<<January 21, 2000>>

Robert J. Rodrigues, M.D. <rrodrigues@paho.org>

Alexandre Rivas, Ph.D. <alex_mau@argo.com.br>

Kenneth M. Kempner <kempner@helix.nih.gov>

Mr. Edison Keiji Yamamoto <keijiy@infolink.com.br>

Paulo Coury <pcoury@saude.gov.br>

(1) Many thanks for your msgs.

ATTACHMENT I from Alex Rivas,

ATTACHMENT II from Robert J. Rodrigues,

ATTACHMENT III from Ken Kempner.

Dear Alex:

(2) Sorry for my belated reply -- I just came back from my trips to the
International Consultative Conference at the WHO in Geneva (from 1/12th
to 14th) and to the United Nations Industrial Development Organization
(UNIDO) and the UN/Office of the Outer Space Affairs in Vienna (from
1/17th to 18th).

(3) At the WHO conference, I met the following person;

Beatriz de Faria Leao, Md, PhD
President 97/98
Brazilian Health Informatics Society
Sociedade Brasileira de Informatica em Saude (SBIS)
Secretary: Health Informatics Center (CIS-EPM/UNIFESP)
Associate Professor and Director, WHO
Collaborating Center on Health Informatics
Rua Botucatu, 862
Ed. Jose Leal Prado
04023-062 Sao Paulo, SP
Tel: +55-11-549-2385, 575-4533, 576-4521/576-4561
Fax: +55-11-572-6601

I would suggest that you invite her to your mini-workshop.

I also met with Robert J. Rodrigues and he confirmed his attendance at
your mini-workshop.

I also met with the following person;

Dr. Pablo Pulido
Executive Director
PanAmerican Federation of Associations of Medical Schools
Apartado de Correos 60411
Caracus 1060-A
Fax: +58-2-945-4275
Sede de la Direccion Ejecutiva
Calle el Torreon, Quinta FEPAFEM
Urb. Sorocaima, La Trinidad
+58-2-93-0875 / 943-2840 / 93-0857
Fax: +58-2-943-285-40

He indicated me his willingness to attend your mini-workshop in Manaus in May.

I also met with the following person;

Francisco Evangelista Vieira
Consultant of Education, Health, Science & Technology
Information Technology for Development Unit (ROS/IDU)
c/o, Inter-American Development Bank
1300 New York Avenue, N.W.
Washington, D.C. 20577
Fax: 202-623-1862

He indicated me his willingness to receive our joint grant application
for the large workshop of your region activity to be held later this year.

(4) Today (January 21) I talked with David Johnson over the phone. He will
confirm the participation of medical teaching hospital of his UTK for
the echocardiograph demonstration with PictureTel via ISDN.

(5) About dates of your mini-workshop:

I now understand that the dates of this workshop in Manaus are May 25 and 26.

However, you may need to have 3 days -- pls see ATTACHMENT IV for my
suggestion of the schedule of your mini-workshop.

(6) Pls make sure the availability of;

(a) PictureTel unit,

(b) Echocardiograph machine,

(c) ISDN at 384 Kbps,

(d) PC with Internet access at 56 Kbps or higher.

Dear Ken Kempner:

(7) I would greatly appreciate it if you can kindly demonstrate or talk
about your Tele-synergy medical consultation workstation with the use of
PictureTel via ISDN line.

Dear Roger Boston and Bill Klemm:

(8) I would greatly appreciate it if you can kindly demonstrate or talk
about your videoconferencing and FORUM computer mediated conferencing system.

Dear Alex:

(9) You may have longer workshops by Roger and Bill on the occasion of the larger workshop.

Best, Tak

From: "Alex Rivas" <alex_mau@argo.com.br>
To: <utsumi@columbia.edu>
Cc: "David Johnson" <djohnutk@utkux.utcc.utk.edu>,
"Marco Antonio Dias" <mardias@club-internet.fr>,
Subject: Mini-worshop in Manaus - Part II
Date: Sun, 9 Jan 2000 13:31:11 -0800

Dr. Utsumi,

I forgot to say something in the message below.

Your mini-workshop suggestions are kept and if there are no technical
conditions to have it with the telemedicine and other demostrations, we
are going to stick with the simpler version.


