Students in Gaza watch world’s first virtual reality operation

20/4/16 Middle East, News, Palestine, Region, Videos & Photo Stories

In a world first, British surgeon Dr. Shafi Ahmed live-streamed an operation using Google glasses allowing students around the world to get a doctor’s view of the procedure last Thursday.
Medical students and staff in Gaza were among some 13,000 viewers who watched the doctor remove cancerous tissue from a 78-year-old patient with colon cancer at the Royal London Hospital.
Coordinating with Dr. Ahmed, Dr. Khamis Elessi, neuro-rehabilitation specialist & head of Evidence-Based Medicine unit at the Islamic University of Gaza’s medical school, organised a live stream event of the operation at the university.
Although the Virtual Reality headsets sent to Gaza have not made it into the Strip due to the strict Israeli siege, Dr. Elessi and his team located three headsets owned by a private company in Gaza.
“Due to the shortage in VR headsets, the preparation for the live-streaming was stressful and the size of the event was limited,” Dr. Elessi told MEMO, “but the experience was very well-received by the students, senior academics and Ministry of Health decision makers that we invited to attend.”
Exchanging medical knowledge and expertise through the internet is not new to Gaza’s medical schools. Dr. Elessi described how his university ran hundreds of lectures in cooperation with the University of Oslo, with whom they are twinned, via video conference. This came after university delegations were unable to travel on exchange programmes due to the siege.
The now 10-year-old siege imposed on the Gaza Strip has hindered students from seeking education abroad or accessing medical resources and training in a way that other students worldwide are. “These online initiatives are a good way of challenging and breaking the siege imposed on Gaza,” Dr. Elessi said of their impact on training Gaza’s medical students.
As Dr. Ahmed has demonstrated with his initiative, the prospects for VR technology in medical education are indeed high. “The live streaming of an operation using live 360° video technology is unprecedented and I am sure future live-streamed operations with live Q&A sessions between our students and the surgeon would go a long way,” Dr. Elessi added. Medical student Osaid Alser said the experience was extraordinary; he thanked Dr. Ahmed for making it happen.
Dr. Ahmed has previously taken the precarious journey to the Gaza Strip himself on a Medical Aid for Palestinians (MAP) delegation and ran lectures on augmented reality as a tool to support surgical training in the besieged enclave among other things.
“I’m so honoured and privileged that the Palestinians in Gaza and the West Bank could join me last Thursday for the world’s first Virtual Reality operation and being an integral part of this world which has just become smaller,” Dr. Ahmed told MEMO.
He stressed that medical training and access to knowledge should not be constrained by where people live or what resources are available. “It is a fundamental human right,” he said.;;;

Israel, Palestine, Health


Gurrumul: is this a case of racial profiling or a symptom of rushed medicine? (1)

