Spread the experience of India in China: making endoscopy mobile

We read with great interest the article by Talukdar & Reddy, “Making endoscopy mobile: a novel initiative for public healthcare” [1]. The authors introduced their experience of delivering mobile endoscopy in remote rural areas in India. They converted a bus into a mobile hospital equipped with custom-made diagnostic and therapeutic endoscopy equipment, and traveled to remote rural regions to provide diagnostic and other quality healthcare services to underserved rural populations. Over the past 5 years this initiative, the Rural Health Care Project, has benefited nearly 10 million patients in southern India. In addition to providing high quality healthcare to these underserved rural regions, the authors have recorded valuable epidemiological data on gastrointestinal diseases within these regions and trained young physicians who could continue to provide these services. This project proved to be a cost-effective healthcare service.

The authors provided an excellent model for making endoscopy mobile in poor remote rural areas of both underdeveloped and developing countries. China is the largest developing country in the world. The populations in remote rural areas in western China, especially in Tibet and Sinkiang, are often deprived of the benefits of advanced healthcare technologies. Therefore, we can learn from the experience in India and establish a mobile endoscopy unit to provide healthcare in underserved areas. A similar model has been employed in China, using trains converted into mobile hospitals, to provide healthcare to such rural regions. In this project, called the Lifeline Express, medical instruments are carried on a customized train to provide ophthalmic treatments for patients suffering from cataracts. Since 1997 this project has achieved great success, with thousands of people having regained their eyesight as a result of the Lifeline Express [2] [3]. Because a train can travel farther and faster than a bus and carry more medical supplies and staff, this model may represent a viable option in rural China for providing treatments such as endoscopic submucosal dissection, endoscopic mucosal resection, polypectomy, and other useful endoscopic technologies. However, further studies are needed to determine the cost – effectiveness of this approach.

Some isolated areas of China cannot be reached either by bus or train because of inadequate or nonexistent roads and railways. In these instances, the use of novel disposable endoscopes can be both useful and effective. Chung et al. demonstrated the safety and effectiveness of a disposable transnasal esophagoscope for diagnostic esophagoscopy, with excellent outcomes in 46 patients [4]. Although additional studies are necessary to determine the effectiveness of this device in clinical practice, a disposable transnasal endoscope may further assist in providing medical care to underserved areas in rural China.

As physicians, we are all committed to providing quality healthcare for those in need. Regardless of one’s geographic location or socioeconomic status, the right of an individual to have access to quality healthcare remains constant. India’s Rural Health Care Project is an excellent model for achieving this goal, and we believe that the rural Chinese people deprived of the benefits of advanced healthcare technologies could also benefit from a similar program.

• References

• 1 Talukdar R, Reddy DN. Making endoscopy mobile: a novel initiative for public healthcare. Endoscopy 2012; 44: 186-189
• 2 Huang H-C, Huang C-K, Nie H-P et al. Therapeutic effect of phacoemulsification in 872 eyes of cataract on Tibet lifeline express. Int J Ophthalmol 2008; 8: 1902-1903
• 3 Li L-M, Zhang M-Z, Liu X-J et al. Therapeutic effects of 1097 operations of phacoemulsification combined with intraocular lens implantation in lifeline express. Int J Ophthalmol 2009; 9: 1325-1327
• 4 Chung JW, Park S, Chung MJ et al. A novel disposable, transnasal esophagoscope: a pilot trial of feasibility, safety, and tolerance. Endoscopy 2012; 44: 206-209