May 25, 2022 • 20 mins
On this episode of the podcast, we speak with two Northwell leaders who have led the effort to create and deploy a 24/7 consultation and support service to Ukraine. This real-time, doctor-to-doctor platform is now offering health care workers a vital resource, particularly for those displaced by the ongoing hostilities in the country. Eric Cioe-Pena, MD, director of Northwell's Center for Global Health, and Jonathan Berkowitz, MD, medical director for the Center for Emergency Medicine, discuss:
- Northwell's Ukraine Relief Fund
- The benefits of telemedicine in a conflict
- Adapting existing infrastructure for Ukraine
- Reactions from doctors in Ukraine and Northwell
- How technology is driving Global Health forward
Support the Center for Global Health's Ukraine Relief Fund
More from the expertsRead more about standing up a telemedicine system in Ukraine from Dr. Cioe-Pena and Dr. Berkowitz.
Listen to Dr. Berkowitz talk more about the overnight telemedicine platform, ER on Demand, which he helped to launch in summer 2021.
Watch episodes of this health podcast on YouTube.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:02):
This is 20-Minute Health Talk.
I'm David Reich-Hale. Over the last three months
Russia's attacks on Ukraine has included more than 200 bombings of
medical facilities.
The attacks have left doctors, nurses and other medical staff in
desperate need of backup.
Today
We speak with two Northwell physicians who have created a program that
(00:23):
is offering support to those in need in Ukraine
With us is Dr. Eric Cioe-Pena
Director for Northwell's Center for Global Health
and Dr. Jonathan Berkowitz, who heads the health systems Transfer Center and
Center for emergency medicine.
Dr. Cioe-Pena, in March Northwell established a Ukraine Relief Fund
(00:46):
and it donated 18,000 pounds of medical supplies.
Just a few months later
your team is working on a new way to, to offer support to Ukraine.
Can you tell us about how this has evolved?
Dr. Cioe-Pena (00:58):
Yeah, I mean, I think you know the one of the things that's been
pretty amazing about Northwell throughout Covid
and then now in the kind of, you know, peri-post pandemic world is
kind of how flexible and adaptable our telehealth services have been
As we've dealt with surges in ICUs
As we've needed to centralize stroke care. As we've needed to reach
(01:22):
people that need an emergency department, but weren't willing
to go to the emergency department and wanted to talk to
an emergency physician remotely.
So, you know when we were thinking about how we could meet the need in
Ukraine, I very quickly started to have
conversations with
Dr. Berkowitz about taking this model that we did very successfully in the
(01:43):
New York area and talk with them about how we could do this
for Ukraine in either, you know, a neighboring country.
If Ukraine had been; in the early days
we thought it was going to be completely overrun by Russia in a matter
of weeks.
And then as the
situation seems to have stabilized a bit more, you know
setting up in Western Ukraine and on the front lines trying to help
(02:05):
doctors that are working tirelessly around the clock
Host (02:08):
Specific to Ukraine
what are the partnerships like and what are the greatest
challenges?
Dr. Cioe-Pena (02:14):
Yeah, our partnerships are basically with either
military or civilian hospitals that are working in various parts of
Ukraine.
We reached out to them through partners; either partners that were that
were helping supply
resupply them, or partners that represented Institutes of emergency
(02:34):
medicine or institutes of trauma surgery that had close ties with the
doctors in Ukraine and it really started as a as a zoom meeting
much like this basically going over, what what they needed and
how telemedicine could be helpful and it was a lot of listening. Jon
and I did a an enormous amount of listening to kind of what they were
(02:56):
seeing what they thought would be helpful.
We threw out some ideas.
as to what we thought might be helpful, but really it was a
dialogue about how can we help support you?
So that your job is easier while we were looking at what was seem to
be like an impossible task from these kind of Frontline doctors
Host (03:13):
I definitely want to get a little bit more into the specifics of what
the doctors are telling you about
what's on the ground in Ukraine, but
Dr. Berkowitz, since you oversee the center for emergency medicine, what's
your role in supporting Northwell's Ukraine initiative?
Dr. Berkowitz (03:30):
Yeah, so, you know, Eric came and said, you know, I think that there
might be an opportunity to utilize telemedicine in a unique way here
and we've done, we're part of a lot of projects from telestroke to our
emergency Telehealth service where we're using telemedicine and really
novel ways.
