Dr Avi Tsur, OB/GYN and high-risk pregnancy expert, tells FemTech World how telemedicine could transform our traditional healthcare system.
The world’s first Women’s Health Innovation Centre, directed by Dr Avi Tsur, OB/GYN and high-risk pregnancy expert, was launched as a collaborative effort by ARC – Accelerate, Redesign, Collaborate – Centre for Digital Innovation, the Sheba Gynaecology and Maternity Centre, and Gertner Institute for Health Policy at Sheba Medical Centre in Israel.
Originally designed to promote patient and doctor safety during the pandemic, the centre combines telemedicine with in-person visits to “enhance treatment and offer patients the best care possible”.
“Sheba Medical Centre is the largest hospital in Israel and one of the leading hospitals in the world,” says Dr Avi Tsur, who serves both as director of the Women’s Health Innovation Centre and of OB/GYN BEYOND, the first virtual obstetrics and gynaecology department, as well as an attending physician at the Josef Buchmann Gynaecology and Maternity Centre at Sheba.
“The Women’s Health Innovation Centre essentially treats all aspects of innovation in women’s healthcare, AI, telemedicine, virtual reality, precision medicine and inventing medical devices and incubates new concepts in telemedicine.
“Once we develop a comprehensive clinical service it is handed over to OB/GYN BEYOND, that is capable of taking it in to the next level, both from a clinical point of view, but also in terms of marketing strategy and budgeting.”
The new hybrid clinic for women with high-risk pregnancy focuses in particular on transforming care for women with diabetes in pregnancy and offers both in-person and at-home visits that include comprehensive care, digital urine dipstick assessment, ongoing glucose monitoring, as well as foetal ultrasound and foetal monitoring.
“Following the Covid-19 outbreak, we started to use telemedicine technologies to treat women in hospital without having contact between the staff and the patients and that was a big step for us in being able to treat pregnant women remotely,” Dr Tsur tells me. “Now this hybrid approach means that multiple tests can be done at home, leveraging various technologies.”
Indeed, new analysis from McKinsey & Company has shown that telehealth utilisation has increased 38 times from pre-pandemic levels. “Telemedicine is very much like our chat right now,” explains Dr Tsur.
“Although our Zoom meeting is not as good as an in-person meeting, it allows us to do things that would not have been possible otherwise. Same goes for telemedicine services.
“When it comes to remote services, we also take into account the time it takes for a patient to get to the hospital, the time waiting for a nurse, an ultrasound and then, for a foetal monitoring assessment,” he continues. “In-person, all of these would take at least three hours, but when we switch to telemedicine visits, they take around 30 minutes.”
Even though telemedicine has certain limitations, Dr Tsur emphasises that there are many things that can be safely done at home. “I think around 90 per cent of things can be done remotely, especially within a hybrid system when we don’t miss the in-person meeting.
“Initially, many physicians and most of the patients were not aware of the possibility of doing an ultrasound or foetal monitoring assessment at home. But we arrange a first in-person visit, we take the patient to one of the rooms where we do telemedicine visits and we let them connect themselves to the foetal monitor so that they have the chance to see the monitor on the screen,” he explains.
“This way they can actually get the feeling of what we do and what we see in hospital. Once they do it, they feel more confident to do it at home next time.”
The Sheba Medical Centre, alongside the Israeli Foreign and Health Ministries, were also involved in establishing Shining Star, a dedicated field hospital in western Ukraine that served Ukrainian refugees and locals and trained local medical teams in telemedicine and field medical care.
The field hospital’s approximately 100-strong staff included doctors, nurses, medical lab workers, medical engineers, and pharmacists, as well as logistics and operational personnel. “We leveraged our technology to provide direct telemedicine services to refugees in Ukraine,” the high-risk pregnancy expert says.
“All of our physicians at Sheba, each one in his expertise, were interested in playing a role in the field hospital and with the telemedicine services, we were very eager to do everything we could to provide the best technologies care remotely.”
Dr Tsur believes that telemedicine can play an important role in humanitarian medicine. With hundreds of women at risk in Ukraine due to sexual violence, bad weather conditions and a lack of care, good pregnancy treatment is imperative.
The Israeli expert adds that: “Western medicine is very risk averse, which is not a bad thing, but I think we have to understand that humanitarian medicine creates different challenges, and being able to take some risks is needed if we seek to make a change.
“What we’ve been doing in Ukraine provided a great jump in expert-to-expert services, leveraging new technologies that allow experts in the field to consult even bigger experts in the hospital. It also taught us that we can’t reach the same ‘perfection’ often expected in the normal life scenarios.”
While the field hospital was limited to a certain amount of time, the use of telemedicine in various aspects of women’s health, during humanitarian crises, will continue.
