Telemedicine refers to the delivery of healthcare over distance using information and communication technology. At its simplest, this can be a doctor consulting a patient over a video call, for example a psychiatrist speaking with a patient remotely. More advanced forms involve the transmission of clinical data such as images, videos, and physiological measurements to support diagnosis, treatment, and follow-up without the need for physical presence.
Some medical specialties adapt more easily to telemedicine than others because of the nature of their work. Radiology is the clearest example, as it is based almost entirely on interpreting images. Many doctors were already practising teleradiology long before it was formally recognised as a separate discipline, often without realising it. In surgery, cameras can be used to allow another surgeon to observe a procedure remotely and provide feedback or a second opinion, either live or via recordings. At the extreme end of this spectrum are robotic systems, where the surgeon operates from a different location altogether.
Pathology is the next most natural specialty to adopt telemedicine. Most diagnoses are based on morphology, where pathologists examine microscope slides to identify disease. These images and videos can be shared in real time or recorded for later use, whether for case discussions, teaching, or second opinions. In Papua New Guinea, anatomical pathology and haematology benefit the most from this technology, as both rely heavily on microscope slide examination and carry a significant workload, particularly in cancer diagnosis.
Pathologist numbers in Papua New Guinea, as well as globally, are limited. As pathology services expand to other provinces, and as the majority of pathologists are trained at Port Moresby General Hospital, the need for communication and collaboration becomes even more important. Instead of transporting the patient or the microscope slides to the pathologist, telepathology helps overcome barriers of geography, transport, logistics, and time. Our setup allows us to do this in a practical, low-cost, and effective way.
We use a standard light microscope fitted with a camera at the top and connected to a control unit, which outputs the image through a video card which converts it into a USB video source which is fed into a computer. Streaming software, OBS (Open Broadcast Software), is used to stream the video feed live via platforms such as Zoom or Microsoft Teams or can be used to record videos for later sharing. This approach supports multidisciplinary discussions with teams such as Paediatrics and Internal Medicine, particularly for conditions like leukaemia where coordinated management is critical.
The same setup is also used for teaching, allowing representative cases to be saved and reused for training, or for one of our own consultants to teach multiple trainees via a shared screen. While this is not telepathology in the strict sense when everyone is in the same room, it still adds substantial educational and clinical value. Currently, we have teaching sessions with overseas specialists in haematology and anatomical pathology where slides are shared in real time and cases discussed. Apart from hosting these sessions ourselves, we are also able to attend sessions hosted by these specialists using their own setups.
However, there are limitations to this platform. In Papua New Guinea, power blackouts and internet fluctuations remain a challenge. Ideally, a full digital pathology system would involve a slide scanner that captures high-resolution images at multiple magnifications, allowing the slide to be navigated digitally. Digital slides preserve stain quality, are not subject to breakage or fading, and reduce physical storage requirements. However, they introduce new demands such as large storage capacity, server or cloud infrastructure, and reliable internet and power supply. Image quality also depends on the camera, display monitor, and overall hardware used.
Despite this, our current setup is an important stepping stone towards crossing the digital divide. When slide scanners eventually become available at Port Moresby General Hospital, laboratory staff will already have foundational skills and experience in digital image handling, storage, and transmission. It also provides an opportunity to standardise workflows and processes. This is low-hanging fruit: a relatively small intervention with a disproportionately high impact, acting as a force multiplier. Pathology has always depended on close collaboration with other disciplines, and this setup reinforces that role going forward.
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