Telehealth used for ultrasound training in Yemen

MARKHAM, Ont. – An emergency room doctor at Markham Stouffville Hospital is leading a team of physicians that is training other clinicians in worn-torn Yemen in the use of handheld ultrasound. Due to the pandemic, they’ve been using telehealth to train and support the clinicians in Yemen.

“Initially, we were supposed to actually fly in and bring the devices with us for an initial one-week training period, but then, the pandemic kicked in just as we got approval for the grant,” Dr. William Cherniak (pictured) told CBC News.

He’s led missions to Uganda and Kenya using the same technology, which relies on a hand-held scanner that connects to a smartphone or tablet but says it’s the first-time people in Yemen are being trained to use the scanners. The international projects work through an organization co-founded by Dr. Cherniak called Bridge to Health.

“We had to figure out how to get these into a country without us going – how to get them to the hospitals we are working with and how do we train people virtually,” Cherniak said.

The impact of COVID-19 has been disproportionately harder on poorer countries, and in Yemen, the situation has been made worse by a civil war that has lasted since 2014, when Houthi rebels ousted President Abdrabbuh Mansur Hadi and seized control of northern Yemen.

Saudi Arabia entered the war in 2015, heading a coalition that backed the country’s Sunni faction against the Houthis, who are Zaidi, a minority Shia sect, and have Iran’s support.

According to the United Nations, more than 233,000 people have been killed in the conflict and more than four million people have been forced to flee their homes.

The UN considers Yemen one of the poorest countries in the Arab world, and food insecurity, lack of access to clean water and a fragile healthcare system means an estimated 24.1 million people, or about 80 per cent of the population, need some form of humanitarian assistance.

Canada has pledged $70 million in aid for Yemen but has been criticized by the UN and others for continuing to sell military equipment to Saudi Arabia. According to Global Affairs Canada in 2020, Canadian weapons exports to that country totaled $1.3 billion.

The ongoing conflict and pandemic travel restrictions have also stopped fly-in medical missions from Canada and the United States.

Cherniak said 12 ultrasound scanners and 10 iPads were delivered to Ibn Sina Hospital and the Hadhramout University Hospital in the port city of Al Mukalla in southern Yemen.

The delivery was funded in part by $250,000 from Grand Challenges Canada, a not-for-profit organization that invests in technological innovations and is supported by the federal government.

On the ground, liaison personnel with MedGlobal, a U.S. NGO that works with Bridge to Health, have helped set up online training for a group of 15 medical staff.

“It’s the first time to my knowledge ever where we’re trying to do 100 per cent of the training 100 per cent remotely,” said Cherniak.

It meant getting the hospitals access to satellite internet. That allowed them to remain connected after much of the country lost internet access after deadly air strikes in northern Yemen that killed 82 and damaged the infrastructure of TeleYemen, the state-owned monopoly that controls internet access in the country.

Half a world away – in his home office in a downtown Toronto condo – Cherniak can review the scans done by trainees in Yemen and give them feedback on how to improve technique and guidance on making a diagnosis.

According to Bridge to Health, except for the local trainer in Yemen, all the doctors involved are volunteers.

Dr. Nahreen Ahmed is an assistant professor of clinical medicine at the University of Pennsylvania in Philadelphia. She is the head of ultrasound training for Bridge to Health. Along with instructing the trainees by video link, she reviews the scans they upload to the cloud.

“If I place a comment on an image, they can see it almost immediately in Yemen. And so that’s pretty incredible to give that kind of real-time feedback,” she said.

Ahmed says while the project is unique, having ultrasound or radiological scans viewed by another physician in a different country is common.

“You have to have an expert review your images, and most of the time, your images are being reviewed remotely,” she said.

From detecting pediatric pneumonia to pregnancy complications and internal trauma from injuries sustained in the ongoing conflict, access to diagnostic medical imaging can save lives. Ahmed says Bridge to Health will be tracking how effective the training and tools are and expand the project to other hospitals across the country if it’s successful.

“We can really improve these kinds of health care outcomes across a country that’s been debilitated by warfare and famine,” he said.