11/4/16 Ranjana Srivastava Contact author; @docranjana

Gurrumul’s story may not represent racial profiling so much as a failure of the medical system to adequately consult patients and take thorough histories
‘The talented and multi-award winning Aboriginal singer Geoffrey Gurrumul Yunupingu made the news for another reason when his nephrologist alleged that his patient’s care at Royal Darwin Hospital was compromised.’
Last week, the talented and multi-award winning Aboriginal singer Geoffrey Gurrumul Yunupingu made the news for another reason when his nephrologist alleged that his patient’s care at Royal Darwin Hospital was compromised by the assumption that his chronic liver disease was related to alcohol abuse rather than -hepatitis, from which may have followed other medical decisions when he presented very unwell to emergency.
Alcohol is a real scourge on Australian society and especially so in the Indigenous population but the specialist made the sensible point that a fundamental erroneous assumption about a patient can have serious downstream consequences, in this instance, excluding “a drinker” from a potential liver transplant.
-Darwin hospital chief defends treatment of singer Gurrumul Yunupingu
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The hospital administration bristled at the accusation of racial profiling; the Northern Territory health minister John Elferink joined the fray with the singularly unhelpful suggestion that this was a pre-tour publicity stunt and before you knew it, the spotlight was back on race and medicine.
But as I read the discharge summary (which clearly identifies alcohol abuse as the cause of liver disease, with hepatitis B almost represented as a peripheral issue), I couldn’t help but think of the doctor who wrote the summary. If Royal Darwin is like every other public hospital, this task would have fallen to a hapless intern, whose first real job started three months ago.
The discharge summary should have been co-signed by a registrar, who in turn should have been supervised by a specialist. The specialist does not read every discharge summary but at its best, the document should reflect the essence of what the specialist, the doctor with the most knowledge and perspective, determined the problem to be. From this follows the investigations that occurred and the outcomes as well as a plan to maintain good health beyond the hospital.
A sound hospital discharge summary that represents the team’s thinking is therefore the patient’s ally – it helps the GP and everyone else, especially in an era of fractured medical care. And yet, ask any GP or even the hospital doctors who spend precious overtime typing them, the typical discharge summary is unduly verbose, maddeningly unenlightening and notoriously unreliable. It is completed in haste and like a host of medical notes, is increasingly a cut and paste job, the harried intern’s fingers battling the administrative demand to produce discharge summaries in time with quick discharges.
To know our patients involves talking to them, in other words, taking a history. Illness is not an isolated occurrence.
Quality takes time but what would you rather have? A thoughtful, well-considered, slightly delayed discharge summary that actually reflects your care or yet another form that you shove at the bottom of the drawer? Most patients who bring me their copy have not even opened the envelope: they assume that the communication is between doctors and they are merely a more trustworthy messenger than the fax. Most say they don’t understand the jargon anyway.
The quality of discharge summaries has always been substandard; I should know because I wrote a few of them myself as an intern. It’s no excuse but 20 years ago, the stakes were different. Today’s wards are filled with very sick and mostly elderly patients with multiple co-morbidities managed by a host of specialists who don’t communicate with each other.
-The stories you need to read, in one handy email
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Cognitive loss, mental illness, substance abuse, economic stress and warring families are a strong feature. A good discharge summary cogently, sensitively and intelligently unites these issues so that the patient feels understood and other doctors feel informed. But such a summary can only be written when we actually know our patients. And to know our patients involves talking to them, in other words, taking a history. Illness is not an isolated occurrence; it happens in the context of our lives – to make sense of a disease, you have to understand the person. And here, we fail.
In the eagerness to deliver better healthcare, amid the constant chatter of design, innovation and streamlining, what is neglected is the importance of the patient narrative. Somehow, we have fooled ourselves into thinking that if we conduct enough sophisticated tests, entertain enough fanciful diagnoses, and attend enough team meetings, talking to the actual patient can be optional.
For patients who are frequent attenders, we rely on old notes and assumptions without checking their provenance. We fall prey to groupthink far more than we’d like. But despite all the advances technology affords, the greatest value in medicine still comes from actually talking to the patient. And while patients may not know the technical details, they know themselves and inhabit their illness like no doctor ever can.
I recently met a new patient who was said to have suffered a stroke. As the medical student related the story outside, I told her that the patient’s inability to move one leg didn’t make sense.
“It’s weird, I know.”
“What does she think is going on?”
“I didn’t ask, I just read the notes.”
An MRI had been booked overnight to solve the mystery but I wanted to talk to our patient. We walked in to find a dishevelled elderly woman whose eyes darted suspiciously. She was cooperative enough with her story but refused to move her leg or let me move it. Taking her history told me it wasn’t a stroke. Then tucked away in the triage notes, I spotted a line about the same presentation some days ago when she decided not to wait for assessment. It sounded like her first cry for help.
“Who brought you to hospital?”
“A taxi.”
“And how did you get inside?”
“I walked.”
Eyes widened but I let her talk, mostly about her being home alone and how she managed. Poorly, it seemed. Finally, I ventured, “I suspect you are worried about a stroke but you’re safe. We’ve just met, I know, but I wonder if you might be depressed.”
Gurrumul complaint is a publicity stunt, NT health minister suggests
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At this, the poor woman burst into tears, conceding that this was indeed her problem. We comforted her and promised help, then I asked her to reassure us that her leg was alright. Gingerly, she sat up. Then an intern held out his hand, saying “I’ve got you” and she walked.
A dutiful son arrived, himself overwhelmed because his mother was losing her memory, had signed over her house to a stranger she met via the internet, and viewed his help as interference. The patient was treated for depression, assessed for dementia, and discharged to assisted accommodation. She didn’t need any of the tests lined up to explain her immobile leg, just someone to look beyond it. The diagnosis lay in her history.
Gurrumul’s high-profile case has now been referred to the health commissioner but there is a salient lesson in it for all patients. Inaccurate discharge summaries are not a typing error; they are a reflection of rushed medicine.
The next time you receive a hospital discharge summary read it for accuracy. If it’s accurate, keep it safely and share a copy. If it doesn’t make sense, ask your family doctor. And if it still doesn’t make sense, or worse, if it’s plainly wrong, tell the hospital to fix the problem. This, I concede, will be ridiculously difficult, but let your impetus be the knowledge that the next time you are sick, the first document your doctors will turn to will be your most recent discharge summary.
Meanwhile, my thoughts are with the intern who wrote Gurrumul’s summary, whose career does not deserve to be clouded by the incident.

Australia, Aboriginal