Telecare Soapbox: Mobile Diagnosis

Livia Bellina, Specialist, General Pathology, works for the Italian National Health Service on Lampedusa Island, which lies between Sicily and Tunisia. In this Soapbox she tells how, with colleague Eduardo Missoni, they are making a reality of their vision of spreading an ethical and low cost health technology everywhere.

Ugandan students

Ugandan students

In April 2008, working as a pathologist on Lampedusa, I found myself in urgent need of confirming a diagnosis of malaria from a blood sample of an African immigrant.

With no other means at hand, I took a picture of the microscope’s field using the camera incorporated in my mobile phone, without additional devices, and sent it via Multimedia Message (MMS) for tele-diagnostic purposes to a reference center. (The method has been filed for patent in April 2008, with the sole purpose to protect the idea from commercialization and to protect its free use and dissemination, EPO application number 09005054.3 2002 – 2008 April.

Through that experience I was motivated to deepen my knowledge of tropical diseases, poverty diseases, global health and international development cooperation.

Meeting Eduardo Missoni at a meeting of the Italian Society for Migration Medicine (SIMM) in Trapani, February 2009, and listening to his words about global health and human rights deeply changed my life — I have been always fighting alone in Sicily for the right to health care and medical dignity.

I asked him if we could work together and soon afterwards we met at Bocconi University, in Milan, where he teaches. In June 2009 our work about low cost diagnostic image transmission (Bellina and Missoni) was published in Diagnostic Pathology, an open access journal.1

Since then, we have intensified our collaboration. Professor Missoni and I have become advocates for the use of this image transmission method and, when needed, I make myself available to teach it in practice.

We believe that access to health and access to care is a fundamental human right and that medical technology must serve it and be fit for purpose. Unfortunately health is a right that is still unavailable to most of humanity.

Sharing my experience in Lampedusa with Eduardo Missoni gave also rise to cooperation in the area of migrants’ health care and rights. We made a presentation on the subject in September 2010 at the 6th European Congress of Tropical Medicine and International Health and 1st Mediterranean Conference on Migration and Travel Health in Verona, Italy.2

We are currently examining other aspects concerning migrants’ right to health, health care delivery, and related economic aspects.

The direct relationship with migrant people landing in Lampedusa and, later, the work with Eduardo Missoni have been decisive for my commitment. I came to realize that I had a mission to facilitate the access of the access to care, including through the adoption of low-cost telemedicine, especially in rural communities.

I contacted the Corti Foundation and, after a meeting with Dominique Corti, in Milan in January , 2009, I made myself available to work in Uganda, where I spent two months (October to November 2009) volunteering at Lacor Hospital, in Gulu. I was sent there as a supervisor of the Corti Foundation, and to support on the job training in diagnostic laboratory work for students of the Laboratory Course for Technicians.

I had previously been in touch with Nobel Laureate Professor Mohammad Yunus, and had offered help in introducing the ‘mobilediagnosis’ method (i.e. the use of cellular phone for tele-diagnosis and support) in rural communities in Bangladesh. I met Prof. Yunus in Milan in Februray 2010 and he invited me to go to Bangladesh and contribute to the improvement of Grameen Kalyan rural health centers and train local health workers.

I spent from April-July 2010 in Bangladesh teaching and applying mobilediagnosis, linking centers in rural areas of Bangladesh and the headquarters in Dhaka. I lived in rural centers there, first in Tangail, in the extreme north and later in Comilla, in the east. For several weeks I taught and worked with my students from early morning to sunset. In Grameen Foundation’s health centers, I organized a ‘school’ of low cost telepathology and basic telemedicine, based only on the minimal equipment available locally and personal cellphones. 16 lab technicians from 16 different rural health centers where involved. I taught the use of the microscope; theory and practice of laboratory techniques and basic parasitology, urine analysis, hematology and stool sample examination, as well as capturing and sending images from microscopical fields, and differential diagnosis and logic clinic.

I also taught six medical doctors from different health centers about logic clinic; differential diagnosis; primary health care, and transmission of ultrasound images with the mobile phone.

In the second phase of my stay in Bangladesh, I was based in Dhaka at the central Grameen office and supported the distance diagnosis for images sent by the lab-technicians I had trained, confirming the validity of the method.

The experience gained using the mobilediagnosis method is summarized in a paper entitled Increasing connectivity of isolated health workers in poor countries using locally available technology co-authored with Professor Missoni, that will be presented at the coming 41st Union World Conference on Lung Health Berlin 11-15 November 2010.

To promote mobilediagnosis we have, since 2009, been developing Our aim is to develop it into an interactive consultation site, to provide FREE support to ALL low skill – low resources and isolated health workers (lab technicians, pathologists, clinicians) in low resources countries or isolated and rural areas, offering diagnostic confirmation from more skilled colleagues.

I am keen to dedicate the rest of my life to working for poor people, as medical pathologist and as teacher, and to promote mobilediagnosis to the poorest communities.

Please visit the site [very good site it is too, Ed. Steve] and if you can help us build a network of support and awareness, please get in touch.

Thanks for your attention,

Livia Bellina
Livia’s blog

Livia is a member of the Italian Society of Migration Medicine (SIMM); the Italian Society of Tropical Medicine (SIMET); the National Migrants’ health Care Work Group (at the Istituto Superiore di Sanità – National health Institute in Rome); the Working Group “European AIDS & Mobility Project” and of COST Action (European Cooperation In Science and Technology)

1 Bellina, L., Missoni, E., Mobile cell-phones (M-phones) in telemicroscopy: increasing connectivity of isolated laboratories Diagnostic Pathology, 2009, 4: 19
2 (Bellina, L., Maugeri, M., Missoni, E., Ethical and public health concerns based on the retrospective analysis of referrals for diagnostic parasitology of immigrants and autochtonous population in Lampedusa island (Italy), European Journal TM&IH, 2009, 14 (Supp. 2) 66)

Categories: Soapbox.


  1. Victor Patterson

    Remote microscope diagnosis

    Brilliant! Cheap and practical and (if used) can make a difference to lots of people in the developing world.

    “If used” is the key; if you used it in the developed world all sorts of IT police would be breathing down your neck because a hacker in Taiwan might intercept the image. This obsession with very low risk privacy drives down the quality of medical care here and we need to be sure we do not export this stupidity to the developing world.

    Keep going!

    [Readers may recall that Victor has worked with mobile health in Nepal, and wrote about it for TeleCare Aware here.]