Here, we describe information pertaining to internet connectivity at our clinic. Although several items are specific to Achham, many of the issues we have faced are relevant to any remote, rural clinic working to improve internet connectivity.

Present Scenario

We established the first two internet connections in our area. The first was via wireless CDMA boosted via an antenna, but the speed and reliability of that was not sufficient. Long-term, we are lobbying the Nepal Telecom to add a tower near to our site. Presently, we use a 0.96 Very Small Aperture Terminal Satellite connection at 128 kbps shared bandwidth unlimited usage. This has enabled our Achham team to stay in regular, daily contact with our US team for assistance on technical issues, data reporting, and protocol development.

Comparison of options

Wireless CDMA

This is the option that shows the highest potential for broad application. It is highly affordable, with usage costs approximately $0.05 per MB. However, the nearest CDMA towers in Silgadi and Mangalsen are located 40 km away. Currently, with a 12 dB antenna and fixed wireless terminal, a reliable phone and spotty internet connection has been established. A 800-900MHz yagi antenna and wireless booster for the area had previously failed to improve (or even establish) connectivity. We are dialoguing with Nepal Telecom (NTC) about developing a tower in Bayalpada where the future hospital and telecommunication center is located. In general, wireless technologies should be the focus of campaigns aimed at governments and private companies to expand internet access in remote areas.

Very Small Aperture Terminal (VSAT) Satellite

Satellite is superior to CDMA in terms of reliability and speed; however, the usage cost is much higher.

Through our supplier (STM), we have purchased a 0.96 meter VSAT for 88,000 NRs (~1300 USD). Per month to get 128 Kbps (dedicated is 64 kbps which is more typical usage) it costs us 9500 NRS (~140 USD). We have found this to be highly reliable once we had a solid energy system in place.

Landlines

In our community, there are no landlines over which to dial into the NTC roaming network. To effectively utilize landlines, we would need to work with NTC to lay additional lines, which is a significant bureaucratic challenge. Usage costs also can be high, since they are charge on a per-minute basis.

Broadband Global Area Network

This is probably only applicable to extremely remote areas where highly subsidized usage fees can be obtained. BGAN system costs approximately $1000-$3000 in capital costs, and usage through Inmarsat costs US$6 per MB.