Before the outbreak of the Syrian civil war in 2011, Syria boasted relatively modern medical facilities and advanced cardiac care, especially in major cities. While rural areas were underserved, most were within a 90- to 120-minute transfer range from advanced cardiac care centers. However, the ensuing years of conflict dramatically altered this landscape. The United Nations High Commissioner for Refugees described the situation as "the great tragedy of the 21st century," with an estimated 220,000 deaths and almost 4 million refugees. Many areas are under constant siege, leaving millions without access to basic healthcare. Nearly half of Syria’s health facilities are either seriously damaged or destroyed, making it one of the most perilous countries for medical practitioners. Many doctors have fled, and those remaining face severe risks of being killed or arrested.
In response to the dire need for healthcare providers and the inability to offer traditional care, telemedicine has emerged as a crucial tool for assisting these vulnerable patients. Telemedicine involves exchanging medical information electronically between sites to enhance patient health status and care. This approach has become a palliative solution to alleviate the critical shortage in healthcare coverage. Telemedicine, particularly tele-cardiology, provides real-time engagement in decision-making, vital for cardiac care. This can involve voice, video, online, or offline recorded communication. During the Syrian conflict, tele-cardiology has facilitated tele-consultation, tele-management, and tele-education.
Utilizing data-sharing technology, tele-consultation leverages low-cost solutions via existing social media platforms and applications like Facebook, Viber, Google Hangout, and WhatsApp. These platforms enable communication through text, audio, still images, videos, and online phone calls. The Syrian American Medical Society has played a pivotal role in implementing tele-education for onsite medical personnel through various social media platforms. Under SAMS' supervision, essential equipment such as portable echocardiography and electrocardiography machines have been delivered from Turkey and other parts of Syria to areas with limited medical coverage or a dwindling number of specialists.
Since 2014, SAMS has successfully utilized telemedicine in cardiology and critical care. Telemedicine has proven to be a potentially life-saving tool in the Syrian civil war, where cardiologists and other subspecialists are scarce. In the tele-cardiology initiative, cardiologists from the United States cover different hospitals in Syria. Electrocardiograms (ECGs) from admitted cardiac patients and new consults are reviewed by on-call cardiologists. Additionally, ST-segment elevation myocardial infarction ECGs are confirmed by cardiologists before administering streptokinase, the only available reperfusion method. The team also confirms the success or failure of streptokinase administration and manages complications like cardiogenic shock, arrhythmias, and mechanical and valvular issues.
Despite extremely limited resources, the telemedicine program has been remarkably successful. U.S.-based cardiologists play a crucial role in evaluating cardiac admissions, including those in intensive care units. Onsite medical personnel—comprising medical students, doctors, nurses, and physician assistants—present cases to U.S.-based specialists, discussing ECGs, echocardiograms, and chest x-rays, while considering limited resources and ancillary tests. Physical examination remains critical in managing most cases. All participating U.S. cardiologists are volunteers, demonstrating a profound commitment to saving lives.
Utilizing low-cost, widely available services like social media platforms and communication applications in medicine during disaster and war has led to life-saving initiatives such as tele-cardiology. Through these efforts, SAMS has significantly improved healthcare access and outcomes for patients in Syria amidst the ongoing conflict.
