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The Catalyst

Google Glass gives new perspective


By Dawn Brazell
Public Relations

Dr. Joseph Sakran is a Google Glass explorer, testing out the potential of this new technology to improve surgical care and medical training at home and abroad. photo by Sarah Pack, Public Relations

Joseph Sakran, M.D., slips on the glasses and taps the side to turn them on. “Take photo,” he commands, pauses and then hands his $1,500 glasses to a friend to see the photo he just took. After adjusting the view, the friend smiles at the image of himself. “Wow,” he says, as they both grin like boys with a new toy.

The ‘wow’ factor is what has people volunteering to become “explorers” from stay–at–home moms to physicians, such as Sakran, who handles general and acute care surgery at MUSC. He became a beta tester for Google Glass Explorer Program in December 2013 and is one of more than 8,000 ‘explorers’ involved in helping shape the future of how Google Glass evolves.

Sakran, who likes to be on the cutting edge of technology, said it fits into Inspiring Quality Campaign led by the American College of Surgeons to improve the quality of surgical care for patients in the nation. “All of a sudden we have this new technology, and I said to myself, ‘how can this technology be used to care for the surgical patient?’”

It turns out quite a bit he’s finding, particularly given his goal of figuring out how to reach resource–poor areas both in America as well as internationally, one of Sakran’s key interests and one reason he was recruited to MUSC from the University of Pennsylvania. His main non–clinical role is to head the global health initiative for the Department of Surgery, a cause dear to his heart.

Explaining why he details how the global burden of surgical disease continues to rise, and remains one of the top killers in low–and middle–income countries, even though communicable diseases still receive more focus. “It’s the red–headed stepchild of public health,” he said, quoting Harvard expert Paul Farmer, M.D. Only 3.5 percent of 234 million major surgical procedures performed in 2004 took place in the countries representing the poorest 35 percentile of nations.

Beyond that, there are areas in the United States that could benefit from the same focus. “You can go to places that are so rural and have such few resources that they are like low–income countries. Those patients could also benefit from this technology.”

MUSC has been a leader in the telemedicine field in reaching resource–poor areas. “In this financially difficult time we’re living in, we’re trying to be cognizant of the resources we’re using. If I don’t have to subject a patient to another procedure, cost of anesthesia and risk of complication, that’s a good thing.”

The technology could save surgeons time and ensure they maintain focus on a patient during a procedure since a CT image or a patient’s record could be accessed by voice command without them having to step away from the patient, he said.

Medical education
Medical education is another definite area of potential gain. “As we talk about the training of the next generation, you really have to pack in a lot of information and procedures in a compact period of time. One way that I envision using this is to have your student or resident wearing this glass. I can physically see where they are having a problem. The flip side of this, if I’m wearing these glasses, they can see what I’m seeing, versus standing in an operating room struggling to peek through a small opening around other people.”

As a training tool, it offers real tissue planes and a way to view and/or record ongoing medical scenarios that provide invaluable case studies for medical students and residents to use. Sakran, whose specialty area is traumatology and surgical critical care, gives the example of using the glasses to record resuscitations in an emergency settings so colleagues could later sit back and assess care, figuring out ways to improve the quality of treatment. The recordings also could be used as case studies to train future emergency care professionals.

“That is going to play a role as this comes out of beta–testing. It’s not yet the end–all, be–all. There are a number of factors that have to be considered.”
Mapping out the legalities of the new technology to protect patients’ privacy issues will be one challenge that will have to be resolved. The other challenge is fine tuning the technology, resolving such issues as the linkage of signals and strength of connectivity between users, especially if it’s being used in rural, resource–poor settings, domestically and internationally. Sakran said the challenges are worth finding solutions, though, especially given the positive impact this technology could have in strengthening the way global health initiatives are evolving.

During surgical residency, Sakran became frustrated with how colleagues often addressed surgical care within resource–poor areas in the world by flying into a country, operating for two weeks and then leaving.

