Telemedicine in the upper Amazon: Interplay with local health care practices

This article is based on the introduction of a telemedicine system in the jungles of northeastern Peru. The system was designed by a European consortium led by a Spanish polytechnic in cooperation with two universities in Lima and the Peruvian Ministry of Health. The purpose of the system was to improve health conditions by extending science-based medicine into a region with well-established traditional healing practices. The central analytical focus of this article is on the interplay between the public health care system, which used the telemedicine system, and local health care practices. The manner in which scientific medicine was delivered through information technology and public health care services is analyzed in terms of the health personnel's activity, the local population 's conceptions of health, and the trajectories followed by patients seeking recovery. The author participated in the design of the second evaluation of the telemedicine system and acted as a participant observer in the regional hospital and peripheral clinics. In addition to interviewing health care staff from the study area, the author also met with traditional healers, and patients in the districts whether or not they were involved in the telemedicine project. New institutional theory provided the analytical framework for the interpretation of the observed behavior of the public health care staff, traditional healers, and potential patients. Empirically, this study describes the informal aspects of the functioning of the telemedicine system, and its partial mismatch with the definitions of health and illness employed by local communities and healers. An argument is made that people's construction of their health, which is embedded in their normal patterns of action, should be identified, and then considered in the design, implementation, and evaluation of future telemedicine projects. This article problematizes an approach to telemedicine-based health development that is weakly accountable to local social contexts and their diversity.