THE PERSPECTIVES OF THE TELEMEDICINE DEVELOPMENT FOR SPECIAL NEEDS MINORS IN KYRGYZ REPUBLIC (KYRGYZSTAN)

Telemedicine is one of the fast-growing and demanded branches of medicine today. By definition, it is providing healthcare using the different types of connection devices, for example, online platforms, messengers, etc. Medical specialists and patients could be removed from each other for kilometers; they even could be in different cities or even countries. For Kyrgyzstan, a mountain country with a lot of remote villages, this aspect of telemedicine is effective, especially for families with disabled children. Another important benefit of the development of telemedicine in Kyrgyzstan is foreign doctors could provide Kyrgyzstan children extra healthcare. It is actually because of the lack of local medical workers.

Looking at the history of telemedicine, it appeared when the first mobile phones, the Internet, started to be a part of daily life. For example, in early 1990s the government of Norway announced the national program of telemedicine for the citizens who live in the remote northern settlements. The similar program was announced by the France government for the people who live in French territories under the Equator. In Russia the first telemedicine session was realized by the A.N. Bakulev Center for cardiovascular surgery of the Russian Ministry of Health in 1997. In Kyrgyzstan since 2011-2016 parents of children with serious diseases (for example, cancer, diabetes type one, orphan diseases, autism) started to use video-calls for connection with medical specialists from Germany and Israel. Interest for the domestic telemedicine in Kyrgyzstan appears in 2020 during the COVID-19 pandemic. On 18th of March, 2022, the Ministry of Health of Kyrgyz Republic and UNICEF held a roundtable to discuss problems of digital health products in Kyrgyzstan. On 31st of October, 2023, the Prime Minister of Kyrgyzstan Akylbek Japarov signed the first law about telemedicine in Kyrgyzstan. The authorities are sure development of telemedicine in Kyrgyzstan is prospective and vital, especially for regions.

To find out perspectives of development of the telemedicine for special needs children in Kyrgyz Republic we conducted a survey for the parents of minors with disabilities using the Google Forms*(По требованию Роскомнадзора информируем, что иностранное лицо, владеющее информационными ресурсами Google является нарушителем законодательства Российской Федерации – прим. ред.). The survey included demographic (age, location, etc.), health state, computer technologies access, social and economical questions. The survey was held for 3 weeks from 4th to 25th of April, 2024, and took 66 responses. The questions of the survey are:

1) How old is your special needs child?

2) What is your child's disease?

3) Are you from Kyrgyzstan?

4) What is your region?

5) How many children do you have in your family?

6) What is sex of your special needs child?

7) Do you know about telemedicine?

8) Have you ever tried telemedicine?

9) Do you trust online-service?

10) Would you like to use telemedicine?

11) What will make you trust in telemedicine?

12) Choose the greatest benefits of telemedicine for you

13) I would like to speak with a doctor in Kyrgyz or Russian language?

14) Do you speak English?

15) Would you recommend telemedicine to your friends and relatives?

16) Is a 15 minutes long appointment enough for you?

17) What is the optimal time for a doctor's appointment?

18) Do you trust your confidentiality using telemedicine?

19) How would you rate your doctor`s competence using telemedicine?

20) How would you rate the quality of your Internet connection for the last telemedicine session?

21) Was it clear to you how to start a telemedicine session?

22) What doctor would you visit using telemedicine?

23) From your opinion, what (medical) specialists are needed in Kyrgyzstan?

24) What device would you like to use for your telemedicine session?

25) Do you use Wi-Fi?

26) Do you use mobile internet?

27) How would you rate the quality of your Internet connection?

28) What software would you like to use for your telemedicine session?

29)  Have your special needs child personal device with the Internet connection (smartphone, tablet, PC, laptop, etc.)?

30) If you had the opportunity to consult with a foreign doctor, doctor from which country would you choose?

31) Have your special needs child mobility difficulties?

32) Have your special needs child speech difficulties?

33) Do your special needs child use a wheelchair or other adaptive device?

34) Do you use private or public medical service most?

35) Would you and your special needs child ask for psychological help if it was absolutely confidential?

36) How much would you pay for a high-qualified doctor's appointment?

Let us start with demographic statistics.

