healthcare to assist in their development of laparoscopic surgery in Tanzania, the benefits of which are numerous.  To assist in this process we were asked a fairly simple question:  "can we receive high quality video, transmitted from a hospital in kilimanjaro, to our offices in Northumbria, that would be of sufficient quality for us to assist and mentor?" 

Whilst this is a fairly simple question, there are a number of reasons why an immediate response would have been no. Cost prohibits all normal methods of transmitting high quality realtime video, such as ISDN lines or satellite uplinks.  The only affordable medium was the public internet and this is fraught with poor infrastructure, particularly in East Africa: lack of ban

dwidth (the quantity of information that can be sent per second); latency (the time it takes to travel from one destination to another) and congestion (everybody wanting to have what little bandwidth there is).

Last year we proved the principle of transmitting from Africa to England via the internet but there were still significant obstacles to overcome, therefore, the question then was:  is there actually any available equipment that could manage poor infrastructure, low bandwidth, long latency and heavy congestion?

The short answer was again no:  most cheap video conferencing systems were poor quality and fragile (nobody had managed to even use Skype or NetMeeting successfully in Tanzania for any length of time); most expensive high quality video systems would fall over at the limited resources.

The answer was to design and build our own system that utilised varying internet availability, reliability and quality; was stripped down to the basics so that every bit of bandwidth was used to transmit video and to work with TTCL (Tanzanian Telecommunications Company) to advise them on what our requirements would be and how they could improve the service as best they could.

The TTCL company has really done a great job and have improved and are continuing to improve the infrastructure of the country, so much so, that they now plan to run fibre optic cable (more speed and bandwidth) from the outlying towns to the main hubs  and run a marine fibre to South Africa to replace the current satellite link that accounts for 2/3 second delay.

One final problem remained, how can we get personnel in Tanzania to effectively run the equipment with limited IT skills.  The answer was to include a remote control application that allows us from our offices, or staff at Northumbria to take control of the transmission system in Kilimanjaro.  All they need to do is switch it on.

The final days of the trip proved the design to be a total success and we reached our bench marks by transmitting full resolution images to Northumbria into the Surgical Skills institute in Hexham.   The system includes two way audio and return video from Northumbria:  this facilitates live tuition,  nurses forums and operative training in addition to the original design brief to facilitate surgical tele-mentoring.