“In many ways, our field hospital was limited in time because of the challenges we faced,” Dr Tsur points out. “Telemedicine, however, allows us to provide ongoing help to patients in remote places and it provides us with opportunities for learning more about humanitarian medicine. In my opinion, there’s a very good symbiosis between innovative inventive technologies and humanitarian medicine.”
The medical expert does not rule out other future projects and says that the team behind the Sheba Medical Centre is happy to collaborate and share their knowledge with other centres interested in doing similar things in various scenarios in countries taking refugees.
“My hope is that in five years from now, maternal foetal telemedicine will be maternal foetal medicine,” Dr Tsur adds. “I hope that pregnant women will receive the treatment that they need at home or at work or wherever they are. I also hope that we, at Sheba, will play an important role in developing the clinical paradigm and technologies serving this revolution, both in telemedicine and AI solutions.”
Would this mean less telemedicine hesitation? “I hope so. It’s our role to show people that telemedicine is safe. 10 years ago, people were hesitant to use mobile banking services, but we are in a totally different place today. I hope the same will happen with pregnancy services.”
For more info, visit eng.sheba.co.il.
Nurses left with no time for training amid “workforce crisis”
Disruption in health services has meant that face-to-face nursing courses had to move online
After they led the fight against Covid, nurses remain four times more likely to take their own lives than people working in any other profession. Michaela Nuttall, founder of the educational platform Learn With Nurses, tells us why they deserve better.
The impact of the pandemic on healthcare services has been immense, reads a 2021 BMJ report. For the over 500,000 nurses in the UK, Covid’s mental health toll has been intensified by physical and emotional exhaustion and an increased risk of burnout.
Despite interrupted training and fear of exposure to the virus, surveys have shown that nurses strived to provide excellent care and support for their patients and colleagues, sometimes at personal cost.
“Nurses were stretched more than ever during the pandemic,” says Michaela Nuttall, cardiovascular nurse specialist and founder of the online educational platform Learn With Nurses.
“At a time when they were forced to work extra hours, look after their kids and take care of their parents, they were left with little to no support and no time for training.”
The sudden disruption in health services along with staff shortages have meant that face-to-face nursing courses had to move online.
However, letting people have time off for training proved extremely difficult, says Nuttall. “Because nurses can’t be at work during training, many were left with no access to training.”
Having worked in cardiovascular disease training herself, Nuttall decided to host a Zoom meeting about the importance of blood pressure control at the start of the pandemic and invited people to join through social media nursing groups.
“I was really missing training and I wanted people not to forget about cardiovascular disease,” she explains. “I put the Zoom link online and about 200 people registered for the first session.
“The need was definitely there. So, I started working with other nurses to build a bigger platform and we went from nothing to everything in a very short space of time.”
Learn With Nurses, now a global online community of specialist nurses, provides free educational support to healthcare professionals and helps them improve the quality of care while promoting evidence-based clinical practice guidance.
“It is not meant to replace formal training,” the founder says. “Our aim is to make training much more accessible and give people a free platform where they can learn, ask questions and interact with other healthcare professionals. We now use a platform called MedAll instead of Zoom because it makes our job much easier and allows thousands of people to join and we try to have a relaxed style that almost feels like you’re talking to a friend over a coffee.”
The courses, delivered in bite-sized sessions of 30-40 minutes, cover a different subject each week, allowing nurses to understand some of the most common health conditions they treat in hospital.
“We’ve made a commitment at the beginning that we will always provide our courses without any barriers to learning,” Nuttall says.
“People tell us how much Learn With Nurses has helped them and although we are looking at memberships and donations to help us fund the training, we don’t want money to be a barrier.”
Nurses like Nuttall say that the NHS is still facing challenges. According to the cross-party Health and Social Care Committee, health services in England are currently facing “the greatest workforce crisis in their history” with the NHS losing millions of full-time equivalent days to staff sickness caused by anxiety, stress and depression.
“Nurses remain under extreme pressure,” says Nuttall. “Almost 90 per cent of them are female and they need our support more than ever.
“Our ambition is to give more visibility to all nurses, but particularly to those from minority backgrounds. I hope that through Learn With Nurses they will find a diverse community where they could feel represented and supported.”
Step us for breastfeeding: educate and support – WABA 2022
This year World Breastfeeding week’s theme is ‘Step us for breastfeeding: educate and support’.
The World Breastfeeding week (WABA) 2022, which takes place from the 1st of August until the 7th, focuses on strengthening the capacity of actors that have to protect, promote and support breastfeeding across different levels of society.
WABA’s aims to inform and educate governments, health systems, workplaces and communities to strengthen their capacity to provide and sustain breastfeeding-friendly environments for families in the post pandemic world.
Anwar Fazal, Chairperson at WABA, said: “World Breastfeeding week is a vibrant global movement that expands and connects the power of one with the power of many. Only by working together we can make the changes we need.”
Breastfeeding is key to sustainable development strategies post-pandemic, as it improves nutrition, ensures food security and reduces inequalities between and within countries.
