Frank Duggan is an emergency doctor far from an emergency room. On a recent morning, he treated a patient with a heart condition from his living room in Hingham — over video chat. His patient was at her home in Kiev, the capital of Ukraine.
“Any more blood pressure readings?” Duggan asked, pausing while a translator transmitted his question.
Since the Russian invasion, his patient has been having trouble getting her medications at local pharmacies. Duggan helped her troubleshoot what to do with the medicine she does have.
“Our plan right now is to stay on the same dose, continue monitoring the blood pressure,” he said at the end of their hour-long session. “We'll evaluate in maybe three or four more days.”
Ukraine’s health care system has been under enormous strain since Russian troops attacked the country in late February. Doctors and tech companies in Massachusetts have offered to help via telehealth, and their efforts are expanding both the places and the ways this technology is used.
“In the world of disaster medicine, telehealth is still kind of evolving.”Gregory Ciottone, Beth Israel Deaconess Medical Center
“In the world of disaster medicine, telehealth is still kind of evolving,” said Gregory Ciottone, the director of disaster medicine in the Department of Emergency Medicine at Beth Israel Deaconess Medical Center and president of the World Association for Disaster Emergency Medicine.
Telemedicine, in some form or another, has been used in emergencies for decades, but advances in access to internet and cellular service have transformed what’s possible.
“We're still trying to figure out best practices and best ways to integrate it into disaster medicine and disaster response,” Ciottone said.
While there are limits to what can be done from a distance, the hope is that telehealth can relieve pressure on local health care systems and boost skills for caregivers on the ground. In Ukraine, telemedicine is already providing care to residents forced to leave their homes, and it could soon be used by doctors seeking live help during surgeries.
A Bridge In Uncertain Times
Hingham-based Medcase is focused on the more than 5 million refugees who have fled Ukraine. The company, which typically provides on-demand medical expertise to businesses, set up free telehealth clinics in Romania and Poland, which border Ukraine. The clinics are staffed by a handful of in-person doctors, nurses and psychiatrists, who are backed up by dozens of specialists available virtually.
Brad Cohen, executive chairman of Medcase, said they’ve served as many as 800 patients a day. Sometimes, this care can be complicated.
“Let's say you're heading to France," he said. "Before you get settled there, you don't necessarily have medical support. What do you do? How do you have your records? How do you represent to your doctor who you are?”
Cohen believes telehealth can provide a bridge for these refugees, offering care and consistency when little else is predictable. That’s one reason Medcase gives refugees access to their medical records on their phones.
“They carry that with them," Cohen said. "And they can access our doctors when they're on the go, not just when they've physically come to a location.”
Training Doctors In War Zones
Proponents of telehealth aren't just aiming to help patients. In Ukraine, they are also working to help doctors on the ground in wartime situations.
“You can provide what we call ‘just-in-time medical education’ to potential providers to allow them to learn lifesaving techniques,” said Ciottone, of Beth Israel Deaconess Medical Center. Through educational videos and tutorials, experts can teach skills clinicians will need to use right away, such as how to treat trauma wounds.
A couple of organizations are seeking to use telemedicine during emergency procedures.
"There are very few hospitals in the world that look like this."Frank Duggan
Ukraine has many skilled physicians, but those physicians can’t always get into conflict zones where they’re needed the most, according to Milton Chen, who runs the American telemedicine company VSee and it's nonprofit arm, Aimee. His team is setting up a system to connect Ukrainian doctors to one another.
With the touch of a button, Chen said, a regional physician will be able to connect with an expert to walk through an unfamiliar procedure, such as an amputation. The platform is not yet being used, but Chen said his team is working with a Ukrainian hospital as well as the country's Ministry of Health.
With a few high-definition cameras, Chen said complex surgeries such a kidney transplants can be done through telesurgery. His company has used this method in Iraq.
Emergency doctor Frank Duggan also has experience facilitating telesurgeries. He’s logged more than 20,000 hours volunteering as a physician in dozens of countries and, along the way, started his own nonprofit, Health Care Volunteers International.
Duggan recently left Hingham for Ukraine, where he is outfitting eight operating rooms for telesurgery at a regional hospital in Kharkiv, near the front lines. The equipment he'll install includes power generators to avoid an outage during a procedure, special cameras and microscopes, video monitors and high-speed Wi-Fi. He expects telesurgeries will begin there in a matter of days.
Duggan's hope is that this work will benefit Ukrainians long after the war is over.
"There are very few hospitals in the world that look like this," Duggan said.
This segment aired on May 16, 2022.