Author + information
- aDepartment of Cardiology, University of Miami Miller School of Medicine/JFK Medical Center, Atlantis, Florida
- bDepartment of Cardiology, Cook County Health and Hospital System, Chicago, Illinois
- cDepartment of Cardiology, Heartland Cardiology/Wesley Medical Center, University of Kansas School of Medicine, Wichita, Kansas
- ↵∗Address for correspondence:
Dr. Abdulah Alrifai, University of Miami Miller School of Medicine Regional Campus, 5301 Congress Avenue, Atlantis, Florida 33462.
Before the Syrian civil war started in 2011, Syria had relatively modern medical facilities and advanced cardiac care, especially in the major cities. Although rural areas might have been underserved, most of them were still within a 90- to 120-min transfer range from an advanced cardiac care center. However, the past 7 years changed everything. The United Nations High Commissioner for Refugees described the situation as “the great tragedy of the 21st century,” with an estimated 220,000 people killed and almost 4 million refugees inside and outside of the country (1,2). Several areas are under siege from constant attacks, which has left millions of patients without any access to even basic health care. Almost one-half of Syria’s health facilities are seriously damaged or destroyed (3). Furthermore, Syria has become one of the most dangerous countries in which to practice medicine, with many physicians fleeing the country. Those clinicians who have stayed there are in extreme danger of getting either killed or arrested.
With the serious need for health care providers and inability to serve those in need by providing traditional care, telemedicine has become a great tool to help those unfortunate patients. Telemedicine is described as exchanging medical information from one site to another via electronic communications to improve patients’ health status and care (4). Telemedicine was considered a potential palliative resolution to help alleviate some of this disastrous shortage in health care coverage. Telemedicine provides real-time engagement in decision making, which is required in cardiac care most of the time. It can be in the form of voice, video, online, or offline recorded communication. Tele-cardiology in the Syrian conflict provided tele-consultation, tele-management, and tele-education. Data-sharing technology in tele-consultation is a low-cost solution that uses already available social media platforms and applications, such as Facebook, Viber, Google Hangout, and WhatsApp, to allow communication in text, audio, still images, videos, and online phone calls.
In addition, tele-education for onsite medical personnel has been provided through different social media platforms. This was implemented under the supervision of the Syrian American Medical Society, which has made extraordinary efforts to provide and deliver necessary equipment, such as portable echocardiography and electrocardiography machines, from Turkey and from other parts of Syria for use in areas with limited medical coverage and/or areas with a diminishing number of medical specialists. The Syrian American Medical Society has successfully employed telemedicine in the field of cardiology, as well as critical care, since 2014 (5).
Telemedicine has proved to be a potentially life-saving tool in the Syrian civil war, where cardiologists and other subspecialists are not available to provide the needed care for patients. In our tele-cardiology experience, cardiologists from the United States are available to cover different hospitals in need throughout Syria. Electrocardiograms (ECGs) from the admitted cardiac patients and new cardiac consults are reviewed by the cardiologist on-call. Additionally, ST-segment elevation myocardial infarction ECGs can be confirmed by cardiologists before administering streptokinase, which is the only available method of reperfusion. The role of the team is also to confirm the success or failure of streptokinase and to manage expected complications including cardiogenic shock, arrhythmias, and mechanical and valvular complications. Despite the extremely limited resources, the program has been extremely successful—surprisingly so. In addition to urgent cardiac care, the role of U.S.-based cardiologists is essential in evaluating cardiac admissions, including intensive care unit and cardiac patients. The onsite medical personnel (medical students, medical doctor, nurse, and physician assistant) present the case to the U.S.-based specialist with discussions about the ECG, echocardiogram (if available), and chest x-ray, taking into consideration the limited resources and ancillary tests that make physical examination play a vital role in approaching most cases. All of the doctors who are participating in this tele-cardiology program from the United States are volunteers.
In conclusion, utilizing low-cost, widely available services, such as social media platforms and communication applications, in medicine during disaster and war can produce life-saving initiatives like tele-cardiology.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation
- ↵U.S. Agency for International Development. Crisis in Syria. Available at: https://www.usaid.gov/crisis/syria. Accessed October 8, 2016.
- ↵United Nations High Commissioner for Refugees. Syria regional refugee response. Available at: http://data.unhcr.org/syrianrefugees/regional.php. Accessed October 8, 2017.
- ↵Gladstone R, Sengupta S. Unrelenting assault on Aleppo is called worst yet in Syria’s civil war. The New York Times. Available at: http://www.nytimes.com/2016/09/27/world/middleeast/aleppo-syria.html. Accessed October 8, 2017.
- Moughrabieh A.,
- Weinert C.
- ↵Price S, McCarthy K. Telemedicine and telehealth. OLR research report. September 7, 2012. Available at: https://www.cga.ct.gov/2012/rpt/2012-R-0296.htm. Accessed December 15, 2017.