The theme is aligned with the thematic area one of the WMW-SDG 2030 campaign which highlights the links between breastfeeding and good nutrition, food security and reduction of inequalities.
The World Health Assembly (WHA) aims to increase the global rate of exclusive breastfeeding to at least 50 per cent by 2050. This policy aims to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners in improving exclusive breastfeeding rates among infant younger than six months.
Exclusive breastfeeding is a cornerstone of child survival and child health because it provides essential, irreplaceable nutrition for a child’s growth and development.
It serves as a child’s first immunisation, providing protection from respiratory infections, diarrhoeal disease, and other potentially life-threatening aliments.
Exclusive breastfeeding also has a protective effect against obesity and certain noncommunicable disease later in life.
Yet, much remains to be done to make exclusive breastfeeding during the first six months of life the norm for infant feeding. Globally, only 38 per cent of infants aged zero to six months are exclusively breastfed.
Recent analysis indicate that suboptimal breastfeeding practices, including non-exclusive breastfeeding, contribute to 11.6 per cent of mortality in children under five years of age.
Breastfeeding could be a powerful tool to meet the 17 United Nations Sustainable Development Goals as it can be linked to all of them.
Amal Omer-Salim, executive director at WABA, said: “By focusing on a broader context, longer timeframe and practical yet ambitious goals, we can create sustainable and engaging campaigns.”
Indian digital health platform on a mission to provide affordable family care
Over 75 per cent of women in India experience postpartum anxiety while 25 per cent struggle with postpartum depression
As the country recovers post-pandemic, we asked Carina Kohli, founder of the digital health platform HUMM, why India desperately needs affordable and accessible family healthcare.
Although 76 per cent of healthcare professionals in India use digital health records, gender-based discrimination remains a prevalent issue.
According to a study conducted in 2016 by researchers at the All India Institute of Medical Sciences (AIIMS), the Indian Statistical Institute and Harvard University, only 37 per cent of women got access to healthcare compared with 67 per cent of men.
Recent figures show that 75 per cent of Indian women experience postpartum anxiety for up to 24 months post pregnancy while 73 per cent of them quit the workforce to start or raise a family.
When the pandemic hit, the country faced big question marks. A 2021 BMJ report found that Covid had a negative impact on the Indian healthcare system, with “the exaggeration of income inequality during lockdown expected to extend beyond”.
“I grew up thinking that healthcare is a human right,” says Carina Kohli, founder of HUMM, a healthtech company focusing on postpartum and postnatal care. “The reality is that in India, the majority of the population either don’t have access to healthcare or can’t afford it.
“I was diagnosed with PCOS when I was about 13 and I felt very isolated. I remember being very insecure and nervous and, aged 19, I started doing research on options for women’s health and fertility in India.”
At the peak of the pandemic Kohli and her team created a web application and launched Baby Space – a digital content and community platform for fertility, pregnancy and childcare.
“We grew that to about 16,000 people,” she says. “But in a country like India where we still deal with issues of affordability, geographical accessibility and infrastructure. Therefore, we realised that access to healthcare is a primary need and we decided to pivot and rebuild [part of the system].
“So we established HUMM to offer affordable unlimited family health care to mothers, families and organisations with a focus on postpartum, postnatal, neonatal and baby care.”
HUMM has a range of on-demand, solution-based health programmes as well as different tools with personalised insights, health plans and progress charts covering physical, mental and emotional health.
“Our incredible doctors and experts often chat with our users on social media and the HUMM app, answer their questions and essentially, build that trust,” Kohli explains.
“Telemedicine has been around in India for a little while and people are now more open to options and they’re more adaptable. They know that this can be a much more affordable and convenient option.”
Has the pandemic helped digital health technology in this regard? “Definitely. The pandemic has influenced consumer behaviour to a great extent,” the founder adds.
“There are still a lot of cultural barriers and people may not be always open about mental health or sexual health, but the response we’ve had has been really eye-opening and we found that couples felt less alone knowing that they had dedicated doctors and experts to speak to.”
The lower costs and the one-to-one consultations with experts are what keep users coming back and Kohli says that receiving positive feedback is by far the most rewarding feeling for her, as a founder.
“We have great doctors in our country and I think information and awareness will definitely help us grow,” she says.
“Our dream is to broaden access to healthcare services across the country because the need is definitely there. Currently, we are India-focused because it’s a huge market where 25 million babies are born every year. But we are also looking at neighbouring countries that deal with similar issues. In the next five to seven years, we might consider countries across Southeast Asia.”
Kohli would love to see more openness to femtech. Although there is a growing interest in the sector, women’s healthcare remains underfunded. “I really don’t like when people talk about women’s health as a niche,” the founder says.
“We are 50 per cent of the population and there is so much we need to do.”
For more info, visit hummcare.com.
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