Journal Club 9/19/22: Medical Tourism

Telemedicine in Low-Resource Settings by Rachel Patel

Telemedicine is defined as the delivery of health care and the exchange of health-care information across distances.

The types of telemedicine are as follows:

  • Live, two-way (or real-time) synchronous audio and video allows specialists, local physicians, and patients to see and hear each other in real-time to discuss conditions 
  • Store-and-forward sends medical imaging such as X-rays, photos or ultrasound recordings to remote specialists for analysis and future consultation
  • Remote patient monitoring collects personal health and medical data from a patient in one location and electronically transmits the data to a physician in a different location 

The advantages of telemedicine in low-resource settings include:

  • Increasing health access across geographical barriers
  • Cost-effectively providing services, from radiology to dermatology to at least some of the millions of patients who lack adequate healthcare
  • Contact precautions (e.g. COVID-19 pandemic)
  • Surveillance and monitoring of medical emergencies, generating health data to inform international aid programs and policies
  • Interconnected network of data sharing as well as funding for international crises

Limitations include:

  • Patients who have emergent health conditions, or need a physical exam or laboratory testing for medical decision making
  • If sensitive topics need to be addressed, especially if there is patient discomfort or concern for privacy
  • Limited access to technological devices (e.g., phones, tablets, computers) or connectivity

Discussion Questions:

  • What are some of the ethical implications of telemedicine?
  • How do you see telemedicine factoring into medical care as we move forward in a post-COVID world?
  • Is there a place for telemedicine in emergency medicine?

The Roots of Global Health Inequity by Grace Bunemann

** A short blog post & presentation are far too brief of formats to discuss this extensive topic adequately. The following is an overview of Chapter 1 from Dr. Joia S. Mukherjee’s book entitled An Introduction to Global Health Delivery. **

To simply explain LMIC (lower middle-income country) Health Systems today, it is important to review the history of slavery and colonialism which led to years of resource extraction ultimately resulting in weak health systems seen in LMIC countries today.

Prior to World War II, the conduct of a government against its own people was considered a matter of national sovereignty, however global opinion changed following the liberation of the Nazi concentration camps. After WWII, it was believed that all people, regardless of their country of origin, have an inalienable set of human rights. These principles were upheld in the Universal Declaration of Human Rights in 1948.

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

The same European countries that were championing human rights had little issue with the continuation of colonialism and denying those who were colonized their human rights. Importantly, only four independent African countries were able to vote for the Declaration (South Africa, Egypt, Ethiopia, and Liberia). 

In 1978, the International Conference on Primary Health Care was held in Alma Ata (currently Almary, Kazakhstan). The conference hosted 600 representatives from the 150 WHO member states and aimed to discuss models for care delivery and develop solutions for people living without access to health care.  

In parallel to the Cold War, socialist republics advocated for government funds to deliver on the promise of health as a human right by building public health systems with doctors, nurses, and hospitals while capitalist states argued that health systems could not be built until economic growth occurred and reasoned that volunteers could be used to deliver basic health services in impoverished countries. 

It is important to note a majority of delegates advocated for the public provision of health as a human right and the Alma Ata Declaration is the result. It advocated for health as a human right and included the need to address the social factors related to ill health, such as lack of food, water, and sanitation. The declaration set modest yet concrete goals like 90 percent of children should have weight for an age that corresponds to reference values, every family should be within a 15-minute walk of potable water, and women should have access to medically trained attendants for childbirth.

The concept that health demanded more resources than those available within an impoverished country’s budget and that health should be financed through international collaboration were radical notions. Several factors impacted the Alma Ata Declaration including physician opposition, Cold War geopolitics, and neoliberal reforms. 

In 1979, a proposed alternative to the Alma Ata Declaration was published in the New England Journal of Medicine entitled ‘Selective Primary Health Care — An Interim Strategy for Disease Control in Developing Countries.’ It praised the goals of Alma Ata as laudable, but ascertained the objective was unrealistic given the impoverishment of those countries with the highest disease burden. This publication countered that it is more realistic to target scarce resources to prevent and control the spread of diseases that account for the highest mortality and morbidity. Selective Primary Health Care became the new standard for global health efforts for years to come. 

“It is impossible to understand global health delivery without understanding the destructive history of slavery, colonialism, and neoliberalism that left governments impoverished and unable to fulfill the right to health.”

Wrap up!

As you can imagine, our mentees had a wonderful discussion surrounding these two topics! We are thrilled to be able to present a brief summary of their work here. Please stay tuned for details about our upcoming meetings.  Connect with us through one of our contact options listed below if you are interested in attending!

Thank you to our authors and presenters!

Rachel Patel, MS4

Rachel Patel, MS4

Rutgers Robert Wood Johnson Medical School

Grace Bunemann, MS4

Grace Bunemann, MS4

Campbell University School of Osteopathic Medicine

Blog Editorial Team

Halley Alberts, MD

Halley Alberts, MD

PGY-2 University of South Carolina Prisma Health Midlands
GEMS LP Co-Director & Blog Editor

Mohamed Hussein, MBBCh

Mohamed Hussein, MBBCh

Trauma Research Fellow
Blog Editor

Jeff Downen, MD, MS

Jeff Downen, MD, MS

PGY-2 University of Florida, Jacksonville
Blog Editor


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  • Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen J, Caffery LJ. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). Journal of Telemedicine and Telecare 2020; DOI: 10.1177/1357633X20916567 
  • Tuckson, R., Edmunds, M., Hodgkins, M. Telehealth. New England Journal of Medicine 2017; 377:1585–1592. Retrieved from 
  • Tolone S, et al. Telephonic triage before surgical ward admission and telemedicine during COVID-19 outbreak in Italy. Effective and easy procedures to reduce in-hospital positivity. International Journal of Surgery 2020; 78 : 123–125. 
  • Perez Sust P, et al. Turning the Crisis Into an Opportunity: Digital Health Strategies Deployed During the COVID-19 Outbreak. JMIR Public Health Surveill 2020;6(2):e19106) doi: 10.2196/19106 
  • Project ECHO: Provides resources to connect frontline healthcare professionals with experts for distance learning and consultation
  • Joia Mukherjee. An Introduction to Global Health Delivery : Practice, Equity, Human Rights. Oxford University Press; 2018. Chapter 1: The Roots of Global Health Inequity.
  • Boston 677 HA, Ma 02115 +1495‑1000. ALMA-ATA at 40: A Milestone in the Evolution of the Right to Health and an Enduring Legacy for Human Rights in Global Health. Health and Human Rights Journal. Published September 6, 2018.
  • Alma-Ata 40 years on | Health Poverty Action. Accessed February 22, 2023.

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Cite this article as: Global EM Student Leadership Program, "Journal Club 9/19/22: Medical Tourism," in International Emergency Medicine Education Project, March 27, 2023,, date accessed: December 11, 2023

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