A small Perth-based telehealth company has been playing an unlikely role in humanitarian efforts to link displaced Ukrainians with doctors around the world, as Cathy O’Leary explains.
As he watched the Ukrainian crisis unfold last year, information technology-trained Robert Hicken watched in horror as millions of displaced people suddenly faced a health care crisis.
Some Ukrainians were living in occupied territories in their homeland – where hospitals and medical clinics had been decimated – while others were fleeing to countries across Europe and beyond.
For the founder and chief executive officer of Perth-based company Practice Innovators International, which owns and operates the telehealth platform GPNow, the challenge was clear but the logistics were daunting.
After Russia invaded Ukraine in February last year, it was estimated
that more than seven million people fled the war-torn nation, while another 44 million remained, often living in volatile and uncertain conditions.
With more than 100 hospitals and clinics damaged or destroyed across the country, it was difficult for those still living there to access medical care, while many refugees who relocated were finding it hard to communicate with local doctors because of language barriers.
Mr Hicken hatched an ambitious plan to tweak existing technology and systems used in Australia to link Ukrainian patients to doctors.
The proof of concept was already there, as the company’s telehealth platform had already been used by aged care facilities, remote Aboriginal groups, bushfire-affected communities and Spinal Cord Injuries Australia to provide access to APHRA-certified medical professionals.
The Yaburara and Coastal Mardudhunera Aboriginal Corporation had partnered with GPNow to provide clinical assessment and consultations for 1000 families across regional WA, while SCIA used the technology to offer online services Australia-wide.
Born in London, Mr Hicken had migrated to Perth in 1989 with a young family, and was inspired to raise funds for spinal care research and treatment after close friend David Prast became a quadriplegic after a surfing accident at Cottesloe Beach in 1995.
Pre-COVID, Mr Hicken had seen the retail evolution of internet sales and decided that telehealth was the next big revolution, but it was still a very doctor-centric model and there were many logistical issues to overcome.
His company raised $1 million to build a system that was high definition and low bandwidth, building a video engine from the ground up before testing it with a medical centre group in Melbourne.
“We had started a pilot with Spinal Cord Injury Australia to use telehealth but it wasn’t really working financially, and then bang, COVID hit, and then there was suddenly funding through the NDIS because spinal cord injury patients were cancelling all their medical appointments,” Mr Hicken said.
“Throughout the COVID period we did 15,000 one-hour sessions. It was kind of surreal, and then Paraquad NSW contacted us and wanted to use telehealth too. At the time it helped a lot of patients stay connected.”
In March last year, the GPNow team decided to build a dedicated virtual clinic of Ukrainian medical professionals to help those in need with free medical advice and care.
With the project needing significant financial and technical support, Mr Hicken reached out to Amazon Web Services, which had just announced it was keen to support humanitarian projects in Ukraine.
Within weeks the Ukrainian CrisisCare Telehealth Service was launched, run in partnership with the World Organisation of Family Doctors (Vasco da Gama Movement), and it started connecting Ukrainian patients to doctors.
It received support in the form of 15,000 cloud service ‘credits’ as well as US$100,000 in cash contributions and technical assistance to keep it running smoothly and protect it from potential cyber threats.
Since then it has been operating on a shoe-string budget to provide primary health care to the most vulnerable and relieve pressure on a health system suffering the effects of war. The medical practitioners are mostly Ukrainian refugees who cannot practice overseas.
To forge connections in the local medical community and find doctors who could provide care, GPNow appointed Dr Vadim Ilyashenko, a highly respected Ukrainian neurosurgeon, as its chief medical officer.
The 24/7 multi-lingual telehealth service has now helped more than 6700 Ukrainian families, with close to 6000 consultations provided by more than 100 medical professionals, including family doctors, paediatricians, neurologists, obstetricians, oncologists, psychologists and psychiatrists.
“There is no medical information on the platform and all of the doctors are anchored to the country where they’re licensed to practise, so the Aussie doctors must be APHRA-certified and provide all their identification and medical indemnity details,” Mr Hicken said.
“We can be beaming in doctors anywhere in the world really quickly to help those in need with free medical advice. People can use their own language and they can choose doctors anywhere in the world. They can view the doctor’s profile and it shows if they’re available online.”
Helping doctors help
About 90% of the doctors with the service are refugees themselves – many of them women, some with children who left their husbands behind in Ukraine.
