Implementing telemedicine under polycrisis: a mixed-methods case study from Myanmar using the RE-AIM framework

Myanmar’s March 2025 7.7-magnitude earthquake intersected with conflict, governance breakdown, and economic collapse, leaving 12.9 million people needing health assistance, yet evidence on how telemedicine functions under such polycrisis conditions remains limited. We conducted an explanatory mixed-methods case study of a volunteer-led, low-bandwidth telemedicine service (March–June 2025), structured by the RE-AIM framework. Data included 359 de-identified consultation records, 90 days of Facebook analytics, interviews with 14 volunteers, and operational documents. The service delivered teleconsultations through 84 medical officers, predominantly for primary care rather than acute earthquake injuries. Service use concentrated among younger urban populations (15-44 years, 86%), under-representing elderly (1.7%) and rural epicentre populations, demonstrating a digital inverse care law. A volunteer-led telemedicine service can be set up quickly to help in a crisis, but it mainly reaches people who are already online and was not a substitute for emergency or trauma care. Future services will need phone-based and assisted options so they can also reach people without internet access.