## 4 Deployment of Telemedicine Services Stage  
The Napo is an Amazonian river that begins in Ecuador and, after crossing to Peru, flows into the Amazon River. The section that passes through Peruvian territory, in which this article will focus, is about 450 km long and has more than 15 communities, most of them of indigenous population with less than 400 inhabitants. In this Amazon region there are very few roads and communications are usually made by river, which makes it slow and expensive to travel long distances due to the price of fuel. This difficulty to travel is combined with the lack of telecommunications infrastructure and makes this region one of the most isolated in the world, which affects the quality of primary healthcare services. The primary healthcare system of the Napo River has 11 medical posts and 3 medical centers, and the hospital with medical specialists is the Regional Hospital of the city of Iquitos, located at the mouth of the Napo with the Amazon. Due to the transportation difficulties already mentioned, a patient's access to a doctor may require 10 h of travel, and even more if specialized care is required. The duration and cost of this displacement represents a serious barrier to the right to health of the Napo River populations and makes the public healthcare system less efficient, which must invest in displacement an important part of its limited resources.  
Figure 4: Sustainability analysis of the consortium for the third stage (color code: blue for short and long-term support; green for short-term and weak long-term support; orange for short-term support; and gray for no support).  
Figure 3: Sustainability analysis of the consortium for the second stage (color code: blue for short and long-term support; green for short-term and weak long-term support; orange for short-term support; and gray for no support).  
In order to strengthen the primary healthcare system in this area, the EHAS Foundation initiated, in 2008, a project that would offer telemedicine services to reduce the isolation of the health facilities in the Napo River. The objective was to put the health technicians of isolated communities in contact with their referring physicians through telephone and Internet services. Thanks to these services, health technicians can request help when diagnosing and treating patients, send epidemiological reports, share information about the inventory of medicines to avoid the loss of stock, coordinate emergency transfers, and send information about patients referred to the health center. But the deployment of a communication network in such a complex environment implies some challenges that cannot be addressed by a single organization while guaranteeing the sustainability of the network. That is why the EHAS Foundation made an identification of possible partners and formed a consortium to work on this project. The consortium consisted of 4 institutions: The EHAS Foundation (a non-governmental organization--NGO), Rey Juan Carlos University (URJC), the Pontifical Catholic University of Peru (PUCP) and the Regional Government of Loreto (GOREL). The following sections analyze the contribution of each of these institutions to the different dimensions of the sustainability of the Napo River network.