"Everything was destroyed over there, and in the first days there was no Internet in Port-au-Prince," team member Antonio Marttos Jr, MD, assistant professor of surgery at the University of Miami School of Medicine and director of trauma telemedicine at Jackson Memorial Medical Center's William Lehman Injury Research Center in Miami, Florida, told Medscape Medical News. "But we were able to connect to our trauma center in Miami."
Thanks to 2 donated portable satellites, the medical team consulted in real time with their Florida colleagues 700 miles away. The size of a computer laptop, each device contained a satellite telephone, satellite Internet, and video camera. "It was the same type of satellite dish that CNN was using to broadcast," Dr. Marttos said.
Although telemedicine is now commonplace in the United States, it may surprise some that it is being used in poor, rural countries such as Haiti. Telemedicine experts say that high-tech advances in equipment make global telehealth possible and that use of this technology can improve diagnoses, speed treatment, and lower costs.
It also comes in handy when a disaster has damaged or destroyed other communications.
Live From Port-au-Prince
The satellites were the Florida team's link to Miami to communicate requests for more medical supplies and medications and to send images of patients needing specialist consultation. Team members also used the satellites for triage and video consultations. When severely injured patients needed evacuation to the United States, the physicians gave a report of these cases to the university's trauma center, so that workers there could decide which Miami hospitals should receive the patients.
Because many patients had crush injuries, Dr. Marttos also videoconferenced with University of Miami burn surgeons to discuss how best to treat the extremity wounds.
"Without this technology, it would have been much, much more difficult to work logistics and communications," he said.
Assisted by the intercountry teamwork that the satellites enabled, the surgeons performed hundreds of operations before returning to Miami.
Improvised Telemedicine
Even when live telemedicine was not possible, some US physicians volunteering in Haiti improvised a way to consult with specialists at their home hospital.
From January 25 to February 6, a medical team from Penn Medicine, in Philadelphia, Pennsylvania, performed surgery at a hospital in Cange, Haiti, which is located outside the earthquake zone and had wireless telecommunication, according to team leader Michael Ashburn, MD, MPH, MBA. Many earthquake-injured patients were transported to Cange or found their own way there, said Dr. Ashburn, professor in the Department of Anesthesiology and Critical Care Medicine at the Hospital of the University of Pennsylvania in Philadelphia.
"We were trying to provide surgical care to individuals who had horrific injuries," he told Medscape Medical News. "We had limited access to lab findings and diagnostic tools. There was no fluoroscopy, and most of the patients had infected wounds that the surgeons could not open."
Under these limitations, the orthopaedic surgeons had to make difficult patient care decisions. Said Dr. Ashburn, "Some decisions were heartbreaking and irreversible — should we try to repair under these conditions or do an amputation?"
Furthermore, almost half of the patients were children, and the disaster response team did not include a pediatric trauma surgeon, he said.
"On patient rounds, our orthopaedic surgeon made a brilliant, on-the-fly decision to use the technology we had on hand," Dr. Ashburn recalled.
Using a camera on a cell phone with Internet access, they took photos of patients' X-ray films and wounds and emailed them to stateside specialists, including a pediatric trauma surgeon.
"It was very, very helpful for the surgeons to share these images with colleagues and get their input," he commented.
Future Connections
Telemedicine was not possible everywhere after the earthquake, of course. St. Damien's Hospital in Port-au-Prince had intermittent Internet access and no satellite hook-up, according to Anthony Alessi, MD, associate clinical professor of neurology at the University of Connecticut Medical School in Farmington and director of the stroke program at Backus Hospital, Norwich, Connecticut. He was in Haiti as part of a medical relief team from Connecticut and North Carolina.
Even before the earthquake, the rural areas near Jérémie, Haiti, where Dr. Alessi had volunteered 3 times previously, did not have live telemedicine capability, he said. Current international attention on Haiti may change that, he believes.
"What's most exciting is that we are building an entire health system in Haiti," he said. "That's where telemedicine and technology will come in. I think Haiti is finally going to be connected to the rest of the world."
The sources for this article have disclosed no relevant financial relationships.
For more coverage of the medical crisis after the earthquake in Haiti, visit Medscape's Alert Center.
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Autor(en)/Author(s): Kathleen Louden
Quelle/Source: Medscape, 18.02.2010
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