A 9-year-old girl in rural Georgia discloses the unthinkable: sexual abuse by her stepfather.
The case is referred to police and local child welfare officials, who contact the Stephanie V. Blank Center for Safe and Healthy Children. A doctor soon conducts a physical examination and speaks with the child.
What makes this story different is the geographic distance between the doctor and the child. The center is in Atlanta, and its medical director, Dr. Jordan Greenbaum, handles the “visit” in real time through telemedicine. The little girl is able to stay close to home in her rural area, in more familiar and reassuring surroundings.
This scenario is typical of an expanding application of telemedicine in Georgia — evaluation and diagnosis of child abuse and neglect.
Georgia is setting the pace nationally for promoting telemedicine as a way to deliver medical care in rural areas, using high-definition cameras to illuminate problem areas and transmit them to a physician hours away with clear pictures.
The examinations can range from routine ailments –- ear and sinus infections, bronchitis, skin abrasions –- to more complex cases, including behavioral health issues.
A horrific problem
Child abuse, including sexual abuse, has attracted increased public attention in recent years. The recent scandal involving a former assistant football coach at Penn State University has intensified debate because clear signs of trouble were apparently ignored for years.
Greenbaum says that every 15 minutes in Georgia, there is a new confirmed victim of child abuse or neglect. And she adds that it’s estimated that one in four girls and one in six boys are sexually abused before their 18th birthday.
The telemedicine network for abuse and neglect is expanding from five sites to 26 across Georgia, a mix of child advocacy centers, walk-in clinics and physician offices.
The abuse-and-neglect application is an alliance among the Stephanie Blank Center, part of Children’s Healthcare of Atlanta; the Children’s Advocacy Centers of Georgia; and the Georgia Partnership for TeleHealth, based in Waycross.
Paula Guy, CEO of the TeleHealth partnership, says Greenbaum was the force behind the creation of the abuse-and-neglect telemedicine network. “It is truly making a difference,’’ Guy says.
The hookup saves time for the victim’s family, who do not have to drive to a major urban center for an evaluation. And a transmission site closer to home will lower the stress felt by the child.
Children usually become comfortable with the setup fairly readily, Greenbaum says. They are familiar with computers and smartphones, she says. “They can see me. Parents are initially taken aback, but within a few minutes, they’re fine.’’
“I can interact with the child and the examiner as if they were sitting in my office with me.”
Greenbaum says bruising from an attack can be seen if the exam is done soon after the abuse.
Much of the time, though, signs of physical damage have disappeared from the victim’s body. The examination checks for sexually transmitted diseases, and the visit also reassures the child that he or she is normal.
A tool of justice
Dr. Debra Lister, a physician, joins a nurse at the transmitting end from an urgent care center in Douglas, in rural South Georgia.
The Atlanta physicians “can see everything that I see,’’ Lister says. “Kids have such a sense of shame,’’ she says. “It’s important for children to know they look normal.’’
Greenbaum is the doctor of record in the case. “She adds expertise [so] that I won’t be missing anything,’’ Lister says.
The final report is emailed to law enforcement, DFCS and child advocacy centers.
And it can lead to convictions.
Lister recalls examining young sisters, 3 and 4, who were abused by their mother’s boyfriend.
After the telemedicine evaluation, Lister says, the report was sent to law enforcement, and the boyfriend pleaded guilty.
The telemedicine process ‘‘is something beyond what we can do,’’ Lister says. “It’s very valuable to our community.’’