For World's Sick, Care Via E-Mail

Roger and Pat Swinfen manage the Swinfen Charitable Trust from their home in Wingham, England. The telemedicine charity has handled almost 1,800 cases since inception in 1998. (By Kevin Sullivan -- The Washington Post)
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No one other than the Swinfens, Rheuban said, has such an extensive network using simple, inexpensive technology -- e-mail and digital photos -- to provide immediate medical consultations to some of the world's poorest people.

Rheuban, one of 40 U-Va. specialists who volunteer for the Swinfens, said she recently consulted on the case of a young girl in Basra who was having heart problems. Rheuban said she was able to diagnose the problem and recommend specialized treatment by reviewing EKG data and other test results sent by the girl's doctors.

The Swinfens are formally Lord and Lady Swinfen. He was elected to the House of Lords seat held by his late father; she was awarded the Order of the British Empire by Queen Elizabeth II in 2006.

They began their project (http://www.swinfencharitabletrust.org) while Roger Swinfen, 69, was working with a charity that helped people with disabilities in Britain and Bangladesh. He said that a doctor with the charity introduced him to the idea of telemedicine, and that he immediately saw potential.

"We decided we had to do something to help the needy in the developing world," he said. "Everyone was doing something, but no one was providing medical specialists this way."

Cases started flowing in from around the world: a man in Bangladesh with a leg crushed in a car accident, a baby girl in Papua New Guinea with eye disease, a baby in Nepal with a hand deformity, women from all over with preeclampsia and other pregnancy-related problems.

The greatest number of cases have come from Iraq, where 39 hospitals have established links to the trust. The Swinfens said they have handled a variety of cases, including gunshots and kidney failure, and even a call for help from a U.S. Army field hospital in Iraq, where a sick young Iraqi girl turned up during the March 2003 invasion.

The Swinfens -- and a single assistant -- monitor the computer at all hours, and they do it by laptop or BlackBerry on their frequent trips to medical conferences to recruit specialists.

Sitting in their old farmhouse, the Swinfens joked about how their garden would be tidier if they didn't have the trust. They laughed about how Roger Swinfen's most recent Christmas present to his wife was a filing cabinet.

But they also worried about how to raise money to keep the trust going -- to pay for the cameras, tripods, batteries and other equipment they send to people in the field. And they worried about who would take over when they are gone.

"Roger and I are not exactly in the first flush of youth," Pat Swinfen said, tapping away at the long list of e-mails on her screen.

That morning, an e-mail arrived from a doctor at a small clinic on the microscopic Pacific island of Niue, asking to establish a link with the trust. Pat Swinfen sent back a note: The trust doesn't refuse anyone, no matter how small or distant.

"You can fill a bucket with sand one grain at a time," her husband said. "But you've got to start."

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