And then the transfer center part of our operation, really has access
(03:53):
to all of our Specialists because that's the part of our health system
that have a doctor anywhere in the New York
Metropolitan region
I need someone who's a specialist in this one area and I want to move
this patient to your hospital to get that treatment.
That's the team that can find those specialists and connect them.
And so it was pretty clear to me that we have all these pieces.
(04:15):
These blocks and just by rearranging those blocks and changing some
of our workflows
we could stand something up really fast, which is what we did
within
a few weeks of the
Host (04:30):
Tell us a little bit about the process when a request
comes in. What happens?
So it goes into a channel in our call center.
It actually sends off a little alarm and the siren.
EMS love sirens.
(04:50):
And then someone on our team kind of
picks it up and starts to work on putting
together a plan for how we're gonna make this consult.
Each one comes in sideways in the sense that there's no Playbook.
We have to say okay how are we going to pull this together?
But we have a, you know, a great team of folks who are used to
(05:11):
getting, you know, unusual requests and kind of finding a ways to get
the mission done.
In speaking with the medical professionals in Ukraine.
What are they telling, you?
Obviously, we're far away.
But we're looking at some of the reports and some of the journalism
that's coming out of Ukraine.
There was a story or package that was published in the New York Times
(05:32):
recently online.
That highlighted the intensity of war.
In the struggles.
They must be facing some of these photos were quite powerful.
Dr. Berkowitz (05:44):
So I've had the privilege of being on pretty much every consult partly
to facilitate.
And so what I'm hearing from them is a lot of anxiety and they're
seeing things they
haven't seen before.
Frankly.
Some of these are cases that we necessarily may not have seen before.
(06:06):
And a lot of this is about phone a friend.
We don't spend a lot of the time talking about anything, but you know,
what, they're trying to accomplish.
At this point.
They usually have a very specific question.
Something like, 'How should I stage the surgery?'
Or 'Which part should I do first?' 'What kind
of equipment should I use?'
(06:26):
Very technical questions about a surgical approach.
or medical approach, how to manage the symptoms
surrounding it.
The entire discussion is this kind of phone
of friend mentality, where I always get the sense
that the doctor in Ukraine feels isolated.
(06:48):
They don't have another doctor to really talk about these complicated
issues, and they're really relieved at the end of these.
These consults, to have kind of had the opportunity to talk with
someone.
Or go through their thinking.
And in many cases, the doctor, you know, on the other side of the line
is is right.
(07:08):
That they have a great plan, but they're not sure and it is a
conference to figure out.
'Is this a good idea?'
What their treatment plan is?
Host (07:18):
Dr. Cioe-Pena
Anything to add?
Yeah, we just say that, you know, when we were asked to do this and we
thought about doing this, you know, this there there was no Playbook.
There was no instruction manual Jon pulled off the
shelf to say, you know, this is how we support doctors in war
One of the reasons why these conversations were
so important with the stakeholders.
(07:39):
And Ukraine was to figure out, not only figure out for ourselves, how
we could be helpful, but also to convince them, that we could be
helpful because a lot of times when people hear telemedicine, they
hear, you know, virtual Urgent Care.
You know, I have a runny nose, and I get a prescription for a
decongestant or a UTI Med.
And that's the end of the consult.
They know the majority of public and even doctors in the community.
(08:01):
Don't know, the level of sophistication that we are using
telemedicine for
We're managing ICU patients remotely using
telemedicine and we did that during Covid.
And so that really I think opens up the possibilities because,
you know, John knows the toolbox.
He knows what we have available and
Then being able to communicate that to the Ukrainian physicians and
(08:24):
say, 'Yeah, we can get you an oral maxillofacial surgeon
within an hour to discuss this case and that's not a heavy lift for
us.'
That's something that we could do.
And I'll draw the other thing I think is understanding the breadth of
the system.
One of the things that we put together later on was just all of the
available services.
So I think people didn't understand that if they needed
(08:46):
a pediatric nephrologist that we probably had several that
were on.
call that day.
You know, we have 78,000 employees that are eager to help Ukraine
Pre-telemedicine.
They weren't able to.
We can't send 78,000 people to Ukraine, but we can connect 78,000 people
to Ukraine through telemedicine and through our efforts.
