Skype and PBXs

I don't have a fixed landline at home (the local telecommunications monopoly claims they don't have the capacity in my area!) and our mobile network is not Internet-enabled so I am forced to use Skype to speak to Nanda in my work lunch hour.

When there is a crisis back in the UK which I have to sort out from afar and our Internet connection (via satellite back to the US) slows down due to bad weather or some other form of network congestion (I ping our servers back in the US before even before trying to use Skype - a return packet rate of anything over 600 ms just won't work), I then have to ask the boss to use work's landline (reimbursable of course).

I have also found that skyping through a UK PBX proves problematic. The touchtones ("press 2 and then #") work fine but once I get through to a person the call breaks up in both directions. Hence last week and this week I have to beg my boss to use work's landline for my bank problems.

So can any of my readers explain this to me?

Whilst on the subject of Skype, tariffs to landlines make interesting reading. It costs me 0.017 Euros per minute to call our UK landline from Africa and not much more to call a UK mobile. However, to skype a fixed line here costs USD 1.195 a minute. Looking at Skype's tariff information three of the eight countries to which to call a fixed line cost more than USD 1.00 a minute are lusophone countries (East Timor, Guinea-Bissau, São Tomé e Príncipe) where Portugal Telecom have/had a majority shareholding in the local telecomms monopoly.

The most expensive Skype-to-landline rate is to the UK overseas territiory Diego Garcia in the Indian Ocean, an arquipelago from which the UK evicted all residents when it rented it to the US as a military base and which has been used extensively in the two Iraq and Afghan wars.

I cannot imagine the token UK administration or the US military have much need for fixed landlines.

Back to Nanssen drifting through the ice ...

The Lighthouse of Pharos

... was one of the Seven Wonders of the World. Located offshore Alexandria, Egypt, it was 120 metres high by far the tallest man-made structure of its time. As well as its beacon, it purportedly had lenses allowing it magnify specks on the already 120 m high horizon. In this way Alexandria survived any attacks upon it.

This a telecommunications/IT post so if you are not interested in such things (and that which constitute my line of work), exit here.

In January much of the Middle East and South Asia suffered enormous telecommunications (and hence Internet) failures when five undersea fibre-optic cables were accidentally cut. An interesting analysis of both the technical and financial impact of the cuts can be found here (the link is to the first post in a series of seven).

I was also pointed to a fascinating article by Neal Stephenson in the journal Wired, dating from 1996, about the development of international digital communications from ancient times until now, and our current dependence on under-sea fibre-optic cables (illustrated multiple web-page version here, print version here). The Lighthouse of Pharos was obviously part of this - its mirrors and lenses being a ¨reflection¨ of equipment invented in the 19th century to read and write the first digital signals transmitted over transoceanic cables.

The Lighthouse of Pharos fell - the Byzantine Empire put out some misinformation that Alexander the Great´s treasure was buried underneath it and the local ruler of Alexandria ripped up the foundations and ... it fell over.

In a stunningly ironic piece of deja-vu the 1996 Wired piece by Neal Stephenson states:

¨The collapse of the lighthouse must have been astonishing, like watching the World Trade Center fall over.¨

Alexandria was now defenseless and the Byzantine Empire proceeded to walk in.

Acknowledgements: Thanks to The Yorkshire Ranter for the links cited. Alex is now moving TYR over to Wordpress. New link here - I´ll update the sidebar when he has completed the transition.

Censorship

The local, I should say national ISP, that happens to have a telecommunications monopoly, has blocked Skype.

Don’t worry regular readers – I can still use Skype to speak to family from work as we have our own independent satellite and Internet connection.

However, we (myself and a colleague) have started to investigate workarounds. Regular international telephone calls (fixed and mobile) are exorbitant – if you look at Skype computer-to-fixed/mobile tariffs, our country is in the top five at 0.79 per minute beaten by Diego Garcia – and who calls there over a regular telecoms link?

I don’t have a fixed line as the telecoms company says they don’t have capacity in our area – so I cannot experiment.

First we need to find out what sort of filtering the ISP has installed – are they targeting Skype servers’ IP addresses or are they identifying Voice over IP (VoIP) data packets? In the former case everyone can just use a different VoIP service, in the latter it appears we can use Tor (link), eProxy (link) and BCap to get past the ISP’s filtering.

VoIP blocking is a notorious device whether for financial or political reasons. In the United Arab Emirates, another ISP/telecomms monopoly, it is financial, in China it is both.

Here, I am sure, it is financial.

There is a moratorium here on civil service calls to overseas – general abuse.

Even though the software is free, Danny and I will make a killing on installation fees

Patientline V

We have posted about the NHS patients' telecomms provider Patientline before most notably in April when they hiked up the prices of making outgoing calls from 10 p per minute to 26 p per minute.

