 First of all, thank you for the opportunity which is given to To meet and to to the telemedicine to to present this project today And thank you for the organizer. I don't know about you, but It's a long two days and I'm a little bit nervous, but I'm very excited to have this opportunity today What I'm going to present to you it's it's about one of the project we have And we're supporting at MSF Canada MSF Canada is involved in scaling up telemedicine in MSF works with the five operational centers And is also the coordination platform for the store and forward telemedicine that Those who are involved in a medical work at MSF already know I'm presenting a pilot project that we have implemented in collaboration with with a CB In Timer gala Pakistan for the management of neurological emergencies Providing distance support using smart phones for smartphone based technology I'm presenting on be on behalf of my colleagues that you can see here on the screen The project place in Timer gala, it's it's in lower-deer district in Pakistan MSF works in Pakistan since 1986 in different operational context that include natural and my main disaster and also to increase access to healthcare For a population where that access to healthcare is very limited You can see here in the map that in Morgana is located in the north west of Pakistan in the fadda area of Pakistan the management of neurological emergency present challenges to Humanitarian medicine Field a worker often lack access to expertise in managing neuro critical care And the district hospital district district headquarters hospital of of Timer gala has access to computed tomography imagery From the private sector. However It has limited access to critical care expertise and access to specialist expertise in that domain This in order to guide an emergency Doctor in their investigation and management of the case that are presented into the emergency department The challenges in that project included also are difficulties to complies with MSF clinical with MSF guidelines to those guidelines have been developed in in Kunduz by by OCB They are also significant mean city mist city scan findings There are challenges also around the cost due to the initial number of prescribed city scans that may not be necessary and Also and probably more importantly. There is a real challenge for the patient that While they wait for having the city scan to be performed They also wait to to be managed and we can imagine that for someone presenting a poly trauma It may be an issue Sorry What we try to achieve here in our small pilot It's to provide better support to the medical officer in the emergency room to increase adherence to our guidelines if possible To reduce minimize the number of means mist findings in city scans and also Ready to improve the management of the patient at the real time in the ICU So what we did it's quite simple We've introduced a technology using a smartphone Connected to 3g because it's available there We've uploaded data dedicated secured telemedicine telemedicine applications I can't tell you more about this application if you want It's not so much about the applications about the secured telemedical environment To be used by the emergency room doctors Remote 24-hour support was provided by four consultants based Mainly in North America in North America in that case, but it could be very different The expertise that was made available was in critical care in neurosurgery in Traumatology and in emergency medicine All neurological emergencies Considered for a CT scan were eligible for having a telemedicine consultation and we've collected data from December 2017 to February 2018 We use the descriptive Analyzes to assess the impact of our intervention Mostly for proof-of-concept. We also used an operational perspective to assess the improvement to patient care And this project received the the necessary ethical clearance So during the the pilot period they've been 155 consultation that were performed 16 of them did not advise a CT scan out of the 140 remaining 53% were for traumatic brain injuries 34% for suspected stroke and here I would like to mention that in Timur Gara Advanced management of stroke. So Trombolysis is not available and 40% were for altered mental health status Management advice were given before the CT scan and Also after the CT scan but also before and after the CT scan. So it's a full consultation The meantime first Response time is a minute and 52 seconds. So the experts was fully aware fully available We also surveyed the users to understand The benefit or assess the benefit of the intervention and we found out that The doctor felt better supported after the consultation after receiving an advice from experts from somewhere else That the consultation led to significant change in the management of the emergencies That often and it's an important element that their advice were new to them So it's a matter of of a transfer of knowledge and That they were notified of misfinding in the in the CT scan at early earlier time So this Rather small Pilot suggests that real-time telemedicine consultation with distant expert is possible Probably in most of our operational context. We may have to figure The connection to the network Also that such intervention like in term of managing neurological emergencies improve adherence to clinical guidelines Reducing also unnecessary scan. We'd like to mention that throughout this pilot project the number of CT scans Performing to Margarha was reduced by three And that MSF paste systematically for all of these scans And that this intervention positively influence the management of the patient Also would like to point it out because we think it's extremely important and and telemedicine is a lot about that Is that the medical officers the users fell better supported and learn from that intervention? For sure this was a pilot's not a research as I've already said it improve management We recommend to perform More studies with larger sample size to continue exploring additional useful usefulness and benefit of such Intervention There are several Work that have been done are being done to assess the performance and the model in in telemedicine in general beyond the one I've I'm presenting I should mention that Ocb in the light of this this result are willing to continue the initiative and is asking us to work on the model to Sustain the interventions and we have some idea for that This is one of a small of the elements that documents how much telemedicine Is Transformational and how much is going to impact the way we work in the year to comes for various reasons that have been already presented during these past two days I would like to see the opportunity here To also mention that if we want to have access, I think there have been many Solution presented over the past two days research work innovation many of them are connected There is a little connection into Available in our medical facilities So if you guys want to have access to new technologies and telemedicine I think we should agree to lobby our operational centers and the IT and whoever we need to To increase bandwidth availability in medical facilities because our colleagues of the patients and all of us deserve having better connectivity to better perform in the field I Would like to thanks all the contributor to this project Firstly with thank you to the OCB Timur Gara project team in Pakistan and the coordination It was not a done deal to test that in Timur Gara in such a sensitive context what it worked I would like to thank those who have provided their expertise into the project our Colleagues at MSF Canada who implemented it and the OCB team was been fully supportive of this initiative. Thank you