(09:07):
And that's the tremendous power that were wielding here.
And I think that's what keeps Jon
and I going is knowing that the potential that this system has to meet
needs and fix inequities globally is tremendous.
And it's just exciting to be a part of.
How have some of these consults gone?
I understand.
(09:27):
One of the earliest calls was done for a facial trauma.
And that was fielded by a Northwell surgeon.
Dr. Andrew Salama.
Can you walk us through how that was handled?
Because I think that will give everybody some insight into how this
works or how we can support what's happening there.
Dr. Berkowitz (09:45):
So, you know, the request came in, we have a system where
they can make a request to us without having to call it in.
I'm really proud to say, I think
we're officially version 5.4 of this.
And by 5.4, I mean, that five times we've completely redone the workflow.
And we're in the fourth minor revision of the fifth
(10:08):
new workflow.
But so the request came in for maxillofacial and I had known
Dr. Salama from the transfer center work as a very well accomplished
maxillofacial surgeon who's done
Who's worked at Walter Reed
Who's an excellent communicator and collaborator
(10:30):
And so we were able to connect our colleague in Ukraine with
Dr. Salama.
They transmitted some images and our colleague in Ukraine
let us know ahead of time that he would need a translator.
So when the time came for the consult, I brought a translator
into their virtual room with us and they just started talking about
(10:53):
that case.
They talk about that case about 10-15 minutes.
It was really incredible to watch.
Favorite part of that consult by far was when the
Ukrainian surgeon began to gesture with his hands
about things on his face.
And Dr. Salama said, 'I don't need an interpreter.'
(11:14):
'I know what he's asking just by his, is it what he's doing with his
hands.'
He's asking about how should I access this part of the body?
And because there's a couple of options and that was to me a very
beautiful thing, the language of medicine, you know,
Two specialists communicating without language and, you know, and the
(11:35):
tone softened up and that doctor became a lot warmer after that when
he realized that they're two specialists in maxillofacial surgery
separated by a war and many miles, but with the same love for
doing great work.
And they, then they talked for, you know, 15-20 more minutes about
other cases and they've kept on a strong relationship.
(12:00):
To that point, that I feel some of the biggest support we can give to
to the doctors
there is that sense of support; that there's a doctor here
Willing to listen to you, you're practicing in a care Island, maybe
maybe in these cities.
Maybe there's a couple of Maxillofacial Surgeons.
I bet a fair amount of these specialists have left, especially
(12:21):
the Eastern regions.
And so having that support on demand, I think is a huge help.
We're encouraging our doctors to build relationships.
We
Want to be there to support the doctors in Ukraine.
Host (12:33):
What does it mean to both of you to be doing this right now?
Dr. Berkowitz (12:36):
These consults have been some of the most touching
moments of my career to witness the connection of these physicians and
to see the Gratitude on the Ukrainian side for the advice that they're
getting.
And then also our physicians and local physician walk away and are so
(12:58):
happy to be able to do something.
It also means a lot
To me because everyone comes back to me and says, I want to connect
with them again.
I have some other other thoughts.
it's just a beautiful thing.
Like I said that physicians communicating connecting literally a world
apart.
Dr. Cioe-Pena (13:17):
When people say they go into
medicine for the right reasons and go into Global Health.
These are the reasons, right.
This is a way that a network, a health system is
leveraging
it's talent to just do good in the world.
And there's really; Ukraine was not on our radar before
(13:38):
this.
We have three core sites in the center for Global Health [Ecuador, Guyana and India]
Ukraine's.
Not one of them.
It's not one of the potentials for the next three that we that we
list, but it was the right thing to do.
Host (13:48):
Covid-19 certainly changed a lot about how health care is delivered.
Can you tell us about some of the lessons learned during the pandemic
about Telehealth and how they informed, what you're now doing in
Ukraine?
So for me, it has because one of those I talked about the building
blocks that we're using and one of the programs we built during the
(14:10):
pandemic was our emergency telehealth program, ER on Demand.
And so that program, a lot of the workflows for the infrastructure for
that.
We literally copied
And pasted, some of those processes to build this program.
So we didn't have to start from page one.
We don't start from the very beginning.
We took something that we knew worked, was growing and effective and we
(14:31):
had to make a bunch of changes but it was, it was easily
understandable.