----- Original Message -----
From: Alex Rivas
To: utsumi@columbia.edu
Cc: Marco Antonio Dias ; David Johnson ; bioamazonia@tba.com.br
Sent: Sunday, January 09, 2000 1:22 PM
Subject: Mini-worshop in Manaus

Dr. Utsumi,

Let me try to clarify what is going on.

In your last e-mail you made me the following questions:

>>>(a) Are you going to have demonstrations during your mini-workshop?

I suggested in my previous msg that you better do the demo
during the large workshop which is to be held later.

<<I understood that; however, there are some local peculiarities
that need to be taken into account. let's by part:

1. Sponsors

We made a great effort to have our 1998 conference. Our main
sponsor at that time, Fundacao Rede Amazonica, is "sort of waiting" what's
coming next. They put a significant amount of resources at that time and are
expecting for some results. To have a mini-workshop now to talk about GLOSAS,
UNAMAZ and University of Amazonas partnership will be okay but they may feel
that we are changing focus. I have kept them updated on everything but my
feeling is that they are waiting for more (I might be wrong though!).

I still do not know exactly how you are planning (where, financing
etc) the big workshop at the end of the year, but I am not sure how potential
local/national sponsors are going to react about a second workshop to talk
about ( for them...) almost the same thing. I understand perfectly the idea of
the mini-workshop followed by the large one, but they may not.

I have talked to many people, particularly from the medical field,
and made some explanations about telemedicine and opportunities. They get
enthusiastic and say to me: " Okay Alex, let's make a plan to go after
funds..." or "Alex, that will be great! What should we do to solve this or
that problem?" I see considerable growing local interest in implementing
something in telemedicine and also a considerable growth of interest in the
issue at the Brazilian level. If I am not wrong, this growing local (remember
that the term 'local' in Amazonia may represent some countries together in
Europe) interest is becoming a great opportunity to start acting at this level.

As mentioned in a previous e-mail, a large Brazilian company
looked for University of Amazonas to start a joint project that is very
similar to what we are proposing. I explained them our project and gave them a
copy of it. During this month or at most, in February, we are going to write
down a proposal togheter to go after funding from Brazilian sources.>>

2. Demonstration

>>> (b) In order to do a similar demo as we did during our Tampere event,
you need to have, at least;

1. echocardiograph machine (better to be made by Hewlett-Packard),

2. 384 Kbps ISDN line,

3. PictureTel or VTEL unit

4. a PC or Mac with 56 Kbps dial-up modem.

<< I understand perfectly the technical constraints to have a similar
demonstrantion of what we had in Tamapere. I am having
conversation with Embratel to see costs and if they have the technical
conditions to offer the service we need. During the last year, I have
visited at least three companies in Manaus that use PictureTel. After I
have a position from Embratel, I am going to look for the
echocardiograph machine because the PC is not a problem.

The next step after that is to find the other part and talk
about the needs to have it done. That is why I asked Dr. Johnson how
willing is the medical telemedicine team from UT is to get involved in
this effort. During our conference in Tampere, I talked to Dr. Shin
Takuma and he also told me to be willing to have that kind of
demonstration with Manaus ( but I have not talked to him recently).

On the other side, UNAMAZ people is already willing to start a
distance education program early next year (using e-mail, NetMeeting
etc.) and they want to see how this work and what is necessary to train
some people from Peru and Venezuela. Tomorrow ( Monday) the board of
directors from Unamaz is meeting in Leticia -- a city in the
Bolivia/Brazil border -- where they are going to present a pre-proposal
that we worked together some weeks ago. According to our partners from
Unamaz, a version of our pre-proposal was already submitted to the
European Union in order to find funds for our 2001 mini-course in
Sustainable Development.

So, before the considerations in the above paragraph, I plan to
have Dr. Boston here in Manaus (I have not talked to him yet) to
demonstrate and give us (Unamaz's people from Brazil - Para, Amazonas,
and Porto Velho -- Peru and Venezuela) a 2 to 3 day course on using these
tools for distance education in the Amazonian context. THAT IS THE PLAN.

>>> 3. Dates

<<It was my fault to inform you the wrong dates. The problem
is that I was looking in an 1999 calendar. May 25 and 26 is the correct
one. However, if all I am planing work out, I may need to put one or two
more days.>>

4. Proposals

<<To give you a better understanding of what I explained in
(1) above, here are a few more words.

