Telemedicine to Timor-Leste: Implementing an International Cardiac Telehealth Service During Population Dislocation, Floods and COVID-19

ABSTRACT

Background: The East Timor Hearts Fund (ETHF) has provided cardiac services in Timor-Leste since 2010, conducting three clinics yearly. With international border closures due to the COVID-19 pandemic, development of collaborative telehealth services was required. Methods: Scoping discussions identified major challenges (structural, patient-related and medical system-related). At two pilot clinics, patient history, investigation and management were collated. Clinic metrics were compared to an index face-to-face clinic in February 2019. Post-clinic discussions identified areas of success and shortfall in the conduct of the telehealth clinics. Results: 23 patients were reviewed at the online telehealth clinics held onsite at Timorese medical facilities. Compared to an index 2019 clinic, there were markedly lower numbers of new referrals (2 vs 190 patients, 8.7% vs 59.4%). Patients seen at the online clinic were predominantly female (17/23, 73.9%) and Dili-based (18/23, 78.3%) with a mean age of 25.9 ± 7.2 years old. The majority (12/23, 52.2%) had isolated rheumatic mitral valve disease. Investigations including electrocardiography, pathology, echocardiography and 6-minute walk tests were conducted in select patients. Medication advice was provided for 10 (43.5%) patients. 11 patients (47.8%) were deemed to require urgent intervention. Post-clinic discussions indicated general satisfaction with telehealth clinics, although frustration at current inability to provide interventional services was highlighted. Conclusion: Our pilot telehealth clinics indicate that capacity-building telemedicine can be rapidly implemented in an emergency setting internationally. Clinic design benefits from careful identification and resolution of challenges to optimise flow. Cardiac patients in Timor-Leste have a significant burden of disease amenable to intervention.