So, all of our agents at the transfer center, who are the ones who are
kind of managing day-to-day these processes.
We just had to kind of say, okay.
This is a mash-up of our on-demand program and telestroke
and our transfer program.
We're going to mash them up in a unique way and create this Global
(14:53):
Telehealth program and everyone understood it right off the bat.
Even so, what are some of the technological
struggles that you that you have?
Dr. Berkowitz (15:03):
So, I mean, the biggest technological struggle
I actually think, is navigating the appointment time.
It seems really simple, but you have a doctor in Ukraine
who is obviously very busy, has a lot going on and then we
have one of our specialists or even sub-specialists and we're trying
(15:26):
to find the time that they can both connect.
So just navigating that in an easy way has been a
challenge.
Another big challenge is getting Imaging files from them.
We want our doctors to be able to look at the CAT scans and x-rays.
So we worked with our Radiology service line and
(15:49):
Dr. Beerus specifically really helped us to put together a system, so we
can get the images from there and have our doctor review, them and
review them before they have a consult.
That they can really speak about the case in depth
Host (16:03):
So what's next in the international collaboration?
When it comes to telemedicine, where are we headed?
Dr. Cioe-Pena (16:08):
Yeah.
So yeah, I mean really, you know telemedicine has changed Global
Health in ways that I don't think we're ever going to go back and I
think that we can say that a lot has
changed because of Covd. You know, necessity is the mother of
invention and and you know the model of the way we used to interact
(16:29):
with international partners, where you'd fly in or you'd fly them up,
you do the training for a week and then you set them loose
and you kind of hope that they get it and they do.
Okay.
I think that's gone.
I think there are better ways to do it.
I think we're seeing that Innovation happening.
I mean, we saw it, you know, I'll give you a perfect example.
In 2020.
We started a nursing leadership program for the country of Guyana for
(16:53):
for essentially, all of the nurses in Guyana.
We identified 60 nurses that we're going to go through this program.
And Covid obviously happened early in 2020 and we
transitioned to zoom and used a virtual platform to do the teaching to
do the dashboard discussions, you know, as if we were having multiple
meetings in country, which was how it was originally planned and we're
(17:16):
going to have multiple sessions.
We fly down have these meetings fly back.
We've been doing that.
We've been doing, telepsychiatry consults and Ecuador in India.
Since 2020, supporting the mental health of a school in Southern India
and several
Clinics in Quito, Ecuador.
I see that as the start.
I see that as something where, you know we are helping these
(17:38):
low and middle income countries transition into the digital age of
health and that we're growing with them that we are figuring out new
ways to provide humanitarian, assistance, and development work that
doesn't necessarily require all of our experts to be in country at the
time that we're doing it and allows us to have follow-up.
So instead of it just being a train-the-trainer, will you teach
(17:59):
someone how to
use point-of-care ultrasound
Imagine for the next six months.
If you could look at all their images live while they're doing it and
then talk to them on a video screen.
I mean, that changes fundamentally, how we'll train people in low and
middle income countries that were partnered with.
Host (18:14):
You have a lot of employees volunteering to help with this program.
What's the response been like among
Northwell staff.
Dr. Cioe-Pena (18:22):
Well, I think one of the things I'll say Jon will tell you the
specific numbers, but I would add that.
I don't think anyone said no. We've asked people
that haven't stepped up to volunteer and explain the situation,
you know, no one has told us.
'No, I can't do this.
I'm sorry.
I don't want to help.'
Right?
Dr. Berkowtz (18:40):
A ton of people who have volunteered
because a lot of this is subspecialty based, anytime I call on
specialist and say, 'Hey, will you help out?'
The answer is always yes.
And a lot of times because the time difference, my answer is
'Okay, great 6AM tomorrow morning.' And the answer is always
'Yes. Okay, 6AM. Where can I show up?'
(19:02):
So I think that that's that's real telling about our physicians'
commitment.
Dr. Cioe-Pena (19:10):
So one of the things I think is important to mention is that when we
donated the funds to Ukraine to Doctors Without Borders, we gave a
matching donation of another $175,000
to Doctors Without Borders to
Help them with their efforts with wars in places, like Yemen
South Sudan, Central African Republic. Countries that, you know,
(19:31):
have been at war for years.
That really haven't made the the publicity or the headlines that
Ukraine has.
We feel like that's important for Northwell to make a
statement.
