Stitching Infrastructures to Facilitate Telemedicine for Low-Resource Environments
Telemedicine solutions have been explored across the world in attempts to potentially transform healthcare delivery in low-resource environments. They aim to enable extension of medical knowledge to remote locations, so as to enhance the efficiency and effectiveness of larger healthcare infrastructures. Empirical studies have shown mixed results at best, however, and for a variety of reasons. In our paper, we presented a qualitative investigation of a longstanding telemedicine program operating out of Lucknow (Uttar Pradesh, India). Invoking the lenses of human infrastructures (Sambasivan & Smyth, 2010) and seamful spaces (Vertesi, 2014), we highlighted the factors that determine the success of this telemedicine program.
There are three important aspects that we identify and describe in the paper — first, conceptualizing telemedicine as the connectedness of two nodes rather than doctors and patients alone; second, identifying the critical ‘carrying agent’ (local doctors at peripheral nodes) and engaging them in program design and implementation; and third, ensuring co-creation by engaging patients in the process. We discuss, finally, how our lenses allowed us to recognize the seams made visible through the juxtaposition of the infrastructures at the central and peripheral nodes, and to emphasize the human elements that addressed these seams for ensuring the facilitation of a successful telemedicine program.
Our analysis presents takeaways for researchers working in similarly under-resourced settings, but also beyond. The challenges faced and workarounds attempted could be powerful for telemedicine programs in general, but also for non-remote settings (e.g., in terms of keeping patients on track with their chronic disease management). Even beyond medicine, the ways in which the central and peripheral infrastructures were stitched together could deliver insights for better understanding distance education programs as well.
Rajesh Chandwani and Neha Kumar. 2018. Stitching Infrastructures to Facilitate Telemedicine for Low-Resource Environments. In Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems (CHI ‘18). ACM, New York, NY, USA, Paper 384, 12 pages. DOI: https://doi.org/10.1145/3173574.3173958