The demonstration in Xi'an is an outgrowth of Bridge to Asia's work with the Institute of Medical Information (IMI) which began (unofficially) in late 1994 at an Internet conference at Tsinghua University in Beijing.

Dr. Hu Tiejun (director of the IMI's CMINET network center) met Bridge staff, and several months later sent an 'SOS' from China - the case of "Ying", the peasant girl with an undiagnosed disease.

"Ying's" case was the first such use of the Internet in China, and showed the need for and possibilities of international consultations over the Internet.

In 1995, as others began using the networks to seek help for medical cases, most exchanges were via e-mail. Later, cases were presented on Web pages. (We assisted with the case of a boy who was losing his vision, by placing the text of his medical history plus images of intraocular views on a Web page, for example.)

Requests from China over the Internet for opinions from doctors in the West increased in number in 1996 and have now become commonplace. (Although many if not most such cases that circulate on public lists are not originated by physicians, but by friends or relatives of patients).

Bridge to Asia launched an information transfer station (ITS) in medicine in 1996, to provide copies of journal articles for physicians in China. The demand for the full-text of biomedical research literature has always been great (and unmet) in most medical universities and libraries, and the ITS in medicine began as a response to that need.

However, we received as many requests for second opinions, and for informal information, as we did for copies of articles or books, that is, for gray matter as well as printed matter, so we modified the ITS and extended its use.

To screen requests for second opinions, we asked staff at the Institute of medical Information to receive cases on our behalf, and to filter out those that did not come from physicians. IMI staff did so, and fully documented the cases - they completed the medical histories, if necessary,and collected and transmitted images to us if images were needed to complete the documentation.

To fulfill such requests, we appealed for help from American doctors, by approaching a Chinese-American Medical Association, medical universities, and individual physicians in the San Francisco Bay Area. While physicians were interested, few had time to respond to cases from China.

To develop the capacity for systematic responses to the volume and diversity of cases which we knew would begin to flow from China, we asked the University of California at San Francisco and Stanford University Medical School to assist.

We continue to be concerned about costs, but believe that with creative solutions it should be possible to deliver benefits of modern Western medicine to the Chinese countryside using the Internet and other new technologies.

It should be possible to do so only partly because of the power of the technology, mostly because of the deep and driving desires of physicians and other health care professionals in the United States and around the world (including China) to reach out to one another and to work collaboratively to solve urgent and complex problems.

The technology, the ITS, Bridge to Asia are enablers of those desires.