Providing Telemedicine in War Zones

Derick Alison
Derick Alison
6 Min Read

In this interview, Brandon Welch, MS, PhD, founder and CEO of doxy.me, explains why telemedicine is so important in high-conflict environments. Part 1 of this interview can be viewed here.

The following is a transcript of his remarks:

In those areas where there is conflict and it is hard to be there and it’s dangerous, that’s where telemedicine can provide some value — getting access to those people or those people getting access to medical professionals.

Healthcare providers are already a limited commodity, and then trying to get them to go or to continue to stay in a war zone is very challenging. Often those providers who’ve lived there previously have the means to leave, or those people left behind don’t have a means to leave, so they’re stuck there. So telemedicine allows for healthcare to be provided to those people who stayed behind.

What’s interesting, though, is that for a lot of folks in those areas, the type of things that they need are more basic. A lot of times it’s like food or gas, medicine, hygiene stuff like antiseptic and soap or things to stay clean. It’s hard to get to and it’s dangerous. Their needs are very much more basic and it’s more survival.

The type of care that telemedicine can provide is almost like secondary healthcare. It’s the mental health, it’s the counseling, it’s the guidance. They’re not going to need mental health counseling when they are dodging bullets and are hungry, right? So it’s kind of like, yeah, there’s a role for telemedicine, but it’s not the silver bullet. There are still greater needs there in certain areas that telemedicine just can’t address.

We do have users in Ukraine and in Israel, and even in Gaza as well. We were just actually pulling up the data in preparation for this, and what’s interesting is that in Israel, for example, we’re looking at the trends over the last year and there was a noticeable uptick in sessions after October 7. It increased by probably about 20% to 30% after the October 7 attacks.

Even in Gaza, there was steady usage and then after that it popped up. Then what’s interesting is it’s kind of variable; that probably has to do with the intermittent internet access. Clearly people are using telemedicine in these areas.

You can assume that in Israel there’s probably a lot more mental and behavioral health or PTSD type of counseling that happened. There is also limited access and limited ability to travel between places, which probably increases the use of telemedicine for safety purposes. Similarly in Gaza, there’s probably an increase in usage due to therapy or counseling or anything like that since the invasion. But you can tell when the invasion happened, there were noticeable drops in usage due to power outages and internet outages and stuff like that.

You’d be surprised how good internet is in war zones. Most people in war zones are using their phones and they have phone access, cellular access, and that’s all you need to have a telemedicine call. So if you have a phone that’s powered up and can connect to a cell tower, you can do telemedicine. Fortunately, that’s nice. You don’t have to worry about landlines or cable internet access or computers and stuff like that, so it does work surprisingly well, as long as the towers are functional.

There have been cases where towers have gone out, in natural disasters, for example. Sometimes nobody will have power, but they’ll have cellular service, which is super ironic. So if you’ve got enough power on your phone, you can get it. But sometimes it’s the opposite. Sometimes you have power but not a cell tower, but that’s usually temporary. Oftentimes cell towers are pretty quick in setting up temporary towers.

The other thing is that sometimes the towers can be overwhelmed with too much communication and the internet goes from 3G or 4G to just basic text messaging or calls. You can’t get internet or the internet’s super slow. So there are these variabilities that you have to deal with, but it is surprisingly good, which is nice to have.

It’s not the silver bullet, like I said. It’s not going to address all the issues, but for those people who it does help, it does help. We’re glad and honored to be able to be used in some capacity to help relieve suffering.

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    Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

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