Saying, 'look it's not just Ukrainians that are being displaced by Wars
right now.
There are over 30 active conflicts on earth right now.
We think all of them need support and attention.
Host (19:54):
Dr. Cioe-Pena and
Dr. Berkowitz
Thanks for sharing insight into this really important program you've
developed.
And to you the listener.
Thanks for tuning in.
I'm David Rice-Hale.
And this is 20-minute help talk.
Get more expert Insight from some of the leading voices in healthcare
today.
(20:14):
Subscribe to 20-minute Health Talk
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podcasts.
This is 20-Minute Health Talk.
I'm David Reich-Hale. Over the last three months
Russia's attacks on Ukraine has included more than 200 bombings of
medical facilities.
The attacks have left doctors, nurses and other medical staff in
desperate need of backup.
Today
We speak with two Northwell physicians who have created a program that
(00:23):
is offering support to those in need in Ukraine
With us is Dr. Eric Cioe-Pena
Director for Northwell's Center for Global Health
and Dr. Jonathan Berkowitz, who heads the health systems Transfer Center and
Center for emergency medicine.
Dr. Cioe-Pena, in March Northwell established a Ukraine Relief Fund
(00:46):
and it donated 18,000 pounds of medical supplies.
Just a few months later
your team is working on a new way to, to offer support to Ukraine.
Can you tell us about how this has evolved?
Dr. Cioe-Pena (00:58):
Yeah, I mean, I think you know the one of the things that's been
pretty amazing about Northwell throughout Covid
and then now in the kind of, you know, peri-post pandemic world is
kind of how flexible and adaptable our telehealth services have been
As we've dealt with surges in ICUs
As we've needed to centralize stroke care. As we've needed to reach
(01:22):
people that need an emergency department, but weren't willing
to go to the emergency department and wanted to talk to
an emergency physician remotely.
So, you know when we were thinking about how we could meet the need in
Ukraine, I very quickly started to have
conversations with
Dr. Berkowitz about taking this model that we did very successfully in the
(01:43):
New York area and talk with them about how we could do this
for Ukraine in either, you know, a neighboring country.
If Ukraine had been; in the early days
we thought it was going to be completely overrun by Russia in a matter
of weeks.
And then as the
situation seems to have stabilized a bit more, you know
setting up in Western Ukraine and on the front lines trying to help
(02:05):
doctors that are working tirelessly around the clock
Host (02:08):
Specific to Ukraine
what are the partnerships like and what are the greatest
challenges?
Dr. Cioe-Pena (02:14):
Yeah, our partnerships are basically with either
military or civilian hospitals that are working in various parts of
Ukraine.
We reached out to them through partners; either partners that were that
were helping supply
resupply them, or partners that represented Institutes of emergency
(02:34):
medicine or institutes of trauma surgery that had close ties with the
doctors in Ukraine and it really started as a as a zoom meeting
much like this basically going over, what what they needed and
how telemedicine could be helpful and it was a lot of listening. Jon
and I did a an enormous amount of listening to kind of what they were
(02:56):
seeing what they thought would be helpful.
We threw out some ideas.
as to what we thought might be helpful, but really it was a
dialogue about how can we help support you?
So that your job is easier while we were looking at what was seem to
be like an impossible task from these kind of Frontline doctors
Host (03:13):
I definitely want to get a little bit more into the specifics of what
the doctors are telling you about
what's on the ground in Ukraine, but
Dr. Berkowitz, since you oversee the center for emergency medicine, what's
your role in supporting Northwell's Ukraine initiative?
Dr. Berkowitz (03:30):
Yeah, so, you know, Eric came and said, you know, I think that there
might be an opportunity to utilize telemedicine in a unique way here
and we've done, we're part of a lot of projects from telestroke to our
emergency Telehealth service where we're using telemedicine and really
novel ways.
And then the transfer center part of our operation, really has access
(03:53):
to all of our Specialists because that's the part of our health system
that have a doctor anywhere in the New York
Metropolitan region
I need someone who's a specialist in this one area and I want to move
this patient to your hospital to get that treatment.
That's the team that can find those specialists and connect them.
And so it was pretty clear to me that we have all these pieces.
(04:15):
These blocks and just by rearranging those blocks and changing some
of our workflows
we could stand something up really fast, which is what we did
within
a few weeks of the
Host (04:30):
Tell us a little bit about the process when a request
comes in. What happens?
