WINGHAM, England — Geese honked happily outside as Pat Swinfen sat in the study of her 16th-century farmhouse, cozy and warm amid thick Oriental carpets and a glowing wood fire.
Pure English countryside idyll — except for the critically ill pregnant woman in Iraq desperately in need of a neurologist.
Swinfen, a retired nurse in her early 70s, sat at her computer and tapped out an e-mail, trying to connect doctors in Basra working on the woman, who had suffered a brain hemorrhage, with a renowned neurologist from Northern Ireland trekking in Nepal.
She soon had an e-mail response from the neurologist, who told Swinfen to forward details of the case.
The Swinfens run the Swinfen Charitable Trust, a telemedicine charity that uses e-mail to link sick people in poor, remote or dangerous parts of the world with hundreds of medical specialists in some of the world's finest hospitals.
Doctors in about 140 hospitals and clinics in 39 nations use the organization to seek help for patients requiring specialized care beyond their capabilities. Through the trust, they can be put in e-mail contact — often within hours — with one or more of the 400 specialists who work without pay as part of the trust's network.
Doctors in distant areas, including Afghanistan, Antarctica and the Solomon Islands, e-mail photos (many taken with digital cameras supplied by the Swinfens), X-rays, test results and case notes. The information is reviewed by specialists, who respond by e-mail to help make diagnoses and recommend treatments.
The only thing linking all the need and all the expertise is a desktop computer in the Swinfens' home, an improbable global nerve center set amid a cherry orchard and wheat fields in the soft English hills about 75 miles southeast of London.
"Help is just an e-mail away," said Swinfen, who runs the operation with her husband, Roger Swinfen, a retired Army officer and member of Britain's House of Lords.
Neither had used a computer before they began the operation on their 36th wedding anniversary in 1998. Their system has since handled almost 1,800 cases and saved numerous lives.
"This is a simple solution that works," said Karen Rheuban, a pediatric cardiologist with the University of Virginia Health System and president-elect of the American Telemedicine Association.
Rheuban said the U.S. military runs a similar system for service members in the field, and many organizations, including the University of Virginia, run extensive telemedicine programs that incorporate videoconferencing. But that requires high-speed broadband and other equipment not often available in the world's remoter areas.
No one other than the Swinfens, Rheuban said, has such an extensive network using simple, inexpensive technology — e-mail and digital photos — to provide immediate medical consultations to some of the world's poorest people.
Rheuban, one of 40 University of Virginia specialists who volunteer for the Swinfens, said she recently consulted on the case of a young girl in Basra who was having heart problems. Rheuban said she was able to diagnose the problem and recommend specialized treatment by reviewing EKG data and other test results sent by the girl's doctors.
The Swinfens are formally Lord and Lady Swinfen. He was elected to the House of Lords seat held by his late father; she was awarded the Order of the British Empire by Queen Elizabeth II in 2006.
They began their project (www.swinfencharitabletrust.org) while Roger Swinfen, 69, was working with a charity that helped people with disabilities in Britain and Bangladesh. He said that a doctor with the charity introduced him to the idea of telemedicine, and that he immediately saw potential.
"We decided we had to do something to help the needy in the developing world," he said. "Everyone was doing something, but no one was providing medical specialists this way."
Cases started flowing in from around the world: a man in Bangladesh with a leg crushed in a car accident, a baby girl in Papua New Guinea with eye disease, a baby in Nepal with a hand deformity, women from all over with preeclampsia and other pregnancy-related problems.
The greatest number of cases has come from Iraq, where 39 hospitals have established links to the trust. The Swinfens said they have handled a variety of cases, including gunshots and kidney failure, and even a call for help from a U.S. Army field hospital in Iraq where a sick young Iraqi girl turned up during the March 2003 invasion.
The Swinfens — and a single assistant — monitor the computer at all hours, and they do it by laptop or BlackBerry on their frequent trips to medical conferences to recruit specialists.
Sitting in their old farmhouse, the Swinfens joked about how their garden would be tidier if they didn't have the trust. They laughed about how Roger Swinfen's most recent Christmas present to his wife was a filing cabinet.
But they also worried about how to raise money to keep the trust going — to pay for the cameras, tripods, batteries and other equipment they send to people in the field.
And they worried about who would take over when they are gone.
"Roger and I are not exactly in the first flush of youth," Pat Swinfen said, tapping away at the long list of e-mails on her screen.
That morning, an e-mail arrived from a doctor at a small clinic on the microscopic Pacific island of Niue, asking to establish a link with the trust. Pat Swinfen sent back a note: The trust doesn't refuse anyone, no matter how small or distant.
"You can fill a bucket with sand one grain at a time," her husband said. "But you've got to start."