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Via E-Mail, Charity Links Sick People in Distant Areas to Speci...

For World's Sick, Care Via E-Mail

By Kevin Sullivan
Washington Post Foreign Service
Monday, November 24, 2008; A08

WINGHAM, England -- Geese honked happily outside as Pat Swinfen sat in the study of her
16th-century farmhouse, cozy and warm amid thick Oriental carpets and a glowing wood fire.

Pure English countryside idyll -- except for the critically ill pregnant woman in Iraq desperately in
need of a neurologist.

Swinfen, a retired nurse in her early 70s, sat at her computer and tapped out an e-mail, trying to
connect doctors in Basra working on the woman, who had suffered a brain hemorrhage, with a
renowned neurologist from Northern Ireland trekking in Nepal.

She soon had an e-mail response from the neurologist, who told Swinfen to forward details of the

The Swinfens run the Swinfen Charitable Trust, a telemedicine charity that uses e-mail to link sick
people in poor, remote or dangerous parts of the world with hundreds of medical specialists in some
of the world's finest hospitals.

Doctors in about 140 hospitals and clinics in 39 nations use the organization to seek help for patients
requiring specialized care beyond their capabilities. Through the trust, they can be put in e-mail
contact -- often within hours -- with one or more of the 400 specialists who work without pay as part
of the trust's network.

Doctors in distant areas, including Afghanistan, Antarctica and the Solomon Islands, e-mail photos
(many taken with digital cameras supplied by the Swinfens), X-rays, test results and case notes. The
information is reviewed by specialists, who respond by e-mail to help make diagnoses and
recommend treatments.

The only thing linking all the need and all the expertise is a desktop computer in the Swinfens' home,
an improbable global nerve center set amid a cherry orchard and wheat fields in the soft English hills
about 75 miles southeast of London.

"Help is just an e-mail away," said Swinfen, who runs the operation with her husband, Roger Swinfen,
a retired army officer and member of Britain's House of Lords.

Neither had used a computer before they began the operation on their 36th wedding anniversary in
1998. Their system has since handled almost 1,800 cases and saved numerous lives.

"This is a simple solution that works," said Karen Rheuban, a pediatric cardiologist with the

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Via E-Mail, Charity Links Sick People in Distant Areas to Speci...

University of Virginia Health System and president-elect of the American Telemedicine Association.

Rheuban said the U.S. military runs a similar system for service members in the field, and many
organizations, including U-Va., run extensive telemedicine programs that incorporate
videoconferencing. But that requires high-speed broadband and other equipment not often available in
the world's remoter areas.

No one other than the Swinfens, Rheuban said, has such an extensive network using simple,
inexpensive technology -- e-mail and digital photos -- to provide immediate medical consultations to
some of the world's poorest people.

Rheuban, one of 40 U-Va. specialists who volunteer for the Swinfens, said she recently consulted on
the case of a young girl in Basra who was having heart problems. Rheuban said she was able to
diagnose the problem and recommend specialized treatment by reviewing EKG data and other test
results sent by the girl's doctors.

The Swinfens are formally Lord and Lady Swinfen. He was elected to the House of Lords seat held
by his late father; she was awarded the Order of the British Empire by Queen Elizabeth II in 2006.

They began their project ( while Roger Swinfen, 69, was
working with a charity that helped people with disabilities in Britain and Bangladesh. He said that a
doctor with the charity introduced him to the idea of telemedicine, and that he immediately saw

"We decided we had to do something to help the needy in the developing world," he said. "Everyone
was doing something, but no one was providing medical specialists this way."

Cases started flowing in from around the world: a man in Bangladesh with a leg crushed in a car
accident, a baby girl in Papua New Guinea with eye disease, a baby in Nepal with a hand deformity,
women from all over with preeclampsia and other pregnancy-related problems.

The greatest number of cases have come from Iraq, where 39 hospitals have established links to the
trust. The Swinfens said they have handled a variety of cases, including gunshots and kidney failure,
and even a call for help from a U.S. Army field hospital in Iraq, where a sick young Iraqi girl turned
up during the March 2003 invasion.

The Swinfens -- and a single assistant -- monitor the computer at all hours, and they do it by laptop or
BlackBerry on their frequent trips to medical conferences to recruit specialists.

Sitting in their old farmhouse, the Swinfens joked about how their garden would be tidier if they
didn't have the trust. They laughed about how Roger Swinfen's most recent Christmas present to his
wife was a filing cabinet.

But they also worried about how to raise money to keep the trust going -- to pay for the cameras,
tripods, batteries and other equipment they send to people in the field. And they worried about who
would take over when they are gone.

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"Roger and I are not exactly in the first flush of youth," Pat Swinfen said, tapping away at the long list
of e-mails on her screen.

That morning, an e-mail arrived from a doctor at a small clinic on the microscopic Pacific island of
Niue, asking to establish a link with the trust. Pat Swinfen sent back a note: The trust doesn't refuse
anyone, no matter how small or distant.

"You can fill a bucket with sand one grain at a time," her husband said. "But you've got to start."

To read more of these features, go to the Worldview page at

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