I plan to present during our mini-workshop one or two
conceptual project to wireless connect the city's children hospital with
other hospital of the city (including the University hospital) and the
blood center. There some people at University of Amazonas that are also
working with other projects (mainly contents) of interest related to the
field that I plan to invite to join us. My intention with these
presentations, after the telemedicine demonstration, is to make people
more interested in the project and accelerated its eventual
implementation locally.

If it all can be done, it will be fantastic!

I hope I have made myself more clear now and would immensely
appreciate your comments.


Alex >>

Dr. Marco Antonio Dias
Dr. David Johnson
Dr. Jose Seixas Lourenco

From: "Rodrigues, Dr. Roberto J." <rrodrigues@paho.org>
To: "'Alex Rivas'" <alex_mau@argo.com.br>
Cc: "Takeshi Utsumi (E-mail)" <utsumi@www.friends-partners.org>,
"'keiji@saude.gov.br'" <keiji@saude.gov.br>,
"'daj@utk.edu'" <daj@utk.edu>
Subject: RE: Amazonia's project
Date: Fri, 7 Jan 2000 20:54:01 -0500

Dear Dr. Rivas,

1. Thank you for your message. I just passed through Manaus two days ago and
had just an overnight stay at the Hotel Tropical upon returning from a 11-day
cruise in the Rio Negro up to Barcelos and back. Unfortunately, I could not
contact you as I wished.

2. I plan to attend the May meeting and would like to help prepare one or more
telemedicine proposals for UNAMAZ. At this stage I suggest the immediate
involvement of Prof. Daniel Sigulem from the Universidade Federal de Sao
Paulo, who has been very active in a number of clinical and educational
initiatives in the area (attached find card with contact information). He can
also demonstrate some of the applications developed at the Centro de
Informatica em Sa=FAde da Escola Paulista de Medicina.

3. I had the opportunity to discuss issues related to telemedicine with Dr
Biasoto at the Ministry of Health and my impression is that they are
interested in supporting projects and I also understand that resources are available.

Best regards
Roberto J. Rodrigues, MD
Regional Advisor in Health Services Information Technology
Division of Health Systems and Services Development
Pan American Health Organization/World Health Organization
525 Twenty-third Street, N.W.
Washington, DC 20037 USA
Tel: (202)974-3826
Fax: (202)974-3614
E-mail: rrodrigues@paho.org <mailto:rrodrigues@paho.org>
NetMeeting Server: ils.paho.org

-----Original Message-----
From: Alex Rivas [mailto:alex_mau@argo.com.br]
Sent: Sunday, December 26, 1999 6:19 PM
To: rrodrigues@paho.org <mailto:rrodrigues@paho.org>=20
Cc: keijiy@infolink.com.br; keiji@saude.gov.br =
<mailto:keiji@saude.gov.br> ;
pcoury@saude.gov.br; daj@utk.edu <mailto:daj@utk.edu>=20
Subject: Amazonia's project

Dear Dr. Rodrigues,

Dr. Utsumi sent me an e-mail with your comments about the inclusion of
telemedicine in our proposal.

In my opinion telemedicine is one of the most important point in our
Amazonia's project. It was not well elaborate in the proposal because my
knowledge about the issue is very limited. I have talked with people who I
know from the medical field and I believe from now on I'll have more help.
Recently, UNAMAZ - Association of the Universities from Pan Amazonia -
decided to have our project as one of its main long term goal. This decision
came in good time!

On the mini-workshop we are going to have on May 25 and 26 I want to have a
telemedicine demonstration and to present at least two pre-proposals for
telemedicine. One of them is related to the pediatric field and the other
one is going to be defined soon (we accept your suggestion...).

Please, I would like to know in what you can help us at this point.

Dr. Utsumi informed you are coming to Manaus soon. Please, let me know the
dates and try to arrange some meetings so we can talk about the project.


Alexandre Rivas

Dear Bob:

(8) The mini-workshop of our South American Group with UNAMAZ consortium
people will be held on May 25 and 26 in Manaus.

As discussed, pls plan to attend it with your educational people.

Dear Alex:

Bob is going to Manaus for his family's vacation soon. If you
both can find time, you may meet together for a brief chat.

