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ST. PAUL, Minn. (AP) — For more than a decade, St. Paul orthopedic surgeon Peter Cole has led medical teams to tropical Peru, where they've performed life-changing surgery on disfigured people living on the margins of society.
The medical workers had become hampered, though, because of inadequate and outdated technology that kept them from executing their charitable duties with maximum efficiency.
Enter the technology geeks.
This is the story of how a team of Minnesota tech gurus got Dr. Cole and his workers tricked out with iPads and other tools in a remote and primitive part of the Americas, boosting their ability to do good.
More broadly, this also is a tale of how two peoples — one led by Cole from a frozen land far to the north, and another on the edge of the Amazon jungle — came together to work miracles on people with all manner of physical deformities.
Since 1998, Cole, who heads the orthopedics department at Regions Hospital in St. Paul, has been traveling to the eastern Peru city of Pucallpa on the banks of the Ucayali River, a major tributary of the Amazon River. That's when a friend showed him and his wife, Nancy, the steamy region and its needy inhabitants.
Many of Cole's patients are of the "trauma" variety — often after surviving accidents on muddy, slick roads while driving or riding in "mototaxis" composed of scooters or motorcycles with flimsy car-like enclosures.
His patients have included an 8-year-old boy suffering from a horrific sickness called tuberculosis of the knee, causing his right leg to twist at roughly a 90-degree angle.
Many of the crippled Peruvians live in remote Amazonian villages reachable only via days-long boat journeys.
"Needless to say, in a place like the Amazon with thousands of patients like that, there are no orthopedists down there," Cole told the St. Paul Pioneer Press (http://bit.ly/1mE40FK ).
What's more, children with congenital deformities are sometimes seen as possessed by evil spirits and murdered unless somehow rescued and raised elsewhere, such as by missionaries, he added.
One patient, a teenage girl who had lost her leg to a snake bite, was shunned by her villagers and was staked to a post, even though she had a child.
Cole, with a growing zeal to help the people, has built a medical campus over the years near Pucallpa to evaluate patients, store medical supplies and house the medical team members he pulls together from around the United States.
Cole's team members do the surgeries at Hospital Amazonico in Pucallpa, alongside Peruvian medical workers.
But the system for keeping track of patients during initial exams, while undergoing surgery and in the weeks and months afterward was an ungodly mess.
Much of this critical information was recorded with pen and paper, often with difficult-to-decipher handwriting. There were scads of digital photos — of injuries, of X-rays, even of those handwritten records — but haphazard procedures for keeping them organized and accessible when needed the most.
"There was much loss of information," said Rosa Escudero, a Peru physician on Cole's team. "X-rays would go missing."
This was bad enough in Peru, but the problem became far worse when Cole and others needed to access medical records from the United States. This, for a doctor accustomed to ultramodern technology in an efficient, data-rich line of work, qualified as a catastrophe.
Then Cole found a computer nerd.
Lori Most, a Minneapolis-based business analyst with a technical bent, happens to be the sister of a Regions physician's assistant who has traveled with Cole to Peru.
"She roped me in," Most said of her sister, Tina.
Most and a collaborator, Cam Gross of the Minneapolis software developer Lift, faced a big challenge: creating a state-of-the-art electronic medical record (EMR) system in a jungle that is hot, humid and decidedly tech-unfriendly, and where online access is spotty at best.
Gross and his Lift development team hit on the solution: To heck with the Internet.
"It had to work offline" with little or no online connectivity, Gross said.
Most and Gross set out to build a "peer-to-peer" network. That's geek-speak for a network in which the iPads would communicate with each other directly — literally from one tablet to another — which is a bit unorthodox. Usually, data sharing of this nature is coordinated via centralized server devices.
In other words, dozens of iPads in the hands of the Peru medical workers would be able to exchange records, X-rays, pictures and more in relative eye winks, using Wi-Fi signals, so everyone could have every scrap of medical data on his or her tablet at any time.
And whenever Internet access was available, the data would get pushed to the "Google cloud" so it would be available elsewhere — such as in St. Paul — said Gross, whose agency specializes in Google-centric projects.
This all sounded wicked cool in theory, but would it really work?
Cole, who calls his nonprofit surgery project Scalpel at the Cross, in a nod to its deeply religious underpinnings, now acknowledges he had to take a leap of faith of sorts with all the weird iPad stuff.
"I thought, 'These software nerds, they have no idea what it's like to go into a jungle hospital with hundreds of clamoring patients in a chaotic environment,' " he said.
Cole was fearful that "this whole thing," the new software system, "was going to slow us down."
Most had similar misgivings.
