Stitching Infrastructures to Facilitate Telemedicine for Low-Resource Environments.

Telemedicine can potentially transform healthcare delivery in low-resource environments by enabling extension of medical knowledge to remote locations, thus enhancing the efficiency and effectiveness of the larger healthcare infrastructure. However, empirical studies have shown mixed results at best. We present a qualitative investigation of a long-standing telemedicine program operating from Lucknow (Uttar Pradesh, India). Invoking the lenses of human infrastructure and seamful spaces, we highlight the factors that determine the success of this telemedicine program. We identify and describe three important aspects: (1) conceptualizing telemedicine as the connectedness of two nodes rather than doctors and patients alone, (2) identifying the critical 'carrying agent' (local doctors at peripheral nodes) and engaging them in program design and implementation, and (3) ensuring co-creation by engaging patients in the process. Finally, we discuss how our lenses allowed us to recognize the seams made visible through the juxtaposition of the infrastructures at the central and peripheral nodes, and to emphasize the human elements that addressed these seams for ensuring the facilitation of a successful telemedicine program.