From mobile phones to robotic arms – changing healthcare in war settings

Delivering healthcare in conflict-hit areas has changed over the decades, thanks to technological developments. EURACTIV spoke to doctors with longstanding experience in the field to see how the sector has evolved.

When Andy Kent left medical school back in 1987 and joined the army, his first posting was in South Georgia in the Atlantic, about 800 miles from the Falkland Islands, towards the Antarctic.

“There was no communication. So we communicated by Morse code back to the Falkland Islands. And that, you know, for five months, I had no verbal communication with back home to my family or my girlfriend,” he said.

Kent is now a trauma and orthopaedic surgeon at UK’s National Health Service in Highland, after having spent 20 years in the British Army as a trauma surgeon.

He spoke to EURACTIV just ten days after his return from a six-week stay in Ukraine.

He first headed out to Ukraine in early March of 2022 and throughout the last year, he spent about 20 weeks there travelling with a surgical team offering hands-on training and assistance in setting up primary healthcare clinics.

Commenting on what he has seen in Dnipro, where he mainly worked in hospital number 3, he said that “there is a huge volume of military trauma coming back there, mainly limb injuries”.

“So the nature of the fighting, trench warfare, it’s very primitive, it’s shrapnel type of blast injuries,” he continued.

Tony Redmond is another ‘frontier doctor’ who has worked in international humanitarian assistance since 1988, organising and leading medical support to natural disasters, major incidents, conflicts, and complex emergencies.

“You wouldn’t think but the mobile phone has made enormous, enormous benefits to medical work in emergencies,” Redmond told EURACTIV, adding that the digital camera was also a game-changer.

Kent agreed, saying that the phone means that there is “always someone looking over your shoulder that can give you advice – and that’s fantastic”.

WhatsApp groups were set up to discuss individual cases “which is reassuring for the doctors on the frontline”, he continued.

Back in 1999 in Kosovo, a medical team was given a new development – a digital camera, Redmond recalled. During a complex operation, with inexperienced surgeons, Redmond remembers sending “progressive digital photographs via satellite phone” to the office of a surgeon in the UK, who then sent instructions as to the next surgical step.

“We went through the whole operation like that which meant that we could do a level of complexity that we could not have done without that,” he said.

Nowadays this can be done through a video call from anywhere worldwide. “That’s a huge step forward,” Redmond said.

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The risk of unmet medical needs increases as certain medical examinations and treatments can be accessed only in the biggest hospitals, resulting in late diagnosis and worsening chronic conditions for those living in rural and remote areas across Europe.

Other medical device advancements 

But the phone and the world wide web were not the only ‘breakthrough’.

The first field hospital on the Iran-Iraq border Redmond ‘set up from scratch’ at the end of the first Gulf war in 1991 had no laboratory.

“We just had to diagnose things based on their clinical presentation,” Redmond said. Nowadays a little handheld device, called point-of-care testing, can do “almost all the range of blood tests that you can get in hospital just at the patient’s bedside”.

Other technologies mentioned by Redmond are portable ultrasound, portable digital X-ray machines, and portable image intensifiers called C-arm. These devices allow doing “a quite complex investigation and surgery”.

As a rule of thumb, internal fixation – a surgical procedure of physically reconnecting bones – is being avoided in field hospitals while external fixators – pins or wires to hold broken bones in proper position – are used to minimise the risk of infection. But this could change in the future.

“Talking to some of their doctors, they say: well, we have to keep it under review because of the increase in technology,” Redmond said.

A device that is being used too is the automated external defibrillator, which is used to help those experiencing sudden cardiac arrest.

It analyses the heart’s rhythm and, if necessary, delivers an electrical shock – or defibrillation – to help the heart re-establish an effective rhythm.

“The portable defibrillator has had an amazing change over my lifetime,” Redmond said.

“When when I first qualified as a doctor, the defibrillator was about five feet high off the ground. It was a huge thing. And painted red, we called it a Red Devil and you had to plug it into the mains,” Redmond recalled adding that the success rate was very low.

Now in the UK, portable defibrillators can be found in old red British telephone boxes available for the general public.

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Looking to the future

Overall, artificial intelligence (AI) is changing the way healthcare is being delivered across the world in different settings.

“I welcome it,” Redmond said, adding that “much of medical diagnosis is just algorithms anyway”.

He was asked to join a group in India, looking to improve healthcare in poor and remote areas, where healthcare is given by non-qualified, irregular practitioners, “because no qualified doctors will work there”.

The solution, in this case, was developing diagnostic algorithms that machines could diagnose the condition, and then practitioners could administer the treatment to the patient.

In Redmond’s opinion, it is a big step forward “that people will be able to manage a lot of their own conditions”.

“I might be in the minority as a doctor in thinking that. A lot of doctors are very sceptical and probably a little afraid. But I think the nature of being a doctor is changing anyway, and it will continue to change,” he said.

According to him, technology changed the way doctors provide care to their patients.

“We’ve always treated the same kind of patients because you have to, but you can treat them with more confidence, more safely, more accurately, and you can monitor their condition much better,” he concluded.

[Edited by Gerardo Fortuna/Nathalie Weatherald]

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