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Last Updated: Sunday, 5 December, 2004, 00:56 GMT
An e-mail saved this boy's life
By Jane Elliott
BBC News health reporter

The snake bite boy
The boy is now waiting for a prosthetic leg

Few thought this little boy would survive after he was bitten by a snake in Nepal.

His parents consulted a Shaman who bound the boy's leg so tightly with a tourniquet it went gangrenous.

When doctors eventually saw him they were at a loss to know how to save him. The bandage had been on for 25 days and his leg was hanging off.

Everyone was resigned to him dying.

Saved

But his life was saved by the dedication of an English peer and his wife, their aid charity, telemedicine and a team of the best surgeons in the world.

Some of world's top surgeons were consulted and gave their advice that his leg should be amputated as quickly as possible to save his life. Against the odds he survived and he is now waiting to have an artificial leg fitted.

From the front room of their home near Canterbury, Lord and Lady Swinfen mastermind an e-mail system that puts hospitals in the developing world in touch with the best surgeons in their field.

There was one patient we had in Iraq with terrible gunshot wounds. He had necrotising fascitis and was so ill it was remarkable he pulled through
Lady Pat Swinfen

The project ensures that whatever the time of day or night and whatever the time zone there is always someone available to answer pleas for help and trigger a response.

Using a special e-mail system doctors in developing countries, once registered, can contact Swinfen Charitable Trust (SCT) for free help with worrying cases.

The system, set up with the expert help of the University of Queensland staff, was based on a system used to link British forces hospitals to specialists.

The Swinfens make sure the service is available round-the-clock 365 days a year. When they go on holiday their system goes with them on their laptop and when they sleep the University of Queensland, in Australia take over.

"Roger and I man the system from 7am until we go to bed. Some days we get two requests and others we get six. They are unpredictable - you never know when they are going to come in or where they are going to come in from," said Lady Swinfen.

"But we do get a lot of fun from it. We have met so many fantastic people in the developing world. "

Emergency response

Although their e-mail "telemedicine" is not billed as an emergency response, Lady Pat Swinfen admit this is sometimes what it becomes.

"There was one patient we had in Iraq with terrible gunshot wounds. Someone in a Basra hospital heard about us and contacted one of their colleagues in the maternity hospital who was linked up with us and asked for help from trauma specialists.

"We sent the request out to four of our specialists. They kept in touch with the Iraqi doctor and day by day he was able to tell them how the patient was doing. He told us that the patient was now much better and was able to eat.

"He had necrotising fascitis and was so ill it was remarkable he pulled through."

The Swinfens
Pat and Roger Swinfen in Iraq

Although the Swinfens are sent much information about their patients - sometimes even their pictures - they do not know their identity, nor do the international surgeons, thus ensuring that whatever their political beliefs all patients get the same standards of care.

They started the system after working with the Centre for the Rehabilitation of the Paralysed (CRP) in Dhaka in 1999.

Here they carried out a year-long pilot which was later published by the Royal Society of Medicine.

Now SCT operates in 18 countries including East Timor, Sri Lanka and Afghanistan and offer specialists in a range of fields including dentistry, paediatrics, obstetrics and gynaecology and plastic surgery from 10 countries.

One of the latest countries to sign up to their system is Iraq. The Swinfens went there after the conflict and now one medical clinic and 12 hospitals across the country can contact them for help.

Lady Swinfen said: "It is working beautifully with these hospitals they are in touch and send us hospital referrals. And from March until now we have had 42 patients referred from Iraq."

The surgeons only send requests for their most difficult cases and more often than not these are patients who are generally expected to die, but thanks to the intervention of SCT most of these 42 have survived.

And they said the success of their system was spreading as more hospitals got in touch.

"We had a case of one person who had been ill since 1990 and we put his doctor in touch with a specialist.

"He was flown to Turkey for treatment and he is now going round telling people how good the system is.

"The specialists are absolutely fantastic. They give us their time free of charge and they answer the most unusual requests."

Mr Stephen Wood, a retired orthopaedic surgeon who works with SCT said helping a system like this was a way of giving something back to the developing world.

"I suppose this is my way of doing some good. I spent a year working in Saudi Arabia and my time there inspired me to do something to help the developing world."

He said he had been involved for about five years and had received a number of referrals.

"I had one case of a 51-year-old man from northern Iraq whose voice had changed so they sent him to Baghdad for investigation.

"He said he was in pain and I discovered some soft tissue problems and a collapse of one of the discs in his neck which looked to me to be very like TB."

Mr Wood said sometimes the surgeons just sent written requests for help, but other times they e-mailed x-rays and pictures so he can build up the fullest possible picture.

The Swinfens forward the request to him and, once he has examined the details, he just presses the reply button and his diagnosis and advice are pinged automatically to the hospital and surgeon concerned.




SEE ALSO:
Video link to aid sick children
19 May 04 |  Scotland
NHS Stories: Telemedicine
12 Sep 03 |  Health
Telemedicine lifeline for villages
21 Oct 02 |  Technology
Burns victim treated by e-mail
02 Oct 02 |  Health


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