Looking at the age of special needs children in Kyrgyzstan, 1.5% of respondents said their child is younger than 1 years, 9.2% said their child is 1-3 years old, 20% — child is 3-5 years old, 12.3% — child is 5-7 years old, 15.4% — child is 7-10 years old, 16.9% — child is 10-13 years old, 16.9% — child is 13-16 years old, 3.1% — child is 16-18 years old, 4.6% — child is 18-21 years old. Average age is 8.9 years old.

Diseases are: 37.5% of respondents — endocrine diseases, including diabetes, 17.2% — autism, including Asperger's syndrome, 10.9% — cerebral palsy, 9.4% — poor hearing, 4.7% — Down`s syndrome, 4.7% — poor vision, 1.6% — cancer, 1.6% — limbs missing, 12.5% — other diseases.

95.4% of respondents confirmed they live in Kyrgyzstan. Other 4.6% are in migration/immigration, including work abroad.

Most of respondents live in Bishkek (50% of respondents). It is the biggest city and the capital of Kyrgyz Republic. Population of Bishkek is 1.17 million people (2024) out of the total population of Kyrgyzstan of 6.79 million people (2024). 16.7% of respondents live in Chuy district (oblast) near Bishkek; 7.6% — Jalal-Abad district (oblast), 6.1% — second biggest city of Kyrgyzstan Osh, 6.1% — Naryn district (oblast), 4.5% — Ysyk-Kol district (oblast), 3% — Batken district (oblast), 1.5% — Talas district (oblast). Other 4.5% of respondents live not in Kyrgyzstan (live in migration or immigration).

Quantity of kids in a family usually affects the family`s budget. 23.1% of responders have only one child in a family, 29.2% have 2 children, 27.7% — 3 children, 15.4% — 4 children, 4.6% — 5 and more children. So, there are on average 2.5 kids in a family with one disabled child.

Looking at the sex of special needs children, most of them are males (75.4%). Females are 24.6%. We do not know the reasons for this gap.

17.2% of respondents said their special needs child has mobility difficulties, 9.7% use a wheelchair or other adaptive device, 5.1% do not get school education because of health conditions. 49.2% of respondents said their special needs child has speech defects. 45.2% of respondents mostly use private healthcare while the other 54.8% mostly use public healthcare.

59.1% of responders had never heard about telemedicine before and only 13.6% have experience of telemedicine but 89.2% of responders would like to use telemedicine if they had the ability (only 10.8% of responders would never use telemedicine).

One of the biggest telemedicine problem is privacy. People believe their personal data could be stolen. Anyway, in Kyrgyzstan 41.5% of responders trust online-service, the same percentage of responders have little doubts and only 16.9% of responders do not believe online-service. 53.8% of responders said the official telemedicine program supported by the Government of Kyrgyz Republic will make them trust telemedicine. For 21.5% of responders Government doctor's license makes them trust telemedicine, for 10.8% of responders — friends and relatives recommendations, for 9.2% — doctor's referral and only 4.6% of responders said they will never trust telemedicine in all ways.

63.6% of respondents find the ability of the foreign medical specialist appointment the greatest benefit of telemedicine, 47% of respondents — absence of need to live home, 42.4% — absence of queues and 27.3% of responders chose confidentiality (maybe because of high corruption in public hospitals in Kyrgyzstan).

There are two official languages in Kyrgyzstan — Kyrgyz and Russian. 73.8% of respondents would like to speak with a doctor in Russian, 23.1% — in Kyrgyz and 3.1% — in other languages (we can assume that these people prefer to use Tajic, Uzbek or Chinese language). 40.9% of responders said that they speak English, which could help with communication with foreign medical specialists, but we can not be sure of the acceptable level of English of the responders.

Usually doctor's appointments in the public healthcare sector in Kyrgyzstan are 15-minutes long. 57.6% of respondents are sure that this time is very little. 24.2% of respondents sure that doctor's appointment should be 30-minutes long, 21.2% of responders — 20-minutes long, 19.7% — 15-minutes long, 15.2% — 25-minutes long, 15.2% - 40-minutes long, 3% — 1-hour long and 1.5% have opinion that doctor's appointment should be more that 1 hour and 20 minutes long.

