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Telemedicine in Ukraine: A system to support frontline healthcare workers · 20-Minute Health Talk

• 0:02
  This is 20-Minute Health Talk.
• 0:04
  I'm David Reich-Hale. Over the last three months
• 0:08
  Russia's attacks on Ukraine has included more than 200 bombings of
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  medical facilities.
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  The attacks have left doctors, nurses and other medical staff in
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  desperate need of backup.
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  Today
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  We speak with two Northwell physicians who have created a program that
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  is offering support to those in need in Ukraine
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  With us is Dr. Eric Cioe-Pena
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  Director for Northwell's Center for Global Health
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  and Dr. Jonathan Berkowitz, who heads the health systems Transfer Center and
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  Center for emergency medicine.
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  Dr. Cioe-Pena, in March Northwell established a Ukraine Relief Fund
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  and it donated 18,000 pounds of medical supplies.
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  Just a few months later
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  your team is working on a new way to, to offer support to Ukraine.
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  Can you tell us about how this has evolved?
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  Dr. Cioe-Pena: Yeah, I mean, I think you know the one of the things that's been
• 1:01
  pretty amazing about Northwell throughout Covid
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  and then now in the kind of, you know, peri-post pandemic world is
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  kind of how flexible and adaptable our telehealth services have been
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  As we've dealt with surges in ICUs
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  As we've needed to centralize stroke care. As we've needed to reach
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  people that need an emergency department, but weren't willing
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  to go to the emergency department and wanted to talk to
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  an emergency physician remotely.
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  So, you know when we were thinking about how we could meet the need in
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  Ukraine, I very quickly started to have
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  conversations with
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  Dr. Berkowitz about taking this model that we did very successfully in the
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  New York area and talk with them about how we could do this
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  for Ukraine in either, you know, a neighboring country.
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  If Ukraine had been; in the early days
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  we thought it was going to be completely overrun by Russia in a matter
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  of weeks.
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  And then as the
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  situation seems to have stabilized a bit more, you know
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  setting up in Western Ukraine and on the front lines trying to help
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  doctors that are working tirelessly around the clock
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  Host: Specific to Ukraine
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  what are the partnerships like and what are the greatest
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  challenges?
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  Dr. Cioe-Pena: Yeah, our partnerships are basically with either
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  military or civilian hospitals that are working in various parts of
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  Ukraine.
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  We reached out to them through partners; either partners that were that
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  were helping supply
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  resupply them, or partners that represented Institutes of emergency
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  medicine or institutes of trauma surgery that had close ties with the
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  doctors in Ukraine and it really started as a as a zoom meeting
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  much like this basically going over, what what they needed and
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  how telemedicine could be helpful and it was a lot of listening. Jon
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  and I did a an enormous amount of listening to kind of what they were
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  seeing what they thought would be helpful.
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  We threw out some ideas.
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  as to what we thought might be helpful, but really it was a
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  dialogue about how can we help support you?
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  So that your job is easier while we were looking at what was seem to
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  be like an impossible task from these kind of Frontline doctors
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  Host: I definitely want to get a little bit more into the specifics of what
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  the doctors are telling you about
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  what's on the ground in Ukraine, but
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  Dr. Berkowitz, since you oversee the center for emergency medicine, what's
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  your role in supporting Northwell's Ukraine initiative?
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  Dr. Berkowitz: Yeah, so, you know, Eric came and said, you know, I think that there
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  might be an opportunity to utilize telemedicine in a unique way here
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  and we've done, we're part of a lot of projects from telestroke to our
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  emergency Telehealth service where we're using telemedicine and really
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  novel ways.
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  And then the transfer center part of our operation, really has access
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  to all of our Specialists because that's the part of our health system
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  that have a doctor anywhere in the New York
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  Metropolitan region
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  I need someone who's a specialist in this one area and I want to move
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  this patient to your hospital to get that treatment.
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  That's the team that can find those specialists and connect them.
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  And so it was pretty clear to me that we have all these pieces.
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  These blocks and just by rearranging those blocks and changing some
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  of our workflows
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  we could stand something up really fast, which is what we did
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  within
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  a few weeks of the
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  Host: Tell us a little bit about the process when a request
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  comes in. What happens?
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  So it goes into a channel in our call center.
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  It actually sends off a little alarm and the siren.
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  EMS love sirens.
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  And then someone on our team kind of
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  picks it up and starts to work on putting
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  together a plan for how we're gonna make this consult.
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  Each one comes in sideways in the sense that there's no Playbook.
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  We have to say okay how are we going to pull this together?
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  But we have a, you know, a great team of folks who are used to
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  getting, you know, unusual requests and kind of finding a ways to get
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  the mission done.