“One cannot question the good–hearted intention of these individuals, who often spent personal time and money to participate in these missions.  I was one of them, and have had the privilege to render services in Haiti, Africa, India and the Middle East.”

Dr. Joseph Sakran (pictured center) teaches a resident in Kenya at Tenwek Hospital how to repair a trauma injury.

Global impact
Sakran began questioning the feasibility of such short–term interventions, though, and thought a better solution would be to work within a community to implement long–term interventions that would be sustainable long after the healthcare workers leave a given area. During residency he established a non–profit, non–governmental organization, Surgeons for Global Health, targeted at narrowing the inequities of care in addressing the surgical burden of disease within low and middle–income countries. The group’s first mission was in 2007, at a local hospital in Embangweni, Malawi. Malawi is a small land–locked country in Africa that ranks among the poorest in the world, with two physicians for every 100,000 people.

Rather than relying on physicians for health care delivery, clinical officers form the backbone of the health care system, he said. Their training consists of a three-year course at a post–secondary school, followed by a lifetime of learning through direct patient care. While in Malawi, surgeons in the program taught clinical officers how to perform basic procedures, such as split–thickness skin grafts and abdominal hernia repairs during a two–month period. Five years later, those surgeons are gone, but the clinical officers continue to provide care for patients in their community, he said.

It’s important to integrate the community into what is being done, and even better, integrate technology to continue the training, he said. “They can put these glasses on, and they can be 4,000 miles away and they are transmitting in real time what’s going on with a patient, and I can say to them ‘here’s what they probably may need to do.’ If you think of the need globally, it is tremendous. There simply are not enough surgeons to go around. We have to start thinking of innovative ways via telehealth, Google Glass and other mobile technologies in order to allow access of care to be provided for millions of people.”

There are two main reasons Sakran feels so strongly about this — one is professional and the other is more personal. Professionally, Sakran doesn’t want patients dying from treatable causes, such as blunt splenic trauma that could be experienced during a car crash. Road traffic injuries rank in the top 10 leading causes of death and disability worldwide. By 2020 it is predicted to be the No. 2 leading cause of death and disability.

“In the U.S. today, no one should die from a splenic injury,” he said, describing an injury that would be hard to treat in some countries, such as Rwanda where clinical officers might not know what to do. “They could put this on,” he said holding up his Google Glass, “and I could literally walk them step–by–step through the procedure. Now that the technology is available, let’s test it, and see if we can make a difference in the standard of care.”

Second chance

His personal driving motivation is that Sakran feels he was given a second chance in life to do just this kind of work.

When Sakran was 17, he was shot in the throat after a high school football game. “A guy pulled out a gun and starting firing shots into the crowd, and I got hit by a random bullet in the neck. Clearly, I’m very thankful to be alive.”

Sakran, who was wearing all white that night, looked down to see his shirt covered in blood. The bleeding was so bad he could not be laid flat to be transported via helicopter because he would choke. An ambulance was called instead. Sakran, who intermittently smoked at the time, remembers attempting to remove cigarettes from his pocket, worried that his parents would discover this bad habit. He remembers feeling outside of his body as he was being transported observing the conversations of the medical professionals who were trying to save him.

Sakran would end up with a paralyzed left vocal cord and have to be home–schooled the majority of his senior year of high school. More than that, though, he wound up with an infused passion for making a difference on a global scale.

“It was one of those experiences that changes your life in an 180–degree fashion. I realized, ‘Man, you’ve been given a second chance, and you better put it to some good use.’”

Part of that good use is keeping his eyes open for the next way to significantly impact public health, he said.

“Part of our responsibility as clinicians is to think outside the box. This is one of those opportunities where we can wait for others to do it or we can be leaders in the field. There’s tremendous opportunity here at MUSC, which is why I came down here because I felt that delta is large. I felt I could make a difference in an interdisciplinary way to care for surgical patients both domestically and abroad.”

To view a video and for more information on Google Glass, visit http://www.musc.edu/pr/newscenter/2014/googleglass.html.

March 31, 2014
 
 
 

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