42.2% of respondents said they would visit endocrinologist using telemedicine, the same percent of respondents would visit psychologist, 35.9% — pediatrician, 28.1% — therapist, 26.6% — speech pathologist, neurologist and psychiatrist, 21.9% — diabetologist, immunologist and social/clinical psychologist, 15.6% — medical geneticist and ophthalmologist, 14.1% — the ENT specialist, 9.4% — cardiologist and gastroenterologist, 1.6% — oncologist and hematologist. 46% of respondents have opinion medical geneticists are needed in Kyrgyzstan, 38.1% — endocrinologists, 36.5% — diabetologists and immunologists, 28.6% — oncologists, 25.4% — neurologists and psychologists, 23.8% — social and adaptive psychologists, 22.2% — speech pathologists and hematologists, 19% — psychiatrists, 15.9% — cardiologists, 14.3% — pediatricians, 12.7% — gastroenterologists, 11.1% — ophthalmologists, 9.5% — therapists, 7.9% — the ENT specialists. 80.6% of respondents would ask for psychological help for themselves and their special needs child if it was absolutely confidential.

Looking at the computerisation of respondents, we think there will not be serious technological problems for telemedicine in Kyrgyzstan. 86.4% of respondents use Wi-Fi, 3% use Wi-Fi but find connection poor, 9.1% do not use Wi-Fi. 90.8% of respondents use mobile internet, 6.2% find their mobile internet connection poor. 47.7% of respondents rate quality of their Internet connection as good, 29.2% as excellent and 23.1% as satisfactory. 37.5% of respondents would use the “WhatsApp” for telemedicine session, 31.3% — the “Telegram”, 17.2% — the “Zoom”, 6.3% — the “Teams”, 3.1% — the “Skype”, 4.7% — other services and messengers. 43.1% of respondents would use smartphone for telemedicine session, 32.3% — laptop, 13.8% — personal computer (PC), 7.7% — tablet. 71.4% of respondents said their special needs child has a personal device with the Internet connection (smartphone, tablet, personal computer, laptop, etc.), 25.4% said that their child uses a family device. Only 3.1% of respondents said they do not have any device with the Internet connection in their family.

Telemedicine provides an ability to take consultation of a foreign medical specialist. 42.2% of respondents would choose a doctor from Russian Federation, 34.4% — from Israel, 12.5% — from South Korea, 7.8% — from Turkey, 1.6% — from Islamic world countries (Saudi Arabia, UAE, Iran), 1.6% — from Kazakhstan.

Now let us take a good look at the experience of people from Kyrgyzstan who used telemedicine. 85.8% of those respondents would recommend telemedicine to their friends and relatives, 72.2% trust in their confidentiality using telemedicine. 60% of respondents rate doctor`s competence using telemedicine as good, 20% as excellent and 20% as satisfactory. 53.2% rated the quality of Internet connection of the last telemedicine session as good, 33.3% as satisfactory, 13.5% as excellent. 69.3% of respondents rated their last telemedicine session in general as good, 23.1% as excellent and 7.6% as satisfactory. 73.5% of respondents said it was clear for them how to use telemedicine instruction, 13.3% said they had little difficulties and only 13.2% of respondents did not understand how to use telemedicine instruction. We can notice citizens of Kyrgyzstan in general highly rate telemedicine, so it has great prospects for development there.

