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The effectiveness of emergency, diagnostic and preoperative telemedicine during disaster relief operation is the major field of interest discussed in this study. An example of the effectiveness of telemedicine is given to emphasize the role telemedicine can play to bridge the gap between the tertiary level health care setups and the primary health care facilities. A case is also discussed to highlight the role played by the remote telemedicine unit in supplying the expert medical consultation during the post disaster rehabilitation and medical follow up of the patient.

Pakistan Haemophila welfare society is the National member organization looking after persons with Haemophila in Pakistan (PWH). It's Rawalpindi/Islamabad chapter is providing care to 230 registered patients in Northern Pakistan and Azad Jammu Kashmir. The absence of Medical facilities coupled with financial constraints and lack of transport facility in remote areas leads to immense problems in care and follow up. Telemedicine is a unique way of overcoming these barriers in management. This is a preliminary experience to reach out to PWH spread out in different geographic locations. 10 PWH with access to and having basic computer skills have been identified. Telemedicine and E- health training center, at Holy family hospital has trained both Staff of PHPWS and PWH. Customized user friendly software has helped in seeking urgent and prompt Consultations with Specialists, and avoiding unnecessary travel. This initial experience will be utilized to extend these services to PWH in other areas of the country.

Pakistan is densely populated country with major rural urban disparity in delivery of healthcare services. Even though the population of Pakistan is concentrated in the villages and small towns, the medical services in those areas are far from sufficient. The telecommunication industry in Pakistan is undergoing a rapid development, as a result of which the communication connectivity all over the country has improved remarkably. Many developing countries have started to realize the importance of eHealth/telemedicine and are pioneering the implementation of telemedicine projects. Telemedicine/eHealth projects in developing countries offer an opportunity for people living in underserved and rural areas to obtain improved healthcare services. Pakistan is not an exception and has started several eHealth/telemedicine projects to improve rural health care. Various private and government organizations have participated in implementation of telemedicine in Pakistan. Pak-US collaboration in telemedicine led to establishment of first telemedicine/E-health training center for capacity building in Pakistan. It has trained 45 doctors and nurses in telemedicine. These trained personals are helping other hospitals, like Pakistan Atomic Energy Commission Hospital, to establish their telemedicine facilities. Moreover during the 2005 earth quake of Pakistan this center established telemedicine centers in effected areas. The need of telemedicine and eHealth was greatly realized in 2005 earthquake of Pakistan. The Government of Pakistan is now considering eHealth as a modality for the rebuilding of quake hit areas. Pakistan space organization (SUPARCO) has also established Pakistan's first satellite based telemedicine network. In collaboration with Ministry of IT, SUPARCO is establishing three satellite based telemedicine centers at big cities. The Government of Pakistan, in consultation with Telemedicine/E-Health training center, is also working on establishing nationwide telemedicine network by connecting all medical college hospitals with district hospitals.

Telemedicine in surgery sometimes referred to as "Telesurgery" has been successfully demonstrated in developed countries. This study is local experience from Pakistan. Materials and Methods: This descriptive study was conducted at surgical unit II holy family hospital Rawalpindi (tertiary care hospital) and Tehsil head quarter Pindi gheb (remote center) from to 1.7.05 to 1.12.05 The objectives of the study were to evaluate the role of telemedicine in pre operative assessment of patients at remote location without the need to travel to tertiary care center at a distant location, post operative care, in comparison with patients seeking surgical treatment in excisting conventional manner. The average number of visits for pre operative assessment at tertiary care hospital without telemedicine was 11 and with the use of telemedicine this number reduced to 1. Time lapse between first appearance at remote site and consultant advice was reduced to 4 days from 15 days. Post operative stay at holy family hospital came down to 4 days from 15 days. Follow up visits were reduced to 1 as compared t o 4 visits. There were no unnecessary referrals with use of telemedicine as compared to 4 cases which could have been managed at remote center without the need of surgical intervention. No complications were observed in the patients evaluated through telemedicine. Telemedicine applications used in the proper technical and clinical algorithms can be very effective in supporting remote health care delivery efforts. The advantages of such applications include increased cost effectiveness by limiting travel, expending services to patients and increased patient quality assurance.

The Asia Pacific Telecommunity(APT) has supported telemedicine activities in Asia Pacific region, especially to promote telemedicine workshop on "the Human Resource Development(HRD) Programmes to Exchange ICT Researchers and Engineers” which have been funded by a special contribution from the Japanese Government. Under the umbrella of the APT-HRD, we have conducted telemedicine workshop from FY-2002 to FY-2005. This paper is reporting its activities and policy in the era of Ubiquitous society. The objectives of the workshop are to bring research teams, governments sectors, private practitioners and other stakeholders in the region to discuss the different applications of telecommunication and information technology in the health care sector including medical ambulance communication with high data speed and other mobile telemedicine solutions.