By Elsie Ramsley and Nikolay Kysel
Albert Einstein said “out of clutter, find simplicity.” For those of us working to establish secure, sustainable digital healthcare channels in high-conflict zones, the sentiment should have special resonance. Multi-disciplinary cohorts of tech engineers, medical professionals, first responders and humanitarians act as agents of order when crisis makes ordinary provision of day-to-day healthcare impossible. And beyond crisis response, many of us want to bring about structural change in an ecosystem more conducive to ad-hoc interventions than generational impact. At Health Tech Without Borders (HTWB), we manage the dual imperatives of telehealth expansion – meeting new needs without abandoning protracted interventions – through zealous adherence to the long game’s rules.
Our presence in Ukraine with partner Nikolay Kysel’s Doctor Online (DO) platform has supported 200,000 teleconsultations thus far while providing longitudinal data to inform a new theoretical framework that we can apply to other regions. This September, HTWB, iDocta, and VSee announced our Commitment to Action in Cameroon at the Clinton Global Initiative’s 2023 Meeting.
Under Project VITAL, we plan to strengthen health systems through a sustainable training model, build healthcare worker capacity, promote skills underpinned by technology and innovation, build resilient communities, achieve equitable health, and empower youth. As the following empirical observations and patient stories begin to form a practical foundation, we locate strands of simplicity amidst the clutter, remaining mindful of the big, audacious goal: a reimagined healthcare system.
Power to the People: Doctor Online’s Broad Reach
Hitting the 200.000 telehealth consultations mark in Ukraine feels like an inflection point. We credit our success to securing strategic partnerships with the best local players, namely Doctor Online’s founder Nikolay Kysel. Kysel knows his business: when the Russian-Ukrainian war began, he moved out of the financial service software lane to build “Memory of Ukraine,” an online inventory of fatalities that granted loved ones an opportunity for closure. Doctor Online soon followed, treating patients from Ukraine’s megacities and small villages, where access to medical care remains critically low.
Patients like Olena and Kateryna live in a small village where Olena raises cattle and sells dairy products to villagers while her 8 year old daughter Kateryna attends school online and dreams of becoming a journalist. When Kateryna’s common cold symptoms lasted for more than two weeks, her older sister pointed them to the Doctor Online app. A medical specialist contacted Olena the same day and provided medication recommendations and detailed care instructions that restored Kateryna to full health.
Yulia, a 35 year old local GP, is a member of DO’s growing volunteer provider corps. Practicing general medicine in a small clinic before the 2019 Russian invasion, Yulia signed on to treat people living in remote towns and villages free of charge when the conflict began. Recently called “an angel of health” by a patient she treated for a skin condition, Yulia says, “for me, it's like a mission. In such a difficult time, every Ukrainian has every right to receive quality medical services and I plan to help my compatriots as long as I have the strength to do so.”
Today, Doctor Online app supports approximately 800-900 consultations daily, and the patient breakdown is 51% women, 34% men , and 15% children. Patients comprise an ethnically diverse group seeking gynecology, cardiology, surgery, oncology, gastroenterology and mental health support services.
In addition Ukrainian refugees living in Poland, Germany, the Czech Republic, and France depend on the platform to navigate the nuances of local medicine. And Kysel says this is only the beginning.
Confronting the Mental Health Epidemic
Doctor Online often serves as a tele-psychology platform to adults and children suffering from mental health issues. To meet the desperate need, DO is expanding to offer behavioral health services – individual, family and couples therapy – to a local population reeling from conflict-related exhaustion, devastation, fatigue and anxiety.
As is the case in the United States, young people are suffering disproportionately: Kysel is working diligently to address clinical questions regarding minor consent and the degree of parent engagement in treatment before the new features launch. Doctor Online is planning to play an integral role in closing mental health care gaps in a high-risk population managing the psychological chaos of ongoing conflict.
The opportunity for telehealth to drive lasting public health change is plainly evident in the aftermath of COVID-19 but ubiquitous disaster disrupts our sustained attention, especially in developing countries. It feels ethical to show up to every crisis, avoiding the favoritism that disproportionate investments of time and resources in certain regions or types of crisis implies. But the worst-case scenario regarding the “everywhere all at once” approach is that everyone gets shortchanged, leaving telehealth’s potential to support structural change unfulfilled. Protracted conflict and its byproducts – complex entanglements of affected populations and weak public infrastructure–need decades, not months, of investment.
Ultimately, telehealth’s legacy depends on how strategically we deploy resources and leverage innovations in medical software able to address geographic, epidemiologic and clinical disparities. But for now, our efforts in Ukraine and our forthcoming commitment in Cameroon seem like big steps in the right direction.