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The Kutupalong Refugee Camp outside Cox’s Bazar, Bangladesh
Tucked between rows of green fields stretching toward palm tree-filled horizons — some of the most beautiful countryside I have ever driven through — lies the largest refugee camp in the world. Right outside the seaside town of Cox’s Bazar, Bangladesh, nearly one million stateless Rohingya people call this crowded, half-built mega-camp home.
Surrounded by a sprawl of hastily built corrugated steel, bamboo, and tarp huts is HOPE Field Hospital. This concrete structure is one of the only inpatient facilities operating in the Kutupalong Refugee Camp that is responsible for the healthcare needs of hundreds of thousands of men, women, and children. 
Even with minimal resources and a modest number of on-site providers — some 50,000 births alone are expected in the camp over the next year — HOPE Field Hospital is able to treat patients for a broad range of medical conditions with the help of leading specialists from around the globe. And it’s all done virtually via audio/video telemedicine technology, saving thousands of miles and dozens of hours of travel.
The urgent need for telemedicine
Now, more than ever, the world needs telemedicine. The COVID-19 pandemic has touched nearly every corner of the world, forcing a drastic shift in our ability to treat patients and keep healthcare workers safe. In an effort to level the curve and reduce community spread, many physicians have turned to virtual care. This shift presents the first large scale example of telemedicine’s potential to support clinical teams for a variety of use cases, specialties, and populations.
The sudden novel coronavirus outbreak magnified the need for reliable access to clinical care. The World Health Organization predicts a global shortfall of 12.9 million healthcare workers by 2035; today, that figure sits at 7.2 million. Telemedicine helps eliminate the distance barrier between providers and their patients via telecommunication technology, improving access to quality, affordable healthcare. 
Last year, Dr. Iftikher Mahmood, founder of HOPE Hospital, invited me to Bangladesh to see the firsthand impact of virtual care in the community. Dr. Mahmood, a pediatrician who immigrated from Bangladesh to the United States in 1996, splits his time between Florida and Cox’s Bazar to assist this growing humanitarian crisis. 
Dr. Mahmood explains that although the medical services available within the Kutupalong Refugee Camp’s fences are grossly underfunded and unproportionate to properly care for a patient population of that scale, telehealth gives HOPE Field Hospital the ability to meet the demands of this susceptible community.
“At first, our services primarily catered to young and expectant mothers. However, we needed to expand to meet the growing needs of our patients. The telemedicine technology that has been made available to us offers the ability to provide healthcare to all people, everywhere.” 
Reducing the morbidity and mortality of vulnerable populations requires equitable access to health workers. In order to provide a consistent medical presence wherever it is needed, we need a pragmatic, cost-effective solution that is simple to deploy and easy to scale. 
Providing consistent, reliable treatment
Half of the world’s population does not have access to essential healthcare services because they are inaccessible, unavailable, unaffordable, or of poor quality. In these regions, millions of deaths occur every year from conditions that would easily be treated in developed countries. Telemedicine stands to address this by instantly extending the reach of specialty providers.
Increasing global access to healthcare is possible, and it is already being done. The World Telehealth Initiative (WTI) is a non-profit organization that uses telemedicine to match healthcare providers to underserved populations, often with oceans between them. Sharon Allen, Co-Founder and Executive Director of WTI, oversees telemedicine clinics operating in 14 locations across Africa, Asia, and Central and South America. While telehealth in general isn’t new, the model WTI uses is a novel concept for global healthcare. 
What sets WTI apart is the organization’s growing network of volunteer physicians who partner to treat patients, without the costs traditional charitable missions incur (trans-oceanic travel or weeks long time commitments). Staffed with a growing set of philanthropic and altruistically inclined health workers, WTI partners with Teladoc Health to efficiently bridge patients to providers who would never be able to meet previously due to geographic and cost constraints. Teladoc Health’s virtual care platform and devices enable WTI’s volunteer medical professionals to deliver essential medical services virtually despite being countries apart.
According to the World Bank, the United States has a doctor-to-population ratio of 1:400. On the other end of the spectrum, Malawi — one of the poorest nations in eastern Africa — has a ratio of 1:62,500. This includes fewer than 10 trained obstetrician-gynecologists for a population of 15 million.
At the Freedom From Fistula Foundation (FFFF) in Lilongwe, Malawai, WTI is providing virtual care assistance to surgically repair obstetric fistulas in women. Obstetric fistulas occur due to prolonged, obstructed births. The baby dies 95 percent of the time, and women are left incontinent, creating a highly stigmatized and dangerous condition. In nations with easier access to clinical assistance, these fistulas are a rare occurrence as routine procedures such as a Caesarean section would erase these complications. By the end of the nineteenth century, obstetric fistulas were essentially eliminated in the United States, with the last fistula hospital in the country closing its doors in 1895. However, fistulas are still prevalent in underserved regions, affecting more than two million women who lack access to appropriate medical expertise and services.
