Forum for Nordic Dermato-Venereology No 3, 2019 Telemedicine | Page 11

Dermato-Venereology in the Nordic Countries Teledermatology in Arctic Greenland L uit P enninga 1 , A nne K athrine L orentzen 1 , J ørgen S erup 2 and C arsten S auer M ikkelsen 3 Ilulissat Hospital, Postbox 514, 3952 Ilulissat, Avannaa Region, Greenland, 2 Department of Dermatology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, 3 Clinic in Derma- tology, Brønderslev, and 4 Research Lab, Department of Dermatology, University of Aalborg, and Private Dermatology Practice, Brønderslev, Denmark. E-mail: [email protected] 1 Providing health care in Greenland is a major challenge (1). Spanning 2,600 km from north to south, and 1,050 km from east to west, Greenland is the largest island in the world (1). In addition, Greenland has the lowest population density on the globe. The population totals 57,000 inhabitants, living in small cities and villages along the coastline, as the inner part of Greenland is covered with a permanent ice cap. There are 18 small cities and 120 small villages. No roads exist between these cities, and travelling between cities requires transporta- tion by helicopter, airplane, boat, snowmobile or dogsled (1). The weather conditions in Greenland can be extreme (1). Most of the country is located north of the Arctic Circle, and due to the Arctic climate, temperatures regularly fall to –30 to –40°C, and can even drop to –70°C in the coldest places. Besides the cold, Arctic storms, gale winds, heavy fog, and snowstorms can complicate traveling from one city to another. T he G reenlandic H ealthcare S ystem The Greenlandic healthcare system is a public healthcare sys- tem which offers free medical treatment and free medication to all Greenlandic citizens. The healthcare system includes physician-staffed local hospitals in 13 cities, regional hospitals in the 4 largest cities Sisimiut, Ilulissat (Fig. 1), Qaqortoq and Fig. 1. The hospital in Ilulissat. Forum for Nord Derm Ven 2019, Vol. 24, No. 3 Aasiaat, and the national Queen Ingrid Hospital in the capital city Nuuk. Patients are referred from local hospitals to regional hospitals, and the Queen Ingrid Hospital serves as the referral hospital for the country. There are 48 rural health care clinics in the small villages, which are staffed by a nurse or health care worker. These rural health care clinics refer to and con- sult with the local and regional hospitals daily by using the telemedical service ‘Pipaluk’ (Fig. 2). The Pipaluk telemedical machine enables the nurse or health care worker in the rural health clinic to send electrocardiograms, clinical photographs, otoscopic images, dermatoscopic images, stethoscopic sound files and live video transmissions to local and regional hos- pitals. In case of emergency or trauma, the physician on call initiates evacuation of the patient by helicopter, airplane, boat, or snowmobile, depending on the level of illness of the patient and the weather conditions. Physicians working at the local and general hospitals are generalists, most often specialists in general practice, surgery, obstetrics/gynaecology or medicine. For elective consultations, medical specialists travel through the country visiting the regional hospitals and physician-staffed clinics, often once or twice a year. This includes visits from consultants in dermatol- ogy, ophthal­mology, neurology, otolaryngology, paediatrics, psychiatry, internal medicine, cardiology, surgery, orthopaedic surgery and obstetrics and gynaecology. During these visits, which last around 1–2 weeks, the specialists consult, diag- nose, treat and operate patients. The visits by consultants reduce trans- portation costs within the Greenlandic healthcare system. It is more cost-effec- tive to bring the specialist to the patients, instead of financing transportation for all patients from remote Greenlandic villages to the centrally located specialist. In emergency cases with acute medical or surgical illness, which requires special- ized care, the patients are transferred to an appropriate referral hospital either at 95