海角大神

At a handful of intensive care units in rebel-held Syria,聽where doctors, medicine, and daily essentials are in short supply, telemedicine is saving lives.

Remote-operated webcams allow doctors working in the safety of countries like the United States to assess the best course of action for critical聽patients聽in Syria, now in its fourth year of聽conflict.聽They then relay their instructions to medical workers in the field.聽

鈥淏efore the era of telemedicine so many patients died because of the deficiency in the treatment and lack of experience,鈥� says Dr. Abd al-Aziz al-Adel, head of the health office in rebel-controlled areas of Aleppo.聽

The telemedicine initiative聽was started last year by聽the Syrian American Medical Society (SAMS). It is a direct response to the shortage of doctors in聽Syria. In their absence, complex trauma cases often聽fall in the hands of nurses and technicians.聽

Dr.聽Tamer Hassan, who heads the SAMS field office in Gaziantep, a border town that is a hub for Syrian refugees and relief organizations,聽runs monthly trainings聽for Syrian medical workers聽in a bid to close the gap.聽

鈥淲e have a real shortage in all specialties so of course we don鈥檛 have [Intensive Care Unit] doctors,鈥� he says. 鈥淲e only have ICU technicians and nurses. Those guys are not real experts, especially when it comes to complex, difficult cases."聽

Dr. Adel, who uses a聽pseudonym for security reasons, says the telemedicine initiative has improved the treatment of patients in ICU units.聽But for field hospitals in rebel areas like Aleppo and Idlib Province, which come under frequent attack by Syrian regime forces, the conditions are still far from ideal.

Most of the ICU patients that Adel and his colleagues treat are victims of aerial bombardment, mainly barrel bombs dropped from helicopters or planes. These cheap improvised devices are typically metal barrels packed with chemicals or explosives and scraps of metal.聽

Webcams, monitors, Skype

Working in shifts, a team of doctors聽scattered across Canada, England, the United States, and Saudi Arabia聽monitor Syrian patients in real time using three webcams connected to the ICU. The supervising medical practitioner moves the cameras to check the monitors, ventilators, and the patient himself.

Based on the data collected, the doctor prescribes treatment and oversees its implementation, counseling his juniors along the way. Skype is used as a platform for communication.

鈥淭he ICU technician has a direct, 24-hour connection with a team of on-call doctors,鈥� says Adel, a general surgeon, who has had to carry out 12 heart surgeries, half of them successful, due to the shortage of specialists.聽

Hospitals and medical staff have been a constant target of regime attacks聽in Syria. At the onset聽in spring 2011, when the regime violently cracked down on peaceful protests, doctors risked torture, death, and detention to treat wounded demonstrators聽and army defectors.

Now, with Syria in the grips of a brutal conflict, field hospitals in rebel-controlled areas operate underground in a bid to escape aerial bombardment. Adel, who experienced several close calls, shows on an i-Pad the rubble-filled remains of his聽bedroom in the Aleppo M1 hospital.聽

鈥淭his is my room after the attack,鈥� he says, pointing to a mattress covered in debris.

He swipes the screen to another picture showing a bombed part of the hospital, which is still operational in other sections. In the picture, a glaring neon ambulance is parked outside.聽That was the giveaway, Adel says.

Medical workers in crosshairs

His latest lucky escape came on June 7 after he slipped back into Syria. Two air-to-ground missiles landed near the Bab Al-Hawa Hospital, close to the border with Turkey,聽which he had just crossed on his way to Aleppo. That hospital treats an average of 2,000 patients聽per month,聽according to Syria Relief, one of the charities running the facility.聽

In September, a missile attack destroyed an entire field hospital in Al-Bab, a rebel base on the outskirts of Aleppo. The attack killed 11 people including two doctors and four nurses. SAMS聽said聽it was the third hospital destroyed in Al-Bab in two years.聽

Hundreds of Syrian health professionals have lost their lives in the line of duty. Many died when regime forces shelled their medical facilities or homes,聽though rebels have also been accused of attacking hospitals, some of which were being used as military bases.聽

Physicians for Human Rights, a聽New York-based organization,聽showing that聽Syrian government forces carried out 90 percent of 156 confirmed attacks on medical facilities since March 2011.聽

鈥淪yrian forces have systematically attacked the health care system in opposition-held areas over the past three years, resulting in the death of more than 460 health professionals and widespread destruction to hospitals and clinics,鈥� it said in a statement.聽

The group's executive director, Donna McKay, says Syria 鈥渋s among the worst examples of targeting medical care as a weapon of war.鈥�

Continuity in patient care

Given these risks, many doctors and nurses 鈥� along with millions of civilians 鈥� have fled Syria. Those who remain are completely overwhelmed. In a bid to pace himself,聽Adel spends three out of four weeks per month in Aleppo, returning to Gaziantep to rest and visit his pregnant wife.

鈥淲e are exhausted. It鈥檚 not just a matter of surgery, it鈥檚 also a matter of follow-up,鈥� says the doctor, who exudes energy despite the bags under his eyes and greying hair.

Three hospitals on the rebel side of divided Aleppo, currently use telemedicine to treat critical patients. Another two are operational in Idlib Province and further facilities are in the pipeline, including an underground hospital complex in central Syria.聽

The main challenge to scaling up operations is securing聽Internet access聽and finding staff willing to stick it out in high risk zones, the two doctors said. One benefit of telemedicine is that it allows for continuity in patient care even after they are transferred to a new facility in the network.

鈥淢ost of the patients are barrel-bomb victims. Maybe 90 to 95 percent of these patients are civilians because of the random dropping of barrel bombs,鈥� says Adel.聽

In general, says the doctor, ICU patients are transferred to other medical facilities as soon as possible because it is very difficult to evacuate a hospital when it is under attack, especially for ICU patients who are teetering between life and death.

鈥淚鈥檓 very happy to know my patients are in safe hands, even if it is remotely,鈥� he says. 鈥淭elemedicine has given us a golden opportunity to save lives.鈥