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  Host: In speaking with the medical professionals in Ukraine.
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  What are they telling, you?
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  Obviously, we're far away.
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  But we're looking at some of the reports and some of the journalism
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  that's coming out of Ukraine.
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  There was a story or package that was published in the New York Times
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  recently online.
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  That highlighted the intensity of war.
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  In the struggles.
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  They must be facing some of these photos were quite powerful.
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  Dr. Berkowitz: So I've had the privilege of being on pretty much every consult partly
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  to facilitate.
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  And so what I'm hearing from them is a lot of anxiety and they're
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  seeing things they
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  haven't seen before.
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  Frankly.
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  Some of these are cases that we necessarily may not have seen before.
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  And a lot of this is about phone a friend.
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  We don't spend a lot of the time talking about anything, but you know,
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  what, they're trying to accomplish.
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  At this point.
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  They usually have a very specific question.
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  Something like, 'How should I stage the surgery?'
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  Or 'Which part should I do first?' 'What kind
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  of equipment should I use?'
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  Very technical questions about a surgical approach.
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  or medical approach, how to manage the symptoms
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  surrounding it.
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  The entire discussion is this kind of phone
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  of friend mentality, where I always get the sense
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  that the doctor in Ukraine feels isolated.
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  They don't have another doctor to really talk about these complicated
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  issues, and they're really relieved at the end of these.
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  These consults, to have kind of had the opportunity to talk with
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  someone.
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  Or go through their thinking.
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  And in many cases, the doctor, you know, on the other side of the line
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  is is right.
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  That they have a great plan, but they're not sure and it is a
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  conference to figure out.
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  'Is this a good idea?'
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  What their treatment plan is?
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  Host: Dr. Cioe-Pena
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  Anything to add?
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  Yeah, we just say that, you know, when we were asked to do this and we
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  thought about doing this, you know, this there there was no Playbook.
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  There was no instruction manual Jon pulled off the
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  shelf to say, you know, this is how we support doctors in war
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  One of the reasons why these conversations were
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  so important with the stakeholders.
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  And Ukraine was to figure out, not only figure out for ourselves, how
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  we could be helpful, but also to convince them, that we could be
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  helpful because a lot of times when people hear telemedicine, they
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  hear, you know, virtual Urgent Care.
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  You know, I have a runny nose, and I get a prescription for a
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  decongestant or a UTI Med.
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  And that's the end of the consult.
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  They know the majority of public and even doctors in the community.
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  Don't know, the level of sophistication that we are using
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  telemedicine for
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  We're managing ICU patients remotely using
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  telemedicine and we did that during Covid.
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  And so that really I think opens up the possibilities because,
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  you know, John knows the toolbox.
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  He knows what we have available and
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  Then being able to communicate that to the Ukrainian physicians and
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  say, 'Yeah, we can get you an oral maxillofacial surgeon
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  within an hour to discuss this case and that's not a heavy lift for
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  us.'
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  That's something that we could do.
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  And I'll draw the other thing I think is understanding the breadth of
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  the system.
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  One of the things that we put together later on was just all of the
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  available services.
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  So I think people didn't understand that if they needed
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  a pediatric nephrologist that we probably had several that
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  were on.
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  call that day.
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  You know, we have 78,000 employees that are eager to help Ukraine
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  Pre-telemedicine.
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  They weren't able to.
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  We can't send 78,000 people to Ukraine, but we can connect 78,000 people
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  to Ukraine through telemedicine and through our efforts.
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  And that's the tremendous power that were wielding here.
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  And I think that's what keeps Jon
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  and I going is knowing that the potential that this system has to meet
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  needs and fix inequities globally is tremendous.
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  And it's just exciting to be a part of.
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  Host: How have some of these consults gone?
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  I understand.
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  One of the earliest calls was done for a facial trauma.
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  And that was fielded by a Northwell surgeon.
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  Dr. Andrew Salama.
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  Can you walk us through how that was handled?
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  Because I think that will give everybody some insight into how this
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  works or how we can support what's happening there.
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  Dr. Berkowitz: So, you know, the request came in, we have a system where
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  they can make a request to us without having to call it in.
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  I'm really proud to say, I think
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  we're officially version 5.4 of this.
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  And by 5.4, I mean, that five times we've completely redone the workflow.
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  And we're in the fourth minor revision of the fifth
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  new workflow.
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  But so the request came in for maxillofacial and I had known
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  Dr. Salama from the transfer center work as a very well accomplished
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  maxillofacial surgeon who's done
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  Who's worked at Walter Reed
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  Who's an excellent communicator and collaborator
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  And so we were able to connect our colleague in Ukraine with
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  Dr. Salama.