Dr. Jeff Wilkinson at the World Telehealth Initiative Malawi Clinic
Dr. Jeff Wilkinson, Professor of Obstetrics and Gynecology at Baylor College of Medicine, has partnered with WTI to use telemedicine to provide remote obstetric fistula care. Dr. Wilkinson is available to the surgeons and patients in Malawi to assist the complicated fistula procedures.
“Like any other complex surgical condition, it takes a lot of time with good mentoring,” Dr. Wilkinson explains. “You work with people who are highly trained surgeons to get enough exposure to feel comfortable doing this surgery. Some surgeries are fairly straightforward, others are more complicated, and still others are extremely complicated.”
One of the hundreds of women treated in Malawi’s clinic was Esperanza, a 19-year-old expectant mother who had to travel six-hours (while in labor!) on the back of a bicycle to reach a clinic. After days of prolonged, obstructed labor, Esperanza had a horrific tragedy – she suffered a still birth and returned home with a fistula.  
Women suffering from fistula complications often become socially ostracized. This fate might have left Esperanza shunned if it weren’t for WTI’s telemedicine clinic. Here, Dr. Wilkinson was able to consult with the local surgeon and guide her through the complicated double-fistula surgery. Thankfully, Esperanza was able to recover and avoid becoming one of the millions of women who suffer for years, or even decades, from untreated fistulas. 
Addressing COVID-19
Back in Bangladesh, COVID-19 has been reported in the Rohingya Refugee Camps and aid workers fear the worst. Due to the sprawling layout of the camps, coupled with the unhygienic conditions, implementing social distancing measures is near impossible, creating the potential for a humanitarian disaster if left unchecked. 
Dr. Iftikher Mahmood in front of a telemedicine device at HOPE Field Hospital
Virtual care is among the best recommended solutions for social distancing and mitigating the spread of COVID-19 according to the Centers for Disease Control and Prevention. Immediately, WTI and HOPE Hospital supported the development of a 50-bed isolation ward in the camp, with supplemental oxygen options and necessary labs — even negative pressure rooms. This isolation bay will be staffed by remote infectious disease specialists and pulmonologists through WTI’s telemedicine infrastructure. “Still, things are extremely tense in the camp,” Dr. Mahmood explains. “Now, regular outdoor clinics are very slow due to extended lockdown.”
Although the nearly one million Rohingya refugees are tightly packed together in the camp,  telemedicine gives the on-site staff hope to restrict the disease spread and isolate and treat infected patients according to WHO guidelines. 
“Telemedicine is magical,” says Dr. Mahmood. “As a member of the physician community, I think we have a tremendous opportunity to take high quality care with telemedicine to some of the remotest parts of the world to offer equality of care.”  
Solving lack of access to healthcare
Governments recognize the benefits telemedicine can have on their citizens’ health for generations to come. At WTI’s Malawi telemedicine clinic’s coronation, Dr. Dan Namarika, the Principal Secretary for Health in Malawi, agreed that telehealth can positively affect his nation, “we must embrace technology to meet the needs of our country. We must use technology as we figure out the best way to prevent needless neonatal deaths and preventable still births.” 
In the United States, COVID-19 public health response efforts included Congress passing the Telehealth Services During Certain Emergency Periods Act of 2020. This instrumental decision removed a longstanding geographical restriction and opened an essential channel for care providers to bring critical coronavirus treatment to Medicare patients. As we look to the future of remote care, it is vital that permanent solutions are secure, reliable, and not cost-prohibitive. 
Modern technology and the proliferation of the internet makes it possible to connect these very same physicians from the comfort of their own living rooms to distant communities across the globe faster, easier, and more frequently than traditional outreach missions, especially in-defense of infectious disease management. 
According to a PricewaterhouseCoopers report, more than half of US physicians — around half a million doctors — have already or will soon adopt virtual care technology to treat patients (this number is sure to rise as data from increased telemedicine adoption becomes available in the weeks following the COVID-19 surge). If each of these physicians are willing to donate one hour a month to seeing patients in vulnerable locations, like the Kutupalong Refugee Camp or Lilongwe, Malawi, that would add up to six million hours a year. The average virtual consult takes only 10-15 minutes, meaning right now, we have the ability to treat an additional 24-36 million patients per year using telehealth. That’s 24-36 million people like Esperanza.  
Augmenting clinical capabilities through technology is a necessary step to solving the healthcare delivery challenge. Together, we can create a future that ensures access to healthcare does not have to be determined by where you were born.
To learn more about Teladoc Health’s partnership with WTI and commitment to having a positive impact on global communities, visit: https://www.teladochealth.com/resources/white-paper/csr-report/

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