FAIRBANKS (AP) -- The first image shows a boy with a cut on his cheek. The second image make it clear this is no ordinary cut.
A medical swab is coming out of the cut from inside the boy's mouth.
The two pictures taken by a community health aide in rural Alaska were sent to a doctor in Anchorage using a new $30 million telemedicine system.
The photographs were shown in a congressional briefing earlier this month to illustrate what telemedicine can offer nearly half the people in Alaska.
The Alaska Federal Health Care Access Network could also cut costs, administrators say.
Over the past winter, village health clinics in Interior Alaska received special carts of telemedicine gear.
With a few taps on the touch screen, village health aides can build case files and send them to doctors in regional clinics and hospitals, such as the Chief Andrew Isaac Health Center in Fairbanks.
Two weeks ago, doctors and other health workers at the center, operated by Tanana Chiefs Conference, got desktop computers hooked to the network.
''In my opinion, it has a very practical application in providing health care from a remote site,'' said Dr. Gina Pender of the Chief Andrew Isaac center.
Alaska has seen telemedicine systems before, but nothing on the scale of AFHCAN.
The system is available to the 250,000 people who in one way or another get their medical care directly from the federal government. That includes Army, Air Force and Coast Guard personnel, veterans and Alaska Natives.
Telemedicine services are available at one Veterans Administration clinic, four Coast Guard sites, nine Army and Air Force installations, 26 public health nursing clinics and 195 village health centers.
''It's the largest telehealth project now in the world, and we're very proud of it,'' said Sen. Ted Stevens, R-Alaska, at the briefing in Washington May 15.
Not everyone is a fan, though.
''It's a big expensive toy and there's a lot of people that like the system because it's high-tech and everything else,'' said Dr. Julian Gonzalez, at Samuel Simmonds Memorial Hospital in Barrow. ''I don't see how it would translate into an effective tool for us in the Bush.''
The carts provided to each remote site are equipped with a digital camera, a video otoscope for looking into ears, and an electrocardiograph to monitor heartbeat.
Those tools, given the expense, don't do much for him, Gonzales said. Skin rashes are generally not life-threatening and, in any case, can't be diagnosed based on a picture, he said. An electrocardiogram can easily be faxed.
But Pender, in Fairbanks, says skin cases are the most frequent type on the network. Telemedicine users are trying to create a consulting contract with a dermatology office in Alaska or the Lower 48 to meet the demand, she said.
The otoscopes are handy for diagnosing ear infections, she said. ''So antibiotics are used more appropriately.''
The quality of service at the clinics has improved, said Stewart Ferguson, director of technology for the telemedicine project.
One doctor who has handled about 150 ear-nose-throat cases via telemedicine said most of those cases previously would have gone on a waiting list at the regional clinic for two to six months.
''He's able to run some of these cases within 24 hours,'' Ferguson said.
The future offers even more possibilities, said Pender.
''It has the potential to replace phone medical traffic altogether,'' she said.
Ferguson said the carts could be outfitted with more diagnostic gear. They were designed and built specifically for the Alaska project.
Gonzalez thinks the money would be better spent on health aide training, preventive medicine and health education.
''It's true there are difficulties with different health aides, that they have different levels of training,'' he said. ''That's why I would rather use that money to bring the health aides into the centers to work with the docs.''
Linda Lekness, AFHCAN project director in Anchorage, acknowledged that not all doctors are fans. However, the system's usefulness is demonstrated by its traffic, she said.
''We have a critical mass here now, and I can see that interest is increasing exponentially,'' she said. ''That's very, very significant.''
The network's first user, in the fall of 2000, was Manilaaq, the nonprofit regional Native corporation based in Kotzebue. Now, there are carts at 195 village sites statewide, and that should increase to 235 by September.
Ferguson, the technology director, said the network has handled 3,000 cases to date. Health aides now are adding 1,000 cases every two to three months, he said. In Washington, Ferguson presented results from a survey of patients that showed they are happy, too.
''Eighty-two percent of the time they are agreeing that this system improved the quality of care,'' he said.
A survey found that use of the network ''prevented'' patient travel in 17 percent of cases. It also ''caused'' travel in 5 percent of the cases, when doctors discovered through telemedicine that a patient needed more care than the remote site could provide.
While the network has spent $27 million of the $30 million provided by Congress to date, Ferguson said, federal partners figure the system has saved them $11.5 million.
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