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  They transmitted some images and our colleague in Ukraine
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  let us know ahead of time that he would need a translator.
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  So when the time came for the consult, I brought a translator
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  into their virtual room with us and they just started talking about
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  that case.
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  They talk about that case about 10-15 minutes.
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  It was really incredible to watch.
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  Favorite part of that consult by far was when the
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  Ukrainian surgeon began to gesture with his hands
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  about things on his face.
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  And Dr. Salama said, 'I don't need an interpreter.'
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  'I know what he's asking just by his, is it what he's doing with his
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  hands.'
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  He's asking about how should I access this part of the body?
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  And because there's a couple of options and that was to me a very
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  beautiful thing, the language of medicine, you know,
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  Two specialists communicating without language and, you know, and the
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  tone softened up and that doctor became a lot warmer after that when
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  he realized that they're two specialists in maxillofacial surgery
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  separated by a war and many miles, but with the same love for
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  doing great work.
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  And they, then they talked for, you know, 15-20 more minutes about
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  other cases and they've kept on a strong relationship.
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  To that point, that I feel some of the biggest support we can give to
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  to the doctors
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  there is that sense of support; that there's a doctor here
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  Willing to listen to you, you're practicing in a care Island, maybe
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  maybe in these cities.
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  Maybe there's a couple of Maxillofacial Surgeons.
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  I bet a fair amount of these specialists have left, especially
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  the Eastern regions.
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  And so having that support on demand, I think is a huge help.
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  We're encouraging our doctors to build relationships.
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  We
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  Want to be there to support the doctors in Ukraine.
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  Host: What does it mean to both of you to be doing this right now?
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  Dr. Berkowitz: These consults have been some of the most touching
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  moments of my career to witness the connection of these physicians and
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  to see the Gratitude on the Ukrainian side for the advice that they're
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  getting.
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  And then also our physicians and local physician walk away and are so
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  happy to be able to do something.
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  It also means a lot
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  To me because everyone comes back to me and says, I want to connect
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  with them again.
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  I have some other other thoughts.
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  it's just a beautiful thing.
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  Like I said that physicians communicating connecting literally a world
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  apart.
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  Dr. Cioe-Pena: When people say they go into
• 13:22
  medicine for the right reasons and go into Global Health.
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  These are the reasons, right.
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  This is a way that a network, a health system is
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  leveraging
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  it's talent to just do good in the world.
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  And there's really; Ukraine was not on our radar before
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  this.
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  We have three core sites in the center for Global Health [Ecuador, Guyana and India]
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  Ukraine's.
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  Not one of them.
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  It's not one of the potentials for the next three that we that we
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  list, but it was the right thing to do.
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  Host: Covid-19 certainly changed a lot about how health care is delivered.
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  Can you tell us about some of the lessons learned during the pandemic
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  about Telehealth and how they informed, what you're now doing in
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  Ukraine?
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  So for me, it has because one of those I talked about the building
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  blocks that we're using and one of the programs we built during the
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  pandemic was our emergency telehealth program, ER on Demand.
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  And so that program, a lot of the workflows for the infrastructure for
• 14:17
  that.
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  We literally copied
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  And pasted, some of those processes to build this program.
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  So we didn't have to start from page one.
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  We don't start from the very beginning.
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  We took something that we knew worked, was growing and effective and we
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  had to make a bunch of changes but it was, it was easily
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  understandable.
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  So, all of our agents at the transfer center, who are the ones who are
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  kind of managing day-to-day these processes.
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  We just had to kind of say, okay.
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  This is a mash-up of our on-demand program and telestroke
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  and our transfer program.
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  We're going to mash them up in a unique way and create this Global
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  Telehealth program and everyone understood it right off the bat.
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  Host: Even so, what are some of the technological
• 15:00
  struggles that you that you have?
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  Dr. Berkowitz: So, I mean, the biggest technological struggle
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  I actually think, is navigating the appointment time.
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  It seems really simple, but you have a doctor in Ukraine
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  who is obviously very busy, has a lot going on and then we
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  have one of our specialists or even sub-specialists and we're trying
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  to find the time that they can both connect.
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  So just navigating that in an easy way has been a
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  challenge.
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  Another big challenge is getting Imaging files from them.
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  We want our doctors to be able to look at the CAT scans and x-rays.
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  So we worked with our Radiology service line and
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  Dr. Beerus specifically really helped us to put together a system, so we
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  can get the images from there and have our doctor review, them and
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  review them before they have a consult.
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  That they can really speak about the case in depth
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  Host: So what's next in the international collaboration?