So it goes into a channel in our call center.
It actually sends off a little alarm and the siren.
EMS love sirens.
(04:50):
And then someone on our team kind of
picks it up and starts to work on putting
together a plan for how we're gonna make this consult.
Each one comes in sideways in the sense that there's no Playbook.
We have to say okay how are we going to pull this together?
But we have a, you know, a great team of folks who are used to
(05:11):
getting, you know, unusual requests and kind of finding a ways to get
the mission done.
In speaking with the medical professionals in Ukraine.
What are they telling, you?
Obviously, we're far away.
But we're looking at some of the reports and some of the journalism
that's coming out of Ukraine.
There was a story or package that was published in the New York Times
(05:32):
recently online.
That highlighted the intensity of war.
In the struggles.
They must be facing some of these photos were quite powerful.
Dr. Berkowitz (05:44):
So I've had the privilege of being on pretty much every consult partly
to facilitate.
And so what I'm hearing from them is a lot of anxiety and they're
seeing things they
haven't seen before.
Frankly.
Some of these are cases that we necessarily may not have seen before.
(06:06):
And a lot of this is about phone a friend.
We don't spend a lot of the time talking about anything, but you know,
what, they're trying to accomplish.
At this point.
They usually have a very specific question.
Something like, 'How should I stage the surgery?'
Or 'Which part should I do first?' 'What kind
of equipment should I use?'
(06:26):
Very technical questions about a surgical approach.
or medical approach, how to manage the symptoms
surrounding it.
The entire discussion is this kind of phone
of friend mentality, where I always get the sense
that the doctor in Ukraine feels isolated.
(06:48):
They don't have another doctor to really talk about these complicated
issues, and they're really relieved at the end of these.
These consults, to have kind of had the opportunity to talk with
someone.
Or go through their thinking.
And in many cases, the doctor, you know, on the other side of the line
is is right.
(07:08):
That they have a great plan, but they're not sure and it is a
conference to figure out.
'Is this a good idea?'
What their treatment plan is?
Host (07:18):
Dr. Cioe-Pena
Anything to add?
Yeah, we just say that, you know, when we were asked to do this and we
thought about doing this, you know, this there there was no Playbook.
There was no instruction manual Jon pulled off the
shelf to say, you know, this is how we support doctors in war
One of the reasons why these conversations were
so important with the stakeholders.
(07:39):
And Ukraine was to figure out, not only figure out for ourselves, how
we could be helpful, but also to convince them, that we could be
helpful because a lot of times when people hear telemedicine, they
hear, you know, virtual Urgent Care.
You know, I have a runny nose, and I get a prescription for a
decongestant or a UTI Med.
And that's the end of the consult.
They know the majority of public and even doctors in the community.
(08:01):
Don't know, the level of sophistication that we are using
telemedicine for
We're managing ICU patients remotely using
telemedicine and we did that during Covid.
And so that really I think opens up the possibilities because,
you know, John knows the toolbox.
He knows what we have available and
Then being able to communicate that to the Ukrainian physicians and
(08:24):
say, 'Yeah, we can get you an oral maxillofacial surgeon
within an hour to discuss this case and that's not a heavy lift for
us.'
That's something that we could do.
And I'll draw the other thing I think is understanding the breadth of
the system.
One of the things that we put together later on was just all of the
available services.
So I think people didn't understand that if they needed
(08:46):
a pediatric nephrologist that we probably had several that
were on.
call that day.
You know, we have 78,000 employees that are eager to help Ukraine
Pre-telemedicine.
They weren't able to.
We can't send 78,000 people to Ukraine, but we can connect 78,000 people
to Ukraine through telemedicine and through our efforts.
(09:07):
And that's the tremendous power that were wielding here.
And I think that's what keeps Jon
and I going is knowing that the potential that this system has to meet
needs and fix inequities globally is tremendous.
And it's just exciting to be a part of.
How have some of these consults gone?
I understand.
(09:27):
One of the earliest calls was done for a facial trauma.
And that was fielded by a Northwell surgeon.
Dr. Andrew Salama.
Can you walk us through how that was handled?
Because I think that will give everybody some insight into how this
works or how we can support what's happening there.
