International Journal of Public Health Research Special Issue 2011, pp (1-3) 1 Reaching the Last Frontier: Video Conference Clinic in Belaga Health Clinic using the Tele-primary Care ® System Alexander Ringga 1 , Ngian Hie Ung 2 , Chin Zin Hing 1 , Toh Teck Hock 1 1 Tele-Primary Care Unit, Sibu Hospital, Sarawak 2 Divisional Health Officer, Kapit, Sarawak Belaga District, in the heart of Borneo, is probably the most remote district in Sarawak. Up until 3 or 4 years ago, it was only accessible by an 8 hour express boat journey from Sibu, the nearest big town. Although Belaga town is now accessible by land (50% are timber camp unsealed road) from Bintulu, the journey takes 5 hours and transport cost is high. Accessibility to Belaga by river is also subject to weather conditions and the town often gets cut off during the dry season and also during the wet season. All these pose immense challenges to the delivery of health care services to the people of Belaga and greatly reduce their accessibility to even basic health services. Access to specialist services is even more challenging as it is only available in Sibu and Bintulu; and visiting clinics in Belaga are infrequent due to the shortage of specialists and difficult transport. Belaga Health Clinic located in Belaga town, is the largest health facility in the district serving a population of 30,000 (5,000 in Belaga town itself). However, it is only manned by allied health personnel, as the doctor post there has not been filled for more than 10 years. The assistant medical officers and nurses are able to manage routine cases. Cases requiring higher levels of care must either be referred to Sibu Hospital or Bintulu Hospital. Emergency cases have to be transported using helicopters. The introduction of the Tele-primary Care ® System to Belaga Health Clinic helped to overcome some of these logistic obstacles by allowing virtual access to specialists in Sibu Hospital through the internet. Using this system, the Paediatric Department in Sibu Hospital started a video conferencing clinic that allowed patients in Belaga Health Clinic to have face-to-face consultations with Paediatricians in Sibu Hospital. This paper describes how the clinic is managed, types of cases handled, benefits to patients and to staff, constraints faced, as well as recommendations for the future. The purposed of this applied presentation is to identify the benefit of a video conferencing clinic in the Belaga Health Clinic. For this project, the ‘action result’ (questionnaire) method was utilized and the following questions were answered. - What are the advantages experienced by using the video conferencing clinic? - What are the obstacles associated with using video conferencing clinic? Is video conferencing clinic advanced enough to be used in communications and the care of patients? - What is the general feedback from patients/parents who were seen in video conferencing clinic? - What video conferencing clinic would work best for the health services? A survey was sent to the health staffs of Belaga Health Clinic, Kapit, Sarawak. The result of the survey indicated that over 80 percent of the total staffs responded positively to having a video conferencing clinic. Challenges of rural health in Belaga District Approximately 50% Belaga’s populations reside in rural areas represented by 53 longhouses with average population density of only 2.5 persons per square kilometer. Overall, rural health in Belaga presents a number of unique challenges, which include inadequate infrastructure and climatic difficulties, isolated, undertrained and overworked health staff, unreliable and expensive transportation, little or no access to health education, great distances from advanced care or specialist care, limited access to adequate primary health care facilities, and inadequate follow-up health care. Limited financial and human resources. For example, there was no permanent Medical Officer in Belaga Health Clinic for more than 10 years. Approximately 90 percent of rural population is currently covered with services provided by trained paramedics. About 50 percent of patients in rural areas had to travel on average 20 kilometers to the nearest health facility. Belaga district cover 30,000 populations, and a huge land areas. Because of these factors and due to isolation, climatic difficulties and poor transportation many people residing in rural areas have only limited access to adequate health care facilities and little or no access to information about benefits and health care options.