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  When it comes to telemedicine, where are we headed?
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  Dr. Cioe-Pena: Yeah.
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  So yeah, I mean really, you know telemedicine has changed Global
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  Health in ways that I don't think we're ever going to go back and I
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  think that we can say that a lot has
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  changed because of Covd. You know, necessity is the mother of
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  invention and and you know the model of the way we used to interact
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  with international partners, where you'd fly in or you'd fly them up,
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  you do the training for a week and then you set them loose
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  and you kind of hope that they get it and they do.
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  Okay.
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  I think that's gone.
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  I think there are better ways to do it.
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  I think we're seeing that Innovation happening.
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  I mean, we saw it, you know, I'll give you a perfect example.
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  In 2020.
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  We started a nursing leadership program for the country of Guyana for
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  for essentially, all of the nurses in Guyana.
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  We identified 60 nurses that we're going to go through this program.
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  And Covid obviously happened early in 2020 and we
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  transitioned to zoom and used a virtual platform to do the teaching to
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  do the dashboard discussions, you know, as if we were having multiple
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  meetings in country, which was how it was originally planned and we're
• 17:16
  going to have multiple sessions.
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  We fly down have these meetings fly back.
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  We've been doing that.
• 17:21
  We've been doing, telepsychiatry consults and Ecuador in India.
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  Since 2020, supporting the mental health of a school in Southern India
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  and several
• 17:29
  Clinics in Quito, Ecuador.
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  I see that as the start.
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  I see that as something where, you know we are helping these
• 17:38
  low and middle income countries transition into the digital age of
• 17:41
  health and that we're growing with them that we are figuring out new
• 17:45
  ways to provide humanitarian, assistance, and development work that
• 17:49
  doesn't necessarily require all of our experts to be in country at the
• 17:53
  time that we're doing it and allows us to have follow-up.
• 17:57
  So instead of it just being a train-the-trainer, will you teach
• 17:59
  someone how to
• 18:00
  use point-of-care ultrasound
• 18:01
  Imagine for the next six months.
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  If you could look at all their images live while they're doing it and
• 18:05
  then talk to them on a video screen.
• 18:07
  I mean, that changes fundamentally, how we'll train people in low and
• 18:11
  middle income countries that were partnered with.
• 18:14
  Host: You have a lot of employees volunteering to help with this program.
• 18:18
  What's the response been like among
• 18:20
  Northwell staff.
• 18:22
  Dr. Cioe-Pena: Well, I think one of the things I'll say Jon will tell you the
• 18:24
  specific numbers, but I would add that.
• 18:28
  I don't think anyone said no. We've asked people
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  that haven't stepped up to volunteer and explain the situation,
• 18:35
  you know, no one has told us.
• 18:36
  'No, I can't do this.
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  I'm sorry.
• 18:37
  I don't want to help.'
• 18:39
  Right?
• 18:40
  Dr. Berkowtz: A ton of people who have volunteered
• 18:45
  because a lot of this is subspecialty based, anytime I call on
• 18:48
  specialist and say, 'Hey, will you help out?'
• 18:51
  The answer is always yes.
• 18:52
  And a lot of times because the time difference, my answer is
• 18:55
  'Okay, great 6AM tomorrow morning.' And the answer is always
• 19:00
  'Yes. Okay, 6AM. Where can I show up?'
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  So I think that that's that's real telling about our physicians'
• 19:08
  commitment.
• 19:10
  Dr. Cioe-Pena: So one of the things I think is important to mention is that when we
• 19:12
  donated the funds to Ukraine to Doctors Without Borders, we gave a
• 19:18
  matching donation of another $175,000
• 19:22
  to Doctors Without Borders to
• 19:24
  Help them with their efforts with wars in places, like Yemen
• 19:28
  South Sudan, Central African Republic. Countries that, you know,
• 19:31
  have been at war for years.
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  That really haven't made the the publicity or the headlines that
• 19:37
  Ukraine has.
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  We feel like that's important for Northwell to make a
• 19:41
  statement.
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  Saying, 'look it's not just Ukrainians that are being displaced by Wars
• 19:45
  right now.
• 19:46
  There are over 30 active conflicts on earth right now.
• 19:49
  We think all of them need support and attention.
• 19:54
  Host: Dr. Cioe-Pena and
• 19:55
  Dr. Berkowitz
• 19:55
  Thanks for sharing insight into this really important program you've
• 19:59
  developed.
• 20:00
  And to you the listener.
• 20:01
  Thanks for tuning in.
• 20:03
  I'm David Rice-Hale.
• 20:04
  And this is 20-minute help talk.
• 20:10
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