Dr. Berkowitz (09:45):
So, you know, the request came in, we have a system where
they can make a request to us without having to call it in.
I'm really proud to say, I think
we're officially version 5.4 of this.
And by 5.4, I mean, that five times we've completely redone the workflow.
And we're in the fourth minor revision of the fifth
(10:08):
new workflow.
But so the request came in for maxillofacial and I had known
Dr. Salama from the transfer center work as a very well accomplished
maxillofacial surgeon who's done
Who's worked at Walter Reed
Who's an excellent communicator and collaborator
(10:30):
And so we were able to connect our colleague in Ukraine with
Dr. Salama.
They transmitted some images and our colleague in Ukraine
let us know ahead of time that he would need a translator.
So when the time came for the consult, I brought a translator
into their virtual room with us and they just started talking about
(10:53):
that case.
They talk about that case about 10-15 minutes.
It was really incredible to watch.
Favorite part of that consult by far was when the
Ukrainian surgeon began to gesture with his hands
about things on his face.
And Dr. Salama said, 'I don't need an interpreter.'
(11:14):
'I know what he's asking just by his, is it what he's doing with his
hands.'
He's asking about how should I access this part of the body?
And because there's a couple of options and that was to me a very
beautiful thing, the language of medicine, you know,
Two specialists communicating without language and, you know, and the
(11:35):
tone softened up and that doctor became a lot warmer after that when
he realized that they're two specialists in maxillofacial surgery
separated by a war and many miles, but with the same love for
doing great work.
And they, then they talked for, you know, 15-20 more minutes about
other cases and they've kept on a strong relationship.
(12:00):
To that point, that I feel some of the biggest support we can give to
to the doctors
there is that sense of support; that there's a doctor here
Willing to listen to you, you're practicing in a care Island, maybe
maybe in these cities.
Maybe there's a couple of Maxillofacial Surgeons.
I bet a fair amount of these specialists have left, especially
(12:21):
the Eastern regions.
And so having that support on demand, I think is a huge help.
We're encouraging our doctors to build relationships.
We
Want to be there to support the doctors in Ukraine.
Host (12:33):
What does it mean to both of you to be doing this right now?
Dr. Berkowitz (12:36):
These consults have been some of the most touching
moments of my career to witness the connection of these physicians and
to see the Gratitude on the Ukrainian side for the advice that they're
getting.
And then also our physicians and local physician walk away and are so
(12:58):
happy to be able to do something.
It also means a lot
To me because everyone comes back to me and says, I want to connect
with them again.
I have some other other thoughts.
it's just a beautiful thing.
Like I said that physicians communicating connecting literally a world
apart.
Dr. Cioe-Pena (13:17):
When people say they go into
medicine for the right reasons and go into Global Health.
These are the reasons, right.
This is a way that a network, a health system is
leveraging
it's talent to just do good in the world.
And there's really; Ukraine was not on our radar before
(13:38):
this.
We have three core sites in the center for Global Health [Ecuador, Guyana and India]
Ukraine's.
Not one of them.
It's not one of the potentials for the next three that we that we
list, but it was the right thing to do.
Host (13:48):
Covid-19 certainly changed a lot about how health care is delivered.
Can you tell us about some of the lessons learned during the pandemic
about Telehealth and how they informed, what you're now doing in
Ukraine?
So for me, it has because one of those I talked about the building
blocks that we're using and one of the programs we built during the
(14:10):
pandemic was our emergency telehealth program, ER on Demand.
And so that program, a lot of the workflows for the infrastructure for
that.
We literally copied
And pasted, some of those processes to build this program.
So we didn't have to start from page one.
We don't start from the very beginning.
We took something that we knew worked, was growing and effective and we
(14:31):
had to make a bunch of changes but it was, it was easily
understandable.
So, all of our agents at the transfer center, who are the ones who are
kind of managing day-to-day these processes.
We just had to kind of say, okay.
This is a mash-up of our on-demand program and telestroke
and our transfer program.
We're going to mash them up in a unique way and create this Global
(14:53):
Telehealth program and everyone understood it right off the bat.
Even so, what are some of the technological
struggles that you that you have?
Dr. Berkowitz (15:03):
So, I mean, the biggest technological struggle
I actually think, is navigating the appointment time.
