Project TeleView – Telemedicine for refugees

Interview with Dr. Hassan Soda and Dr. Nagham Soda, Neurological Clinic of Bad Neustadt, Germany

01/23/2017

Refugees who come to Germany struggle with language and cultural barriers – also when it comes to medical issues. Patients are often not able to state their medical history or acute conditions, which requires extra time and means increased costs for medical offices and shelters. The telemedicine project TeleView seeks to offer a solution to this problem.

Image: Six men and a woman standing in a row. The woman is holding a document in her hands; Copyright: Rhön-Klinikum, ZTM Bad Kissingen

The project TeleView has won the price for telemedicine 2016 of the German Society of Telemedicine (Telemedizinpreis 2016 der Deutschen Gesellschaft für Telemedizin). Dr. Nagham Soda is holding the certificate. Dr. Hassan Soda is standing to her right; © Rhön-Klinikum, ZTM Bad Kissingen

Using video consultation, this project permits physicians with migration background to assist in the treatment of refugees by obtaining a medical history and reaching a diagnosis, regardless of whether the refugee is at a doctor’s office, hospital or refugee shelter. This optimizes the medical care of the refugees and supports the health care system.

What exactly is TeleView?

Dr. Nagham Soda: TeleView is a telemedical procedure in the form of a video consultation between the TeleView physician (who is at a hospital for example) and a refugee as well as a medical professional, who are in different locations. This might be a refugee shelter, a hospital or a medical office.

Dr. Hassan Soda: TeleView started as a volunteer project. Both of us along with several other colleagues with migration background saw it as our duty to help refugees that came to Germany. We wanted to support people with our language knowledge and medical expertise. However, the problem was that we weren’t able to help all refugees in the region. Ultimately, the TeleView idea was born from the desire to help.

How does a consultation typically take place?

N. Soda: First, the medical history is obtained. This takes place prior to the consultation via a standardized medical history questionnaire available in two languages – German and Arabic. During the consultation, you get answers to questions on the patient’s medical history before addressing the main issue: what is the patient’s chief complaint? In addition, it is also possible to perform minor exams with the help of the local expert. For instance, the medical experts can measure the blood pressure or test the pulmonary function. At the end of the video consultation, we are able to make recommendations and take adequate measures. Some cases subsequently require a visit to the family doctor or a medical specialist. Yet we also had cases where just the consultation was sufficient.
Image: Two people are sitting in a room, looking at a screen; Copyright: Rhön-Klinikum, ZTM Bad Kissingen

At a refugee shelter, the patient can tell the physician, connected via internet, all of his pains in his own language. With the help of the local expert minor exams can be performed; © Rhön-Klinikum, ZTM Bad Kissingen

Why do we need a project like TeleView?

N. Soda: There are a number of reasons. One reason is the standardized form we provide with the medical history questionnaire. The use of this type of questionnaire makes a lot of sense when refugees are asked the same questions over and over during every doctor visit. The second point is the language barrier that it eliminates. Yet another aspect is the cultural barrier: refugees who come to Germany experience culture shock. Usually, they don’t really get a handle on the new (health) system and the new country. I come from Syria for example and therefore know the differences. 

What’s more, there is a lack of psychosomatic care for refugees. Most refugees come from war-torn areas and are severely traumatized. Many patients utilize TeleView not just because of their physical ailments but also because of the available psychiatric care.

H. Soda: Oftentimes, the refugees who have come to Germany don’t have a single document with them. Once a refugee has finally arrived at an emergency shelter, the physician has a number of questions: what’s his/her past medical history? What types of medications does she take? Does he have any pre-existing conditions? That’s why we didn’t just want to offer teleconsultation with the TeleView project, but we also intend to electronically capture all relevant information at the same time. Should there be an emergency within two or three weeks after the consult and the patient has to be admitted to the hospital, information is directly available. This is an enormous help for the attending physicians.

In addition, our consultation can also ensure that the refugee doesn’t need to visit several doctor’s offices due to a misunderstanding or because relevant information about their medical history is missing. In doing so, the TeleView project overall saves a lot of time and money. And it has also improved the medical care for refugees.  

Image: Dr. Nagham Soda is sitting infront of a laptop; Copyright: Rhön-Klinikum, ZTM Bad Kissingen

TeleView gives the refugees the feeling of being in good hands. First, there are no communication difficulties and second, the refgugees can talk with the physician openly about their medical history; ©Rhön-Klinikum, ZTM Bad Kissingen

What are the advantages of TeleView compared to the use of interpreters for example?

N. Soda: Needless to say, the volunteer interpreters are doing a great job. Having said that, they typically don’t have any medical knowledge. They grapple with or can’t cope with medical jargon, to where there have already been some misunderstandings between the refugee, interpreter and the physician. Another reason is doctor-patient confidentiality, which is not something interpreters are ethically bound to. That’s why many refugees only vaguely explained their ailments because they felt uncomfortable revealing their entire medical history to a stranger.

What’s next for the project?

H. Soda: Our latest project is the development of an app for refugees: along with the medical history questionnaire, it contains a lot of important information about the German health care system. The refugees can enter their information into the app and show it as needed. Currently, the app is available in two languages – Arabic and German. These options are meant to be expanded.

TeleView has started as a pilot project. We have supported about 1,000 refugees in the region between April and September of 2016 and handled approximately 70 cases in Bad Kissingen with the help of TeleView. We first wanted to see whether this type of project actually pays off – for the refugees, the hospitals, and the medical practices. The goal is to expand this during a second phase so that we will be in charge of about 2,000 refugees. During the first phase, we had about ten physicians with migration background at our disposal, who conducted these consultations during their spare time. For the second phase, we still need to consider whether it makes sense to employ full-time physicians for teleconsultations.

 

The partners for the TeleView project pilot phase were the Center for Telemedicine Bad Kissingen and the Rhön Clinical Center. They were supported by the district of Bad Kissingen and the Bavarian Red Cross.

Image: Olga Wart; © Rolf Stahl
The interview was conducted by Olga Wart and
translated from German by Elena O'Meara.
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