"Our main goal was to not be slower than paper," Most said of the new system, called CrossCare. "We didn't want to do this if it couldn't be fast."
But she said she "was really nervous" about data going back and forth between iPads via the peer-to-peer networking system. "I worried it would be slow."
Gross was also sweating, and not just because of the humidity.
"I was definitely on edge more than once during the build and again on the morning of clinic day," Gross said. "I've got a great picture of my developer, Peter Schwarz, with fingers crossed as we were setting up in the clinic."
That "clinic day" occurred in November, during the iPad system's shakedown cruise at Hospital Amazonico.
Prospective patients, many of whom had journeyed from remote reaches of the Amazon basin, were quickly shuttled from station to station as they were evaluated for possible surgeries.
Every step of the way, medical workers used iPads with add-on keyboards for typing patient information into a Lift-developed CrossCare app. With a yank, they could remove the iPads from the keyboards to use the tablets as digital cameras, creating a detailed visual record of each patient.
None of this is exactly new. Cole's clinic had been using iPads for a while, though far more awkwardly.
What happened after all of the tap-tap-tapping and picture taking was the shiny-new part.
Information entered into one iPad showed up, within seconds, on all other iPads and got consolidated into a proper medical database that was replicated on every tablet — no fancy servers or broadband connectivity required.
The peer-to-peer network worked.
Most remembers nervously eyeing the Wi-Fi router that gave the iPads their ability to interact with each other.
"There was no air conditioning, and I watched the router to make sure it wouldn't overheat," she said. "It ended up being fine."
Gross, meanwhile, monitored everything via laptops, which would serve as backup devices if the iPads somehow choked. They didn't.
Once would-be patients had been examined and evaluated, Cole's medical staff gathered to confer about which of them were the best candidates for surgery.
With an iPad hooked up to a projector, any patient photograph or X-ray was just a few taps away.
"It saves a lot of time," Cole said. "All we do is log on and look up a name. Everything is there for surgical planning."
Then came the surgery at the Pucallpa hospital — where Cole had long insisted that U.S. and Peruvian medical workers work side by side in order to learn from each other.
Again, iPads were everywhere — one beside every operating table for surgeons to pull up patient particulars in seconds.
Cole said the iPad system also helped resolve one of the biggest flaws in his medical ministry — the fact that patients sometimes disappeared after the surgeries, returning to their often-remote homes.
"I felt hypocritical ... leaving and never knowing how my patients did," he said. "If I operate on a patient, following up is important. If I can't prove what I'm doing is working, I have no business doing it."
Escudero, the Peruvian doctor, has the job of monitoring patient progress after surgeries, but she had been hampered by inadequate record keeping.
She had long resorted to awkward procedures, such as organizing patient photographs, records and other pieces of information as a PowerPoint deck.
The new CrossCare system — named for the doctors who cross borders for medical care — changed everything, she said.
"I can tap a link for the patient and see all the follow-up stages," at two weeks, six weeks, six months and one year, Escudero said. "No more PowerPoint."
Escudero said she is inspired every day by the profound impact she and her fellow Scalpel at the Cross workers are having on those who otherwise would be hopeless.
"They come to us lost and leave us renewed," Escudero said. "It is a privilege to help such people a bit."
Cole literally cackles as he describes examples of how his ministry has made a difference — in large part with the help of wife Nancy and daughter Danielle, who are active participants.
That boy with the leg bent at a 90-degree angle?
"I saw him in his village, and he was riding a bicycle and playing soccer, running around with the other kids," he said. "It was truly amazing."
That teenage girl with the amputated leg, staked to a post with a kid to raise?
After she'd journeyed a great distance to Pucallpa with her baby hanging on her back, helped by missionaries, Cole measured her for a prosthesis, with an assist from Danielle. The doctor had that extension manufactured in the States and had it brought down on a subsequent trip.
"When we fitted this girl with the prosthesis and she took her first steps, she started to cry," Cole recalled. "I think everyone started to cry."
Now she is married and "living a productive life," he said.
Cole, now a believer in the peer-to-peer network Gross and Most pioneered, said he has a vision.
"Let's think big here," he said. "This little product for our mission trip could become the whole medical record for the orthopedics department" at the Pucallpa hospital, and even for all of its other departments, he speculated.
Some doctors there have been hungrily eyeing the technology, he said.
"We could duplicate this in mission programs that go to Africa, or to India," with data from all these locales readily pooled to create medical knowledge that helps all such teams, he added.
"You could have a global network of mission hospitals," all with the simple yet robust networking, he said. "Imagine what could happen with all that medical information."
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Information from: St. Paul Pioneer Press, http://www.twincities.com
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