It seems really simple, but you have a doctor in Ukraine
who is obviously very busy, has a lot going on and then we
have one of our specialists or even sub-specialists and we're trying
(15:26):
to find the time that they can both connect.
So just navigating that in an easy way has been a
challenge.
Another big challenge is getting Imaging files from them.
We want our doctors to be able to look at the CAT scans and x-rays.
So we worked with our Radiology service line and
(15:49):
Dr. Beerus specifically really helped us to put together a system, so we
can get the images from there and have our doctor review, them and
review them before they have a consult.
That they can really speak about the case in depth
Host (16:03):
So what's next in the international collaboration?
When it comes to telemedicine, where are we headed?
Dr. Cioe-Pena (16:08):
Yeah.
So yeah, I mean really, you know telemedicine has changed Global
Health in ways that I don't think we're ever going to go back and I
think that we can say that a lot has
changed because of Covd. You know, necessity is the mother of
invention and and you know the model of the way we used to interact
(16:29):
with international partners, where you'd fly in or you'd fly them up,
you do the training for a week and then you set them loose
and you kind of hope that they get it and they do.
Okay.
I think that's gone.
I think there are better ways to do it.
I think we're seeing that Innovation happening.
I mean, we saw it, you know, I'll give you a perfect example.
In 2020.
We started a nursing leadership program for the country of Guyana for
(16:53):
for essentially, all of the nurses in Guyana.
We identified 60 nurses that we're going to go through this program.
And Covid obviously happened early in 2020 and we
transitioned to zoom and used a virtual platform to do the teaching to
do the dashboard discussions, you know, as if we were having multiple
meetings in country, which was how it was originally planned and we're
(17:16):
going to have multiple sessions.
We fly down have these meetings fly back.
We've been doing that.
We've been doing, telepsychiatry consults and Ecuador in India.
Since 2020, supporting the mental health of a school in Southern India
and several
Clinics in Quito, Ecuador.
I see that as the start.
I see that as something where, you know we are helping these
(17:38):
low and middle income countries transition into the digital age of
health and that we're growing with them that we are figuring out new
ways to provide humanitarian, assistance, and development work that
doesn't necessarily require all of our experts to be in country at the
time that we're doing it and allows us to have follow-up.
So instead of it just being a train-the-trainer, will you teach
(17:59):
someone how to
use point-of-care ultrasound
Imagine for the next six months.
If you could look at all their images live while they're doing it and
then talk to them on a video screen.
I mean, that changes fundamentally, how we'll train people in low and
middle income countries that were partnered with.
Host (18:14):
You have a lot of employees volunteering to help with this program.
What's the response been like among
Northwell staff.
Dr. Cioe-Pena (18:22):
Well, I think one of the things I'll say Jon will tell you the
specific numbers, but I would add that.
I don't think anyone said no. We've asked people
that haven't stepped up to volunteer and explain the situation,
you know, no one has told us.
'No, I can't do this.
I'm sorry.
I don't want to help.'
Right?
Dr. Berkowtz (18:40):
A ton of people who have volunteered
because a lot of this is subspecialty based, anytime I call on
specialist and say, 'Hey, will you help out?'
The answer is always yes.
And a lot of times because the time difference, my answer is
'Okay, great 6AM tomorrow morning.' And the answer is always
'Yes. Okay, 6AM. Where can I show up?'
(19:02):
So I think that that's that's real telling about our physicians'
commitment.
Dr. Cioe-Pena (19:10):
So one of the things I think is important to mention is that when we
donated the funds to Ukraine to Doctors Without Borders, we gave a
matching donation of another $175,000
to Doctors Without Borders to
Help them with their efforts with wars in places, like Yemen
South Sudan, Central African Republic. Countries that, you know,
(19:31):
have been at war for years.
That really haven't made the the publicity or the headlines that
Ukraine has.
We feel like that's important for Northwell to make a
statement.
Saying, 'look it's not just Ukrainians that are being displaced by Wars
right now.
There are over 30 active conflicts on earth right now.
We think all of them need support and attention.
Host (19:54):
Dr. Cioe-Pena and
Dr. Berkowitz
Thanks for sharing insight into this really important program you've
developed.
And to you the listener.
Thanks for tuning in.
I'm David Rice-Hale.
And this is 20-minute help talk.
Get more expert Insight from some of the leading voices in healthcare
today.
(20:14):
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