Meraka Telehealth:Project Chapter

Telehealth details

Project background

The tele-health application developed in Tsilitwa, Eastern Cape Province South Africa formed part of the Department of Science and Technology’s Innovation Fund project entitled “Information and Communication Technologies (ICTs) in support of communities in deep rural areas”. The project was implemented between 2001 and 2003 and the CSIR was the lead organisation of a consortium comprising the HSRC, ARC, Naledi ya Africa and Renewable Energy (Pty) Ltd.

This project’s aim was to develop and implement an innovative communications infrastructure that was independent of the State telecommunication utility companies, and to develop capacity within the community involved, with appropriate information content, to support sustainable development in rural areas.

The project involved the two communities of Tsilitwa and Sulenkama that were geographically separated by a “koppie” preventing direct access between the villages and requiring people to travel the 15km by dirt road. These towns are approximately 100km north East of Umtata. The two villages are typical of the former Transkei area and to this day have no electricity to homes, no running water, dirt roads and no telecommunications. The villages are spread out and people build mud-block houses with thatch roofs or corrugated iron. Some houses are constructed from brick with tile roofs. The population is mostly unemployed totalling approximately 2000 in each village.

The community facilities in Tsilitwa include a pre-fabricated clinic and technical school that, through the efforts of the headmaster, is electrified. The clinic ran on solar power until 2002 when it was electrified. The village of Sulenkama some 15km away has more infrastructure boasting a 200 bed community hospital called Nessie Knight with electricity (generator back-up) and 3 DECT telephone lines. The telephones do not usually work and the hospital staff rely on their personal cell phones to call Umtata for an ambulance.

ICT infrastructure

Initial configuration

The ICT infrastructure implemented during the DACST funding included an MPCC at Tsilitwa and Sulenkama, PC network at the Tsilitwa school, a WiFi network connecting Sulenkama hospital and police station to a number of sites in Tsilitwa including the clinic, school and the MPCC. Each of these sites was connected in the network and voice communication was possible by means of VoIP. The Tsilitwa clinic was linked to the Sulenkama hospital with a web-cam to facilitate tele-consultation between the clinic sister and doctor at the hospital. In addition, external e-mail was piloted at the clinic using a GSM modem as cellular coverage was available in the area. The clinic sister was provided with a digital camera to capture pictures of patients with skin disorders or wounds. The images were then sent to a specialist in Umtata for diagnoses and advice.

New configuration

In 2003 the CSIR were successful in winning funding from the World Bank Development Marketplace that funded the expansion of the network to other clinics around Tsilitwa. In addition, an application was made to the Universal Service Agency (USA) for sponsorship of a VSAT to provide internet and e-mail connectivity to the Sulenkama/Tsilitwa cluster. This is imperative to continue with the tele-dermatology already piloted at Tsilitwa through the use of GSM. (The GSM was piloted for a year and then discontinued due to high running costs). An MOU was signed between the USA, Department of Health and the CSIR for the implementation of the VSAT and ongoing support.

At the beginning of 2004 the Department of Public Works embarked on a building programme in OR Thambo District Municipality for the construction of new clinics. At the project site in Tsilitwa this meant the demolishing of the old clinic and the transfer and re-installation of WiFi equipment to the new clinic. This move resulted in a whole new set of challenges being presented to the project team and the re-design of the existing network to focus on connectivity for health to a number of clinics in the area. The new network design was based on the installation of the VSAT at Nessie Knight hospital, Sulenkama and WiFi connectivity to the new clinics at Tsilitwa and Kalankomo. In addition, the WiFi network was to be extended to the new clinics at Guru and Mahlungulu provided line of sight conditions prevailed.

After having erected the RF equipment to the new clinics the link between Tsilitwa clinic and the “koppie” and Tsilitwa to Kalinkomo clinic was successfully tested. The team then needed to test the line of sight to Guru clinic. The link prediction using the GISRAP software developed by the CSIR indicated there was possible line of site but this was subject to on-site evaluation. A 10m mast was erected at Tsilitwa with directional antenna pointing to the “koppie”, Kalenkomo clinic and Guru clinic.

After it was determined that there was no line of site using the CSIR WiFi equipment between Tsilitwa and Guru it was decided that the link would be tested using “non-line of site” equipment manufactured by Alvarion. This operates in the 5.8GHz frequency and has unique signal propagation characteristics. The mast had to be taken down at Tsilitwa and a different antenna was erected for the Alvarion equipment. The alignment of the antenna to Gura was done using a GPS. This gives approximate directional information only and panning of the antenna is required. Despite these efforts no link could be established between Tsilitwa and Guru clinic and the antenna for the Alvarion equipment was dismantled.

The network then only included Nessie Knight hospital at Sulenkama, the “koppie”, Tsilitwa clinic and Kalankomo clinic. Guru and Mahlungulu clinics could not be connected to the network. At this point the question was asked what could be done to provide connectivity to the clinic. The antenna mast had been previously erected and enclosure box fitted to house the WiFi equipment. The decision was taken to complete the installation by installing the power cabling, trunking and LAN point with the idea that we would provide a PC for the clinic. This would at least introduce the clinic staff to e-Health and connectivity might be provided by some other means, such as 3G, at a later stage.