Alexandre Rivas, Ph.D.
Diretor do Centro de Ci=EAncias do Ambiente / UFAM
Director of the Center for Environmental Sciences / UFAM
Tel.: +55 92 644.2322 C.P. 4208
Fax.: +55 92 644.2384 Manaus - AM - Brasil
alex_mau@argo.com.br <mailto:alex_mau@argo.com.br>

Date: Fri, 7 Jan 2000 13:04:45 -0500
To: utsumi@columbia.edu
From: "Kenneth M. Kempner" <kempner@helix.nih.gov>
Subject: Your Visit to the NIH
Cc: fg36q@nih.gov, cmacedonia@aol.com

Dear Dr. Utsumi,

My colleagues and I were very pleased to meet with you yesterday afternoon,
and we enjoyed the active discussion about our common interests. Hopefully
we will be able to work together on an international telemedicine
collaboration in the near future.

Please have a pleasant journey to your meeting in Geneva next week, and we
would like to be in contact with you when you return to the United States.
We would also like you to describe our TELESYNERGY System to your
colleagues, if it is appropriate for the topic being discussed.

The TELESYNERGY System is described on the following web site:

The National Cancer Institute's new "Partnership in Science Program",
provides institutional outreach to distant hospitals that wish to
participate in NIH Clinical Trials. The TELESYNERGY System is the official
medical consultation platform which links institutions that participate in
this program. The "Partnership in Science Program" is described on the
following web site:

The NCI All Ireland Cancer Conference was held October 3-6, 1999. The
TELESYNERGY System was transported to this conference and demonstrated via
a dial-up ISDN PRI circuit to the NIH Clinical Center in Bethesda. See the
following Web site for detailed information about this conference:

For further technical information about the initial version of our
TELESYNERGY Medical Consultation WorkStation (MCWS), see the following web
site: http://imcs.cit.nih.gov/publications/spie97/

Thank you for your interest in our medical consultation activities here in
Bethesda, and we are looking forward to meeting with you again soon.

Best Wishes,



Sent by Kenneth M. Kempner
Chief, Image Management and
Communication Section
Computational Bioscience and
Engineering Laboratory
Center for Information Technology
National Institutes of Health
Building 12A, Room 2019
12 South Drive MSC 5624
Bethesda, MD 20892-5624 USA
E-mail: kempner@helix.nih.gov
Tel: (301) 496-9344
Fax: (301) 402-2867

Tentative Schedule and Outcome of Mini-workshop
Manaus, Amazona
May 25-26, 2000


09:00 Greetings by delegates

10:30 Coffee break

11:00 Global University System

Dr. Tapio Varis,
Acting President,
Global University System

11:30 Education and Learning in the 21st Century

Dr. Marco Antonio Dias,
Vice President for Administration,
Global University System

12:00 Lunch

13:30 Technological Future of Global University System

Dr. Takeshi Utsumi,
Vice President for Technology and Coordination,
Global University System

14:30 Demonstration of Low Cost Videoconferencing for Global Distance Learning

Professor Roger Boston,
Houston Community College

15:30 Coffee break

16:00 Continuation of the above

17:00 Dinner

19:00 Tele-Synergy System with Medical Consultation Workstation

Dr. Kenneth Kempner,
National Cancer Institute,
National Institute of Health

20:00 Demonstration of Echocardiograph

Medical School,
University of Tennessee/Knoxville (UTK)

21:00 Adjourn


09:00 Distance Learning on Sustainable Environment

University of Tennessee/Knoxville (UTK)

09:30 Computer Mediated Conferencing System with Multimedia Web

Professor Bill Klemm,
Texas A&M University

10:30 Coffee break

11:00 Continuation of the above

12:00 Lunch

13:30 TeleHealth and TeleMedicine in Latin America

Dr. Robert J. Rodrigues,
Pan American Health Organization

14:00 Brainstorming Sessions:

To learn from UNAMAZ members about,

1. current status of distance learning and telemedicine
(including the delivery infrastructure),

2. their need in the future, particularly when a broadband
Internet will be available.


Alexandre Rivas, Ph.D.
University of Amazonas

Dr. Robert J. Rodrigues,
Pan American Health Organization

15:00 Coffee break

15:30 Brainstorming Sessions:

To present what can be (or will be) available from North America,

1. via narrow-band Internet and ISDN, etc., i.e., through
currently available telecom infrastructure,

2. via broad-band Internet when it is available.


