Shahin Yusuf
(shahinyusuf21@gmail.com)
Imagine a pregnant woman living on a remote riverine island in Assam. She has completed her antenatal check-ups at the nearest health centre, but the doctor advises her to undergo an ultrasound. The nearest functioning facility may be several hours away, requiring a boat, an auto-rickshaw and another bus. For a family living on daily wages, the ultrasound is not merely a medical test; it becomes a question of transport, lost wages and time.
This is an illustrative composite, not the account of a particular patient.
The irony is that the technology required to examine her may now fit into a small medical bag.
Assam already has 1,014 primary health centres and 151 community health centres, besides 4,621 sub-centres, according to the Directorate of Health Services. Yet diagnostic capacity remains unevenly distributed. Assam’s own health department acknowledges that the availability of and access to quality radiology services have been challenging and has consequently developed free diagnostic services and tele-radiology.
The maternal-health numbers make the problem more consequential. According to NFHS-5, only 49.2% of rural mothers in Assam had at least four antenatal-care visits, compared with 62.6% of urban mothers. Only 62.7% of rural mothers had an antenatal check-up in the first trimester. Assam’s maternal mortality ratio was estimated at 125 per 100,000 live births in 2020–22, down from 195 in 2018–20, but it still indicated a substantial maternal-health burden. Although the figure has improved significantly, with more recent statistics showing a further decline from 195 to 85, diagnostic services remain in a dismal state. Such a system would not only benefit pregnant women but also help detect other common ailments, such as fatty liver disease, cancer, and gallbladder or kidney stones.
Assam could establish an Assam Rural Tele-Ultrasound Network, with portable ultrasound machines at selected PHCs and CHCs, trained doctors or appropriately trained healthcare personnel to acquire defined images, secure transmission of those images to radiologists at district hospitals and medical colleges, and digital reports returned to the originating facilities.
This is not science fiction. A tele-mentored handheld-ultrasound study involving 708 patients across rural and remote facilities demonstrated that local general practitioners could perform ultrasound examinations under real-time supervision from experts located more than 300 km away. A recent maternal-fetal tele-ultrasound feasibility study also found that remote scans could produce clinically useful measurements, although the technology requires appropriate training and quality assurance.
Assam already has the beginnings of this architecture. Its free-diagnostics programme envisages tele-radiology, with images transmitted from peripheral institutions to specialist hubs. Its maternal-health programme also provides for free obstetric ultrasound examinations through authorised private diagnostic centres where government facilities lack in-house USG facilities, with reimbursement of Rs 500 per scan under the 2024–26 guidelines.
The next step should be to take the machine to the patient rather than perpetually transporting the patient to the machine.
There is, however, an important legal safeguard. Ultrasound cannot be treated merely as another mobile gadget. Where it falls within the scope of the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 (PCPNDT Act), registration, authorised use, record-keeping and safeguards against sex selection must accompany the machine. Assam’s own guidelines require empanelled centres to comply with the Act and maintain the prescribed documentation. Technology should therefore strengthen regulation through authenticated users, digital records, audit trails and traceable equipment, not weaken it.
There is also an economic argument. Gauhati Medical College and Hospital alone reports approximately 17,000 ultrasound examinations annually, illustrating the enormous demand concentrated at major centres. At Dhubri Medical College, more than 2,000 ultrasound examinations were recorded in several individual months of 2024. Extending basic diagnostic capacity to peripheral areas could reduce unnecessary journeys and allow tertiary centres to concentrate on complicated cases. The proposed system could have three layers: portable machines at rural facilities, mobile ultrasound units for hard-to-reach communities, and tele-radiology hubs at district hospitals and medical colleges. Where connectivity is weak, images could be stored and transmitted asynchronously when a connection becomes available.
This is where Dr A.P.J. Abdul Kalam’s vision of PURA—Providing Urban Amenities in Rural Areas—acquires a modern medical meaning. Physical connectivity brings the device. Electronic connectivity carries the image. Knowledge connectivity brings the radiologist. The final objective is human connectivity: ensuring that a woman in a remote Assam village can access expertise that would otherwise be hundreds of kilometres away.