In the end, let us study economical perspectives of telemedicine development in Kyrgyzstan. 19.4% of respondents ready to pay 350-500 soms (363.69-519.55 Russian rubles; 3.94-5.63 US dollars, exchange rate on 28th of April, 2024) for 40-minutes long high-qualified doctor's appointment, 17.7% — 500-700 soms (519.55-727.38 Russian rubles; 5.63-7.88 US dollars, exchange rate on 28th of April, 2024), 17.7% — 700-1000 soms (727.38-1039.11 Russian rubles; 7.88-11.26 US dollar, exchange rate on 28th of April, 2024), 12.9% — less than 350 soms (less than 363.69 Russian rubles; less than 3.94 US dollar, exchange rate on 28th of April, 2024), 9.7% — 1000-2000 soms (1039.11-2078.21 Russian rubles; 11.26-22.52 US dollar, exchange rate on 28th of April, 2024), 9.7% — 2000-3000 soms (2078.21-3117.32 Russian rubles; 22.52-33.78 US dollar, exchange rate on 28th of April, 2024), 6.5% — 3000-5000 soms (3117.32-5195.54 Russian rubles; 33.78-56.30 US dollar, exchange rate on 28th of April, 2024), 6.5% — more than 5000 soms (more than 5195.54 Russian rubles; more than 56.30 US dollar, exchange rate on 28th of April, 2024). On average it is 1357 soms (1410.07 Russian rubles; 15.28 US dollar, exchange rate on 28th of April, 2024). Average salary in Kyrgyzstan is 33 500 soms (34 810.09 Russian rubles; 377.22 US dollars, 2024). There are 35 000 special needs minors in Kyrgyzstan (24.KG, 2022). Therefore, having 1 appointment per a month and 70% of special needs children, cash turnover of telemedicine will be 398.96 millions soms (414.92 millions of Russian rubles; 4.39 millions of US dollar, exchange rate on 28th of April, 2024) per a year. 

In conclusion, we can be sure that telemedicine is a prospective branch of medicine in Kyrgyzstan. Apparently, telemedicine in 2020-2030s will be supported by the Government of Kyrgyz Republic, especially for remote locations. Rate of computerization in Kyrgyz Republic is high, so there will not be any serious technical problems for the telemedicine providing.

Charts and diagrams by the Survey (4^th -25^th of April 2024, Kyrgyzstan)

Survey question 1

Figure 1. How old is your child with special needs?

Survey question 2

Figure 2. What is your child disease?

Survey question 3

Figure 3. Are you from Kyrgyzstan?

Survey question 4

Figure 4. What is your region?

Survey question 5

Figure 5. How many children do you have in your family?

Survey question 6

Figure 6. What is sex of your special needs child?

Survey question 7

Figure 7. Do you know about telemedicine?

Survey question 8

Figure 8. Have you ever tried telemedicine?

Survey question 9

Figure 9. Do you trust online service?

Survey question 10

Figure 10. Would you like to use telemedicine?

Survey question 11

Figure 11. What will make you trust in telemedicine?

Survey question 12

Figure 12. Choose the greatest benefits of telemedicine for you?

Survey question 13

Figure 13. I would like to speak with doctor in…

Survey question 14

Figure 14. Do you speak English?

Survey question 15

Figure 15. Would you recommend telemedicine to your friends and relatives?

Survey question 16

Figure 16. Is 15-minutes long appointment enough for you?

Survey question 17

Figure 17. What is optimal time for doctor`s appointment?

Survey question 18

Figure 18. Do you trust in your confidentiality using the telemedicine?

Figure 18. Do you trust in your confidentiality using the telemedicine?

Survey question 19

Figure 19. How would you rate your doctor`s competence using the telemedicine?

Survey question 20

Figure 20. How would you rate quality of your Internet connection for the last telemedicine session?

Survey question 21

Figure 21. How would you rate your last telemedicine session?

Survey question 22

Figure 22. Was it clear to you how to start telemedicine session?

Survey question 23

Figure 23. What doctor would you visit using the telemedicine?

Survey question 24

Figure 24. From your opinion, what specialists are needed in Kyrgyzstan?

Survey question 25

Figure 25. What device would you like to use for your telemedicine session?

Survey question 26

Figure 26. Do you use Wi-Fi?

Survey question 27

Figure 27. Do you use mobile Internet?

Survey question 28

Figure 28. Do you use mobile Internet?

Survey question 29

Figure 29. How would you rate your Internet connection?

Survey question 30

Figure 30. What software would you like to use for your telemedicine session?

Survey question 31

Figure 31. Have your special needs child personal device with the Internet connection (smartphone, tablet, PC, laptop, etc.)?

Survey question 32

Figure 32. If you had opportunity to consult with a foreign doctor, doctor from which country would you choose?

Survey question 33

Figure 33. Have your special needs child mobility difficulties?

Survey question 34

Figure 34. Have your special needs child speech difficulties?

Survey question 35

Figure 35. Do your special needs child use wheelchair or other adaptive device?

Survey question 36

Figure 36. Do you use private or public medical service most?

Survey question 37

Figure 37. How would you pay for high-qualified doctor`s appointment?

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