Dr. Takeshi Utsumi,
Vice President for Technology and Coordination,
Global University System

Dr. Robert J. Rodrigues,
Pan American Health Organization

Professor Roger Boston,
Houston Community College

17:00 Adjourn

19:00 Conference dinner

Dinner speech


20:00 End of second day


09:00 Educational exchange in the 21st Century

Dr. David Johnson
Distinguished Professor
University of Tennessee/Knoxville (UTK)

09:30 Brainstorming Sessions:

To discuss and plan the theme and program of the larger
workshop/conference (as to the follow-up to our Tampere event -- for
3 to 4 or 5 days) where UNAMAZ people will jointly work;

(a) to formalize the draft of a joint pilot project proposal at


(b) to make the feasibility study, action plan, etc. to realize the
project of establishing domestic and international distance
learning and telemedicine,

1. firstly, via the currently available narrow-band Internet,

2. in the near future, via the proposed broad-band Internet,

(c) to configure administrative and business schemes,

(d) to construct joint funding proposals.


Dr. Takeshi Utsumi,
Vice President for Technology and Coordination,
Global University System

Dr. Robert J. Rodrigues,
Pan American Health Organization

10:30 Coffee break

11:00 Continuation of the above

12:00 Lunch

13:30 Session Keynote Speech

14:00 Brainstorming Sessions:

To plan joint fund raising for the larger workshop/conference.


Dr. Takeshi Utsumi,
Vice President for Technology and Coordination,
Global University System

Dr. David Johnson
Distinguished Professor
University of Tennessee/Knoxville (UTK)

15:30 Coffee break

16:00 Continuation of the above

17:00 Adjourn

Outcome of the workshop

* Assessment of the technical capacity and infrastructure set-up of UNAMAZ members
* Enhancement of their human and infrastructure capacity (whenever required)
* Organization and implementation of distance learning (DL) courses
* Assessment of the effectiveness and sustainability of the approach established
* Development of a wider programme to broaden the utilization of DL to
other sector and specialties
* Outline of the larger workshop
* Fund raising strategies for the larger workshop
List of Distribution

Robert J. Rodrigues, M.D.
Regional Advisor in Health Services Information Technology
Division of Health Systems and Services Development
Pan American Health Organization
Regional Office of the World Health Organization
525 Twenty-Third Street, N.W.
Washington, D.C. 20037
Fax: 202-974-3614
NetMeeting Server: ils.paho.org

Alexandre Rivas, Ph.D.
Adjunct Professor
Director of the Center for Environmental Sciences
University of Amazonas - Brazil
C.P. 4208, Manaus 69053-140
+55-92-635 32 33
+55-92-644 23 22
Fax: +55-92-644 23 84

Kenneth M. Kempner
Chief, Image Management and Communication Section
Computational Bioscience and Engineering Laboratory
Division of Computer Research and Technology
Center for Information Technology
National Cancer Institute
National Institutes of Health
Building 12A, Room 2019
12 South Drive MSC 5624
Bethesda, MD 20892-5624 USA
Fax: (301) 402-2867
http://www-dcs.nci.nih.gov/branches/rosp/index.html -- about TELESYNERGY
http://www-dcs.nci.nih.gov/branches/rosp/partnersci.html -- about "Partnership
in Science Program"
http://imcs.cit.nih.gov/publications/spie97/ -- about TELESYNERGY Medical
Consultation WorkStation (MCWS)
http://www.allirelandcancer.com/ -- about NCI All Ireland Cancer Conference on
October 3-6, 1999.

Mr. Edison Keiji Yamamoto
Secretaria de Assistencia a Saude
Ministerio da Saude
Esplanada dos Ministerios - Bloco G - sala 701
Brasilia - D. F.
BRASIL 70058-900
Fax: +55-61-225-0054

Paulo Coury
Secretariate of Health
Ministry of Health
Brasilia, Brasil
* Takeshi Utsumi, Ph.D., P.E., Chairman, GLOSAS/USA *
* (GLObal Systems Analysis and Simulation Association in the U.S.A.) *
* Laureate of Lord Perry Award for Excellence in Distance Education *
* Founder of CAADE *
* (Consortium for Affordable and Accessible Distance Education) *
* President Emeritus and V.P. for Technology and Coordination of *
* Global University System (GUS) *
* 43-23 Colden Street, Flushing, NY 11355-3998, U.S.A. *
* Tel: 718-939-0928; Fax: 718-939-0656 (day time only--prefer email) *
* Email: utsumi@columbia.edu; Tax Exempt ID: 11-2999676 *
* http://www.friends-partners.org/GLOSAS/ *

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