What is the current situation in Afghanistan? Are you able to carry out your work with your colleagues there at all?
Mosafer: There is an incredible dynamic in Afghanistan at the moment. The situation is changing on a daily basis. When the Taliban took power, we stopped our telemedicine activities for the time being – also to protect our employees. We have since been able to get the local staff who were in danger because they had expressed criticism of the Taliban out of Afghanistan. Of course, we miss them: as telemedicine assistants, which we had trained them to be in previous years, they are the link to the doctors and clinics. Some of our helpers were able to stay. They are now working in our telemedicine centers again. What restrictions are still in place?
Mosafer: Before the change of power, we had twelve telemedicine centers throughout Afghanistan. At the moment, four of them are back in operation. Most of the equipment – laptops, image scanners for X-rays and MRI scans – disappeared during the war. With the appropriate financial resources, this could be rectified quite quickly. What cannot be replaced are the specialists who had to flee abroad. We are currently considering how we can replace the expensive infrastructure of telemedicine centers with an app. The concept is there, but implementing it is expensive. As long as international funding for Afghanistan is frozen, we can’t do anything here for the time being.
How does telemedical treatment work?
Mosafer: When we started our work in Afghanistan, we were still making live diagnoses. Doctors in England, Sweden and Germany examined patients in Afghanistan via video link. We quickly realized: This is not feasible for organizational reasons. Today, the actual examination takes place at our colleagues’ homes in Afghanistan. Helpers specially trained by us at the telemedicine center feed the documents into the system, where our specialists can analyze the data and recommend treatment. We cover the entire medical spectrum: from internists to ENT specialists, dermatologists and gynecologists. Does this mean that the doctors never see their patients in person?
Mosafer: Of course, there are also cases where the colleague consulted wants to get a personal impression. At such an appointment, we then work with at least three cameras: the patient sits in front of one, the doctor in front of the second and X-ray or MRI images are visible via the third camera. However, this approach is the exception rather than the rule . In your experience, how promising is telemedical treatment?
Mosafer: We have been active in Afghanistan for more than ten years. According to our statistics, we have been able to treat around 90 percent of our patients successfully thanks to telemedicine.
What technical challenges are you facing – is there stable internet in Afghanistan?
Mosafer: There’s no question that a stable Internet connection is a challenge. Until 2010, we worked from Internet cafés in Afghanistan. In the meantime, together with the Erfurt-based company TecArt, we have developed software that works wonderfully for data exchange and, above all, protects patient data from unauthorized access. The current rulers in Kabul have asked our coordinators to continue the telemedicine project at all costs. Technically, however, we currently have major problems with the Internet: We are therefore unable to operate our telemedicine centers in remote areas. And many of our patients from remote areas cannot come to Kabul at the moment.
But that also means that if you want to continue helping people, you have to work with the Taliban?
Mosafer: Let me put it this way: telemedicine transcends borders – religious, ethnic, economic. If our network is better known among the population, we can help the people in Afghanistan directly – without having to go through politicians. However, this requires capital for public relations work to explain to the population how useful telemedicine can be.
To what extent does the experience gained from your telemedicine work in Afghanistan help you in your day-to-day work at Zentralklinik Bad Berka/Weimar?
Mosafer: In times of the pandemic, telemedicine is also an issue here in Germany. When people think of telemedicine here, they usually think of the patient-doctor relationship. In my opinion, however, this is unsuitable for a quick introduction to the topic: such a relationship requires trust and trust takes time. That’s why we should start with teleconsultation, which means that doctors exchange information about patients using data and images. Does telemedicine currently have a different status than before the coronavirus pandemic began?
Mosafer : In this country, there were already political efforts to promote telemedicine shortly before the coronavirus pandemic began. However, the term telemedicine was defined very broadly – for me, an electronic health card has nothing to do with telemedicine. I miss a strategy for how telemedicine could be incorporated into everyday medical practice and people’s everyday lives. What would your strategy look like?
Mosafer: If you were to stand in front of a supermarket today and ask people what telemedicine is – I bet that 70 percent would not be able to answer the question. People in Germany know just as little about telemedicine as people in Afghanistan. So the first thing we need is a major awareness campaign on the subject of telemedicine. A second step: we need to create the infrastructure to be able to provide telemedicine everywhere. In Afghanistan – due to the military situation – there is broad mobile phone coverage. This is not the case here in many areas. And thirdly, doctors would have to invest massively in their practices to make telemedicine technically possible: We need a government funding program for telemedicine – similar to the one we have for electric cars.
In view of the ageing population and the future of rural areas, what role does telemedicine play?
Mosafer: I see great opportunities for rural areas. I can imagine setting up telemedicine centers in areas with dwindling and aging populations. These would be staffed by specially trained telemedicine nurses who have a personal connection to people. Doctors in clinics and specialist practices can use state-of-the-art technology to make decisions based on the transmitted data. This would at least ensure basic care.
About the person:
Dr. Azim Mosafer (born in 1962) fled Afghanistan in 1980 after the invasion of the Soviet Union. He studied medicine in Bonn. Today, the spinal surgeon works as a senior physician at Zentralklinik Bad Berka near Weimar. There he also founded the Afghan-German Medical Association Weimar (ADAV), which is working to develop the healthcare system in Afghanistan.
