27 Nov 17 06 Jul 21

'It's about capacity building': MSF's telemedicine program brings advanced care to places where specialists can't always go

When Dr. Raghu Venugopal explains the potential role of telemedicine in the emergency humanitarian medical work of Doctors Without Borders/Médecins Sans Frontières (MSF), he often cites an example from the Democratic Republic of Congo (DRC), where Venugopal, a Toronto-based physician, worked as a supervisor at MSF’s hospital in Kimbi in 2015.

“There was a woman who was experiencing severe abdominal pain,” he says. The pain was crippling, but the cause of it was unclear, so he performed a series of ultrasounds. Resources at the Kimbi hospital were limited, and the fact that medical staff had access to an ultrasound machine was a relatively rare diagnostic luxury for the area. But while Dr. Venugopal was able to see from the ultrasound images that the woman had some unexplained nodules in her liver, he did not have the expertise to know what they meant, and there were no other qualified specialists at the hospital — or, for that matter, in the region. So the team uploaded the image files to MSF’s telemedicine platform, through which a volunteer from a network of clinical specialists could provide their expert opinion. A radiologist in the US was able to tell him that the situation was not of critical concern to the patient’s health. “This was a great illustration of the use of telemedicine,” says Dr. Venugopal.

'Telemedicine can make a huge difference'

Telemedicine allows remote medical teams to consult with a whole network of experts whenever they are confronted with cases that go beyond their immediate capacities. With no access to advanced diagnostic tools or specialist expertise, medical workers in places like Kimbi often have limited abilities to fully understand many of their patients’ more complex symptoms, and therefore can’t necessarily always provide advanced lifesaving care. For Dr. Venugopal, telemedicine can help change that, and “bring some of the best medicine to some of the worst-off patients in the world.”

Dr. Joanne Liu, a Canadian physician who currently serves as MSF’s international president,  was instrumental in developing MSF’s use of telemedicine after realizing the critical support it can provide to the organization’s doctors in the field. She echoes Dr. Venugopal’s sentiments: “Suddenly you’re not all by yourself in the middle of South Sudan or Congo,” she says. “Telemedicine can make a huge difference.”

MSF began introducing telemedicine into its field operations in 2010. Scaling up new technologies can be difficult at the best of times, and the fact that much of the organization’s work involves urgent crisis response in resource-poor settings has provided additional challenges. But as of this year, more than 6,000 cases have been managed using MSF’s telemedicine services — representing thousands of patients who would otherwise have not received the kind of critical clinical diagnoses that are often taken for granted in places with more advanced health systems.

Those numbers alone suggest that telemedicine can play a fundamental role in MSF’s humanitarian mission, and help the organization deliver urgently needed healthcare to places where there is otherwise little or no access to medicine. But while stories like Dr. Venugopal’s, in which he received support from a specialist half a world away, reflect the way that telemedicine is currently being incorporated into MSF’s medical field work, for Fabien Schneider that is just the beginning of a set of transformative opportunities.

“For the time being, that model of telemedicine, in which medical teams in the field can get access to a second expert opinion, is most of what we do,” says Schneider, who oversees MSF’s international telemedecine program from MSF Canada’s offices in Toronto. “But it’s about more than that. It’s about capacity building and education. Our work so far shows that we ultimately need to add intuitive solutions allowing for real-time consultations. That will improve the management of both simple and complex cases in places where the necessary expertise and capacity don’t currently exist.”

Greater knowledge-sharing

When the medical team in Kimbi uploaded images to the MSF platform, a participating specialist was able to access the data and then help make a diagnosis. This is the “store and forward” model of telemedicine: data is sent to a network of specialist consultants who can provide additional information to the doctor in the field. For Schneider, the next step is to build MSF’s telemedicine program on something “fluid, a hybrid between store-and-forward and at-the-same-time telemedecine, something that can provide greater knowledge-sharing and can be tailored to the project’s needs.”  

To reach this goal, MSF Canada is working with partners and experts in the field to develop a telemedicine model that suits the organization’s unique humanitarian needs, and can help provide secure services that perform well in the low-bandwidth conditions where MSF often operates.

At MSF’s field project in Madoua, Niger, medical workers combine the organization’s store-and-forward system with Reacts, a real-time telemedicine platform developed by Canadian medical professionals based in Montreal. The local MSF team is able to share cases and have weekly live clinical case discussions with global experts (pictured above). The real-time, dynamic nature of these sessions helps create a high level transfer of knowledge, which in turn contributes to a higher level of medical expertise in the field. Because this model includes both real-time and non-real-time solutions, it can also be adapted to the needs of different projects, and can help document medical challenges.

“We were looking for technological solutions that would allow our colleagues to seek live expert advice from others in MSF and from specialists around the world, in a coordinated manner,” says Schneider. "Combining our platform with Reacts allows us to provide reliable remote support and care, even in situations where logistics and bandwidth conditions are challenging.”

MSF’s current model of humanitarian medical intervention often requires qualified international medical personnel to be directly on the ground. With telemedicine, the practical limitations of that approach can potentially be mitigated, not only by virtually connecting experts from anywhere on the globe, but – more significantly — bringing expertise itself to the projects sites.

“That is where the near future lies,” says Schneider. “If we can continue developing these capacities, and collaborating with the people who are driving this technology forward, then we have a chance to make a real difference in our ability to bring medical care to the places that need it the most. Technology evolves faster than we can adapt to it. We should not be afraid of it, but rather embrace and invest in opportunities to create a lasting impact on our medical operations.”

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