COMMUNICATION BETWEEN KIDNEY FOUNDATIONS WORLDWIDE Kim Solez, M.D.

Communication between kidney foundations worldwide. 1.Common solution to problems. 2.Electronic commmunication in nephrology education, research, and practice. 3.Facilitation of diagnostic consultations, research collaboration. 4.Sharing of ideas on educational approaches and programs.

Modalities: CD-ROM, Fax on demand, , WWW, Internet videoconferencing, telemedicine, telepathology. Advantages - Much can be accomplished using these new technologies which could not occur in any other way. Nearly instant opinion gathering and consultation.

Bandwidth considerations The Internet in high bandwidth environments: Only 35% of human communication is words. With Internet video conferencing can capture gestures, body language, inflections of the voice, facial expression etc. plus share images, documents, software applications with "shared white board" or complete remote control of other computer! Requres 56 K modem or faster connection. The Internet in low bandwidth situations: Web site educational content can be placed on CD-ROMs cheaply and easily so sites can be accessed without going to the World Wide Web. -based low bandwidth discussion has been enormously successful in nephrology while WWW-based discussion has not. So potentially everyone has access to the Internet resources that have proven most valuable in nephrology.

All countries can benefit from Internet-based discussion in Nephrology. connectivity has reached almost everywhere. Very few exceptions: Afghanistan, Angola, Cape Verde, the Comoros Islands, Equatorial Guinea, Libya, Mauritania, São Tome and Principe, Somalia and Western Sahara. Connecting is becoming easier all the time. Within East Africa (Uganda, Kenya, Tanzania), phone calls are treated as "local" and are therefore relatively inexpensive. Thus, you need only have an account created in one place. You can for instance call Kampala from Nairobi or Zanzibar for low-cost. Indeed, there are a sizeable number of clients in Uganda or Tanzania who dial into a server in Nairobi!

Rapidity of change. Everything becoming easier, faster, cheaper. In 1993, only four countries in Africa were connected to the Internet. By August 1997, all but ten African countries were connected. Similar progress is being made in developing countries around the world.

How NKF cyberNephrology and ISN Informatics Commission can help with transition to greater use of high technology communications for kidney foundations worldwide. We are poised to help and can do so in many ways: -Technical support. - discussion groups in nephrology. -Providing WWW content on CD-ROMs. -Computer hardware and software donation and on-site training in Internet connectivity as part of Renal-Tech project.

Renal-Tech Project Cooperative program with ISN donates computer hardware. software, and computer/Internet training to renal units in developing countries. Visits to Nigeria, Zimbabwe, Nepal, Cuba, and Peru. Hope to expand to visit 24 additional countries in three years. Please approach: or Zina Munoz Zina Munoz if you believe your country could benefit.

"We strongly believe that better telecommunications will enhance our ability to deliver improved quality of life, electronic health and learning services to previously disadvantaged areas in the continent". President Nelson Mandela in an address to the Africa TELECOM 98 Exhibition and Forum Johannesburg 4-9 May 1998 "I have come to understand that a lack of knowledge in a major factor in many of the mistakes that have occurred in Africa since the 1960s.” President Yoweri Kaguta Museveni - Uganda

Latin American Developments: Telecommunications reform -- accompanied by competition, cheaper rates and better service -- is arriving, especially in Argentina, Chile, Peru and potentially Brazil. In Argentina, meanwhile, the high cost of a local telephone call was recently cut in half for calls made to Internet service providers. A recent study by International Data Corporation (IDC) indicated that almost 80% of Internet access accounts in Brazil are home- based. In contrast, Mexico's home penetration is only 29%. These numbers highlight the greatest and least Net access in Latin American Nations.