Manitoba has the highest prevalence of ESRD in Canada. Northern Manitoba is a very sparsely settled area with a high proportion of aboriginal ESRD patients. Relocating to urban areas for dialysis is psychosocially and culturally stressful to patients. Delivering dialysis care in a home setting has demonstrated advantages in both clinical, economic, and health related quality of life domains. Establishing home hemodialysis in very remote communities has significant challenges, including poor and inadequate housing, unreliable water supply, limited community medical backup, and poor road access to communities especially for delivery of supplies. These challenges necessitate the development of strong community partnerships, and well documented processes for contingencies. A dedicated interdisciplinary support and training team at the urban hub is essential.
Alaska shares many characteristics with other rural and remote regions of the Asia-Pacific, including a small population spread over a large area, lack of roads linking villages to hospitals, a significant indigenous population, and a shortage of doctors in rural areas. Communication with village health aides was originally by high frequency (HF) radio. Satellites brought reliable voice communication in the 1970s. Alaska has now introduced the first permanent upgrade to the voice satellite system, known as the Alaska Federal Health Care Access Network (AFHCAN). This satellite-based system is now the world's most extensive telemedicine network, linking 248 sites, including 158 village health centers. This paper examines the approach used to design the network, and includes preliminary findings on utilization of the network and associated cost-savings. It also discusses the U.S. Universal Service Fund subsidy for rural health care facilities. It concludes with lessons learned that could be applicable for other remote and isolated areas and developing regions.