Reviews / Recensions

CJRM 1999;4(2):105-6

Letters to the editor should be addressed to: Canadian Journal of Rural Medicine, Box 1086, Shawville, QC J0X 2Y0; cjrm@fox.nstn.ca; fax 819 647-2845

© 1999 Society of Rural Physicians of Canada

This book would not, unfortunately, meet the needs of a busy rural GP who is involved in the intensive care or the management of acutely ill patients — unless s/he is a masochist.

The authors present 21 different cases that might present to an intensive care unit. The cases are well presented and are followed by several questions. No answers are provided and this scenario continues throughout: more questions, no answers. However, there are some very current references.

Specific criticisms of the book by a physician practising critical care in a rural hospital should be mentioned. There are frequent references in the text to consultations with various specialists on site. This is not a reality in rural Canada. There are references to CT scans in some of the cases in which the CT scans direct the logical evolution of the case. This is irrelevant in rural areas where CT is generally nonexistent. In the evolution of a patient's illness there is discussion of the information supplied by the Swanz­Ganz catheter. Again this would tend to exclude the majority of rural hospitals.

I believe that this book may be a useful teaching tool for some physicians in rural practice but it does not meet the needs of physicians who require rapid access to useful information in order to help a critically ill patient. In their defence the authors, in their introduction, state that this book offers only a framework for intensive care. Nonetheless, the book poses too many questions and not enough answers. I would not recommend it to rural physicians as a reference text for critical care cases.

Thomas C. O'Neill, MD, CCFP
Shawville, Que.

Inmarsat's WorldPhone

You're on call for obstetrics and you have a "first timer" overdue by 6 days. But it's Saturday and you have a golf game and she's in early labour. Your cell phone, if you have one, doesn't work very well in your rural area, and the pager sets up the possibility of being on the 9th hole and farthest away from a phone if and when a page comes through. You finally phone and cancel your golf game.

New technology may now allow you to play golf and stay in voice contact with the hospital no matter how remote the golf course is. We checked out Inmarsat's WorldPhone, which allows users to telephone worldwide from just about anywhere in the world. The phone is not dependent on line-of-sight towers (practically nonexistent in most of rural Canada it seems) but on satellites. Inmarsat claims its phone covers 95% of the world, a far sight more than any cell phone, as many a rural resident has learned.

Inmarsat first got into the business as a provider of marine telecommunications, but this phone would be useful for anyone working in remote or rural areas. In fact, Inmarsat bills the phone as a unit that will provide service "in areas where other telecommunications facilities are poor, unreliable or nonexistent."

I drove out to Charteris, Que., and tested the WorldPhone in the bush where no cell phone has ever worked for me. The unit is the size of a lap-top computer, weighs 2.7 kg and is contained in a hard, rain-resistant plastic case. It comes with a carrying case and a universal AC adapter. The unit includes a flat antenna and an RF transceiver, which are housed in the lid of the case. The actual telephone and battery pack can be taken out of the case but remain attached to the antenna by a 9-m coaxial cable (or longer if needed). There is a screw socket in the lid so that the unit can be mounted onto a tripod or suctioned to a window.

I opened the unit so that the lid with the antenna was at about a 45° angle and turned the phone on. It prompted me to input the PIN that was allocated to me. I did and pressed OK, and the unit told me it was searching for a satellite. It found one but the strength of the satellite connection in the shaded signal bar on the LCD display showed it was not strong enough for good reception. I turned the antenna in a slow arc as it searched for a better satellite. It found one that it liked and logged onto the satellite and the base station. I was then prompted to make a call. For the first time from deep in the woods of west Quebec I was actually able to have a clear conversation with someone in Shawville, 5 km away, without the connection being cut or extraneous noise making conversation impossible, as has always happened with a cell phone here.

One drawback with the phone is that there is sometimes a delay similar to that of radio telephones, where transmission is not instantaneous. According to Andrew Ivey, Inmarsat's marketing manager, this may be due to how the call is routed by the network provider once the signal is received from the satellite. If the call is routed through a terrestrial network it can compound the delays so that they become noticeable. "Some delay under these circumstances," he says, "can and should be anticipated."

The phone itself is not cheap. It starts at US$3000 and up, depending on the bells and whistles. Some of those bells and whistles include being able to connect to the Internet and send and receive email by hooking the unit up to your computer, but not if you are a MacIntosh user — it's not compatible with Macs, so I was unable to check out their claims in this area. Charges for phone calls start at US$2.75, and all outgoing calls require you to dial 00 then the country code, area code and number. The phone works with an SIM (subscriber information module) card, which contains subscription information from either your Net service provider or your Inmarsat service provider.

The WorldPhone lives up to its billing: "out of reach, still in touch." It would be a good investment for a hospital or a group practice where overworked surgeons, GP anesthetists and GPs taking call away from the hospital can actually do something such as play golf without worrying about whether the cell phone will fizzle or the pager will beep on the 9th hole. Of course, an even better solution for rural doctors would be to make their call schedules "doctor friendly."

NERA WorldPhone is available from: Stratos Mobile Network in Toronto, Ottawa and St. John's or from the distributor: Network Innovations in Toronto with head office in Calgary. Web site: www.nera.satcom.no

Suzanne Kingsmill, BA, MSc
Shawville, Que.