“Doctors are paid €10 a day to be online, and €10 for every consultation, capped at €1000 a month. If they do more sessions than that – and many do – they don’t get paid for it,” Mr Hicken said. “They’re an amazing group of dedicated people.”
Despite many being highly qualified medical professionals, they could not otherwise find paid work.
“We had one woman who was an expert oncologist with 20 years’ experience and living in France, who was working at McDonald’s because her qualifications weren’t recognised,” Mr Hicken said.
“These doctors are loving this because they can care for their fellow citizens online. So, it’s a win-win for patients and doctors.”
Mr Hicken said most projects were about increasing revenue but the main KPI with the not-for-profit Ukraine project was about saving lives, with many people willingly volunteering many hours of their time.
Among those helped through the service has been a young woman from Kyiv, Anastassia, who had been living alone in a Polish hostel, separated from her partner who was a Ukrainian soldier.
After seeking help, the 18-year-old was found to have multiple tumours in her neck and spine, and teams of doctors worked globally to have her relocated to Amsterdam for life-saving surgery.
“Everyone in our team, all our doctors, have deeply moving stories, as well as horror stories, so we have used the story of Ana to try to make the numbers human,” Mr Hicken said.
Of course, the Perth-born telehealth project is only a small part of a suite of humanitarian efforts by doctors and other volunteers around world.
Efforts on a bigger scale
Soon after the escalation in war last February, Médecins Sans Frontières (Doctors Without Borders)started helping people evacuate from the east to the west of the country by medical train as the front lines inched closer.
One year later, MSF continues to respond to the humanitarian needs of the people affected by the conflict. Across Ukraine and in surrounding countries, hundreds of its staff are working in partnership with local organisations to provide lifesaving medical and mental health care to those who need it most.
That includes providing patient care on board two medical trains, developed with Ukrainian Railways. The medically equipped carriages help to evacuate patients out of hospitals close to active war zones and refers them to hospitals away from the frontlines. One train provides basic medical care and can carry up to 50 patients. The other train is able to carry around 26 patients and is equipped to provide intensive care for patients in serious condition.
Between March and December last year, the two trains evacuated more than 2600 patients and 78 orphans. Other key medical needs include insulin for diabetes patients, as well as medicines for people with other chronic diseases.
A recent report by several human rights and humanitarian groups, including Physicians for Human Rights, estimated that between February 24 and December 31 last year there were 707 attacks on Ukraine’s health care system.
As a result, 218 hospitals and clinics were damaged or destroyed, 65 ambulances were attacked, and there were 181 documented attacks on other health infrastructure such as pharmacies, blood centres and dental clinics.
At least 62 health workers had been killed and another 52 injured, while many more were threatened, imprisoned, taken hostage or forced to work under Russian occupation.
Back in Australia, Mr Hicken is worried about the future of the Ukraine telehealth service, because the funding from AWS is running out.
While the project has achieved his goal – to use technology to provide medical care to those affected by the war in Ukraine – he is frustrated that, with no end in sight for the war, thousands more people need help.
“What’s killing me is that we know we can help 500,000 families a month – so there are thousands of families who are missing out on the basic primary care they should be getting,” he said.
Appealing to Perth’s business sector
He recently addressed a meeting hosted by the Rotary Club of Subiaco to implore corporate and private sponsors to dig deep so that the platform can continue in 2023 to employ displaced Ukrainian doctors to plug the gaps in the damaged health infrastructure.
The project is seeking €100,000 to continue its work in the first part of this year, with about €17,000 raised so far, and is appealing directly to some of WA’s big business leaders and entrepreneurs.
“We want to keep this service going and reach many more Ukrainians in need of care and in ways that traditional aid programs cannot provide,” Mr Hicken said.
“We’ve worked so hard to get here, but we really need help, because we’ve run of money and AWS can’t give us anymore, so we’re seeking private or corporate sponsorships – really anyone who can help.
Help still needed
“The people in Ukraine needing help are still there, they haven’t gone away.
“Many of their doctors are going through great hardship as they are unable to practise outside of Ukraine. We have been helping them to carry on practising medicine to support their families, and our payments have been putting food on their tables.”
Mr Hicken said when the project was first getting off the ground many people thought it was a “crazy crackpot idea” and when he started asking for money some people thought it was a scam.
Others wanted to know why an Australian company was involved.
“I’ve even had Ukrainians look me in the eye and ask “why are you helping us?”
“I probably only gave us a 10% chance but now we’re really doing it.”
“We don’t even call it a war – we don’t take sides. It’s all about helping Ukraine.”
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