Abstract
Telemedicine of course has antecedents that made the development of our discipline possible. The matter of communication over distance should recognize the importance of a Frenchman, Claude Chappe, who introduced the system of semaphore flag signals across France in the 18th Century. The language triumph of Samuel F.B. Morse with his code in 1844 makes us mindful of the great importance of computer language in our digital evolution. Converting language to electronic dashes and dots was just as transformational then as “hypertext markup language” (html) a few years ago. However, the problem of compatibility and international cooperation so important today was solved in its first electronic challenge by the Union Télégraphique Internationale (the International Telegraph Union). Submarine cable, such as the first transatlantic cable in 1858, encountered the complexity of international borders where signals might have to be interrupted and regulated by that nation before continuing on to the intended recipient. This organization celebrated its sesquicentennial last year. On May 17, 1865, 20 nations met in Paris to consider an array of problems in international interaction relative to the telegraph. The participants agreed to international codes and subsequent treaties that allowed the free flow of electronic signals across oceans and borders with messages easily generated and readily understood at the destination.
After telephony was introduced in 1876, the International Telegraph Union continued to facilitate progress and cooperation. The organization was crucial to the international agreements that allowed radio communication to proliferate without national acrimony after Guglielmo Marconi completed the first transatlantic messaging in 1901. In 1906, the first wireless transmission of voice and music was introduced by Aubrey Fessenden. In that year, the Union changed its name to the International Radiotelegraph Union. The Union was always in step or even ahead of evolving technology. Why should a regulatory and treaty organization be ahead? Certainly a sound organization like the International Telegraph Union could anticipate what technology would be disruptive and prepare for its impact with steady foresight and progressive regulation to permit international usage. After the Titanic disaster of 1912, the Union met that year in London to promulgate international agreement for specified frequencies monitored regularly for distress signals. SOS!!! NOW!!
In 1932, the Union changed its name once more to the International Telecommunications Union (ITU). In 1947, the importance of sustained work by this body was recognized by bringing it into the United Nations as an agency, and there it remains: busy, productive, and solving problems. The Union is responsible for allocation of radiofrequencies and satellite orbits. The ITU's contribution to the development of television was recognized by two Emmy awards in 2008. The agency was also crucial in the regulatory recommendations for satellite communications, Internet technology, and compatibility.
The ITU has obviously broadened its attention to information and communication technology, and in recent years the proliferation of access to telecommunications in the developing world. The problems of digital divide continue to plague development, and the ITU is at the forefront of change and resolution as has been its history. The Union offers training, conferences, and a solid forum for international cooperation in the spread of telemedicine to all the countries of the United Nations. The ITU, based in Geneva, is actively engaged in telemedicine within its development sector, ITU-D. The group organizes its work around questions and holds conferences to advance toward answers to those questions. There were 10 in April 2016 alone.
The Union is most astute in recognizing the importance of geography in the advancement of telemedicine and telecommunications in that current emphasis is on six regions rather than restricting its work to global considerations. Rather than inviting developing nations to come marvel at some new technology in Paris or New York, the ITU brought some experts to the region of interest where the participants recognized one another, as well as common problems, and could process the new information in the context of national and regional problems. This has been greatly important. A developing country confronted by hunger, health issues, war, disaster, etc., might not recognize the importance of a technology like the cell phone. The ITU did!! That entity has played a major role, since 1973, in bringing the enormous benefit and low cost of cellular communications to those countries that needed a low-cost way to communicate. The Union recognizes rapporteurs in various regions and holds meetings to address specific questions and its considerations span from cybersecurity to infrastructure to business interactions. The ITU has 193 nation members and 800 private sector entities or academic institutions.
It should be clear that telemedicine has a history joined with that of the ITU. Sometimes we get a little myopic in our work and believe that today's problems are radically new and perhaps there is no solution for interoperability, access, security, capacity building, funding, and international agreement. Sometimes we are intimidated by the interaction with the private sector vis-à-vis the regulators. Happily, the ITU teaches us still that there are no insurmountable problems. Imagine getting the French, German, and English together to agree on much of anything in 1912!! By the persistent course of logic, inevitable technology, and diplomacy, the ITU has shown the way. Partnership, international understanding, and the high aspiration for combinations have sustained the activities. Also, the lesson to all bureaucracies is not to be reactive and ponderous. They can be proactive, creative, and fully responsive to the highest motives of human welfare. We can learn from the evolution of the ITU not only that telemedicine has a past, but in fact that we have a marvelous future, and the lessons of the ITU will continue to be an inspiration. We invite to you to explore this organization through its Web site (