In the face of competition from mobile phones (after a relaxation on their use in hospitals), Patientline has reversed its decision and lowered the price of outgoing calls back to 10 p per minute. Incoming calls will remain at 49 p per minute!

Just for comparison a local call in the UK with the operator British Telecom on a fixed line is 3 p per minute. (BT call calculator here).

Patientline IV

Patientline, the telecomms service provider to patients in NHS hospitals, is in the news again - this time for pressurising patients to sign up for their services.

Patientline III

Lucia tries to draw me into the Patientline debate - I refuse to be drawn!

However, I will make some observations on the Borchardt Ward at the Royal Manchester Children's Hospital. Each bed has a Patientline terminal and yes, televison for children is free. However, each bed also has a regular donated televison set (with headphones).

Concerning telephone sets there are two regular payphones, one at the entrance to the ward and one in the middle of the ward that accepts both incoming and outgoing calls. Given a relatively relaxed mobile phone policy as well and the fact that the younger children have little need for phone services, then it is little surprise that Patientline will not be making a profit on Borchardt Ward, and I suspect throughout the RMCH.

Patientline II

I really didn't want to get into the Patientline bed-side telephone price-hike debate - my original post on Patientline was not about this, but rather about electronic medical records.

However, in the light of professional medical opinion that mobile phone use in hospitals should be relaxed (that we reported here), of continuing cuts in government spending on the National Health Service, and the trend towards the privatisation of NHS services, it is both interesting and ironic to note that in their Announcement of the results for the year ending 31st March 2006, two of the "challenges" facing the company are

• Ward closures and an increasing number of empty beds have reduced the number of terminals being used.
• The relaxation by some trusts of their policy regarding the use of mobile phones within hospitals, despite concerns relating to patient privacy (especially given the photographic capability of most modern mobile phones) and to the intrusion into what should be a quiet environment, has also affected performance.
  

Patientline

The local press has picked up on Patientline's bedside telephone price hikes. And the local Unison shop steward is not impressed! See our previous entry on Patientline here.

P.S. And read the comments to see what the consumers think.

P.P.S. And the Welch Family (via NHS Blog Doc - link right) comment here.

Electronic Medical Records

Dr Crippen has written several times about the government's £6.8 billion pound initiative to put everybody's medical records on a centralised national computer system (for example, here and here). I feel he is right to be concerned.

Today I read that the private telecomms operator Patientline is raising the prices of its telephone services for patients in many UK hospitals by 160%! I won't criticise them for providing bedside television to the under-16s for free but ...

However, that is not what this post is about ... as a result of the above story I visited Patientline's website and found that they offer a range of other telecomms services to the NHS Trusts including keeping electronic patient records that can be consulted at the patient's bedside. No mention here of data protection and security. I wonder if any of the PCTs have taken up the service

John - we have every reason to be concerned at the Spine, but having my medical records held electronically by a private company that is £80 million in debt is perhaps even more scary!

Mobile Phones in Hospitals

Link to a story at the BBC in which calls are made to relax rules on mobile phone use in hospitals.

I have to say that it is very useful to us for me to call Nanda on her mobile on appointment days to check everything is ok. If not, I can then make arrangements for Jaime's childcare etc. Last Friday is a shining example.

Voice over IP

Here's an interesting trial from the land of flying doctors, Australia, to support pediatric cancer fighters and carers at home by using video telephones.

I know how important VoIP is now being to us to be able to stay in touch and to make sure everything is ok during, for example, hospital visits. Thus later this morning I wilI phone Nanda at the hospital on her mobile from my computer using Skype to ensure they will be able to get home in time to pick up Jaime from school. If something is wrong, I can then get in touch with the school, the social worker etc to sort something out. All at minimal cost.

Unfortunately, Nanda has not yet got a grasp on Skype on the laptop Talia gave us and that is in the U.K. so we cannot yet video chat for free. But I will be sorting this out on my next visit.

I would have preferred to use WengoPhone as it supports video on Linux (which Skype doesn't, only on Windows!) and is open source (which Skype isn't). But for various technical reasons it's not working for me. When our U.K. video Skype is working, I'll just have to boot into Windows (yuk!).

Update 13:00: Kezia went to hospital with a fever. Now her line is blocked or dislodged so they cannot yet give her a blood transfusion. Awaiting an X-ray. Have had to arrange to get Jaime picked up from school and potential childcare over the weekend. Thanks M. Rung the school and hospital. Will ring back later.

Update 15:30: they managed to clean the line and she is now having the transfusion. The nurse tells me Kezia's doing fine. But it looks like they will have to stay over the weekend.

Thank you to the inventors of VoIP!