June 30, 2008
The Florence Nightingales of the Internet
By Terri Judd
From the study of their Kent home, a British couple are saving lives by putting the sick and injured from war zones in touch with expert medical opinion. By Terri Judd
Medicine without frontiers
At his wits' end, the doctor in Baghdad dispatched his plea for help - an email detailing a patient with a particularly difficult case of uterine cancer. More than two thousand miles away, in the study of her Kent home, Pat Swinfen swiftly forwarded the request on to a British specialist.
The man who received that email, Dr Philip Savage, replied: "Don't give up on this woman. Her life can be saved." And that, with the help of continued advice from the eminent oncologist from Imperial College, is exactly what the Iraqi doctor did.
Every day a small charity set up by Lord and Lady Swinfen uses email and digital photography to put patients from some of the most deprived and war-torn regions of the world in touch with globally renowned surgeons and consultants. Last year alone the charity, which was established in 1998 and is funded almost entirely by the couple, helped more than 400 people.
From their home near Canterbury, Lord and Lady Swinfen spend almost every waking hour monitoring three computer screens. The moment an email comes in from a doctor explaining symptoms with photographs and X-rays, they forward it on to a specialist in that field - every one of whom, like the Swinfens, gives their time for free.
"It is like being a sister in charge of a ward that never runs out of beds, never turns a patient away and has no political master," explains Lady Swinfen, 70, a former nurse with the Queen Alexandra's Royal Army Nursing Corps.
She goes on to list some of the hundreds of people the charity has helped, including the man brought into a Basra hospital with a bullet wound to the abdomen. His details were emailed to doctors in London, Johannesburg, Birmingham and Brisbane.
"All four came back and said this is a dead man, but they kept working on it," says Lord Swinfen. "All four emailed every day, sometimes more often. Eventually the Iraqi doctor saved him and he went home. He had necrotising fasciitis, and they still saved him." The Swinfen Charitable Trust does not officially deal with emergencies, but no one is turned away.
The way in which the charity works is simple. The Swinfens take normal digital cameras - bought from high-street shops for no more than 200 - and train medics in war-torn countries how to download the images they take and email them to the charity's headquarters. Requests for help are then forwarded on to volunteer specialists who either email their advice back, or, in urgent cases, call the medic. Hospitals too poor to afford complicated video links have sudden access to a wealth of expertise. Thanks to the Swinfens' work, just under 140 hospitals in regions as far flung as Laos and Lithuania are now being aided by 382 eminent experts from the UK, US, Australia, Canada and New Zealand.
"It's cheap and it is so simple that it works," said Lord Swinfen. "With the advent of computer technology and email, it has become easier with time. It just seems so stupid not to do it."
In their study, sofas and medical journals jostle for space with countless photographs of their children and grandchildren - and a snap of an Iraqi girl with captivating brown eyes. "Isn't she gorgeous?" Lady Swinfen exclaims proudly. Her delight is understandable. Without the charity, six-year-old Ayah would not be alive today - and neither would her two-year-old sister, Fatima.
Nor, for that matter, would the nine-year-old girl from Al Hillah with renal failure who was brought into an US army field hospital under fire, the 18-year-old mother from Baghdad who almost lost her first baby due to pre-eclampsia, the young man from Bangladesh whose leg was saved after a road accident, the four-year-old boy brought into a Fallujah hospital with thallium poisoning, or the 15-year- old carried for three weeks down from the Nepalese mountains to Kathmandu suffering from juvenile rheumatoid arthritis.
To keep every diagnosis impartial, and for reasons of medical confidentiality, the Swinfens rarely know the names of those they are helping. But the Iraqi doctors they deal with are particularly generous in their gratitude. They never forget to send Christmas cards, and inundated the couple with worried emails on the day of the London bombings. Ayah's parents were so thankful they emailed them in person. The young couple from Basra had struggled to conceive and, in a nation with so many more urgent medical problems, fertility treatment is not a priority. With the help of a consultant in Cardiff, they now have two little girls and continue to send over pictures of Ayah as she grows up.
The pair speak with unabashed admiration for the doctors on the other end of the emails, such as the British medic working out of the back of a car in the Hindu Kush mountains of Afghanistan and the French consultant in Antarctica. But they reserved particular praise for the Iraqis who persist in peril. So far two of their network in the country have been murdered.
Lord Swinfen, a former Army officer who spent many years with the John Grooms Association for the Disabled, was working in Bangladesh at the Centre for the Rehabilitation of the Paralysed in 1998 when he met Lt-Col David Vassallo on a trip home. The Army surgeon had thought up the idea of transmitting images back from Bosnia to Surgeon Commander Peter Buxton at the (since closed) Royal Haslar military hospital in Portsmouth. Lord Swinfen took the idea on board in Dhaka and, within a year, two other hospitals - in Nepal and the Solomon Islands - had embraced telemedicine.
Having never used a computer before, the couple bought one for their 36th wedding anniversary. With 120 - 20 from each of them and their four adult children - they set up the charity. Their reputation has spread by word of mouth, and they receive daily offers of help from doctors or pleas for aid from hospitals. Their work often mirrors the trouble spots of the day. Current requests come from Zimbabwe, Burma and the earthquake-hit region of south- western China.
The couple, who work with the help of part-time office researcher Sharon Checksfield, have taken just one week's holiday in the past decade. Looking out at her overgrown garden, Lady Swinfen said that they have no time to tend to their roses. She gave her last dinner party the night seven requests came in for help hours before her guests arrived. The dining room is now covered in paperwork.
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