Friedrich Schiller Denkmal
Friedrich Schiller

Schiller-Institut e. V.
"Zweck der Menschheit ist kein anderer als die
Ausbildung der Kräfte des Menschen, Fortschreitung."
Friedrich Schiller

     Konferenz in Flörsheim, November 2012   

Dr. med. Antonio Güell
Space Medicine Specialist, Toulouse, France

Written Submission

Satellites are good for your health

I would first like to thank the organizers of the Schiller Institute for inviting me to speak on this theme, which I consider fascinating and interesting.

I was a medical doctor for 15 years. I worked at the Toulouse Medical Faculty in the Neuropsychiatry department. After 15 years, I completely changed my life, because I became an assistant director of the CNES [French National Space Studies Center] in charge of Space Applications, Societal Applications, Patents, Technology Transfers, etc.

I stopped working in that position on July 1, 2012, and am now retired. But I continue to defend the advantages that satellites can bring to citizens globally.

The theme of your conference is ``A new paradigm for the survival of civilization.'' Paradigm is a word which, in French, can correspond to a set of ideas, which often allows us to come up with an original idea, and I insist on the original word. As we shall see, it is obligatory to carry through on these ideas and to innovate. The word innovation has guided me throughout my career as a doctor or at the CNES, and you will understand why.

The ideas may be technological, methodological, humanitarian, or humanist. But in all cases, they are the product of basic scientific research, as [the previous speaker] Didier Schmitt mentioned, for space exploration in the broad sense of the term. And this scientific research leads systematically, or 95% of the time, to applied research, which contributes to the well-being of the population of a given country, continent, or all of mankind.

My presentation is divided in four parts.

Why should we innovate in the area that I call ``health and satellites''? I will give you two concrete examples. One on the environment, and one which concerns 7.5% of the people in this room, and I'll tell you why a bit later. Then, I will give some conclusions and recommendations on innovation.

Although I'm retired, I am a consultant with the Institute of Space Medicine of Toulouse, which was created when the European Space Agency, the CNES, and the DLR [German Aerospace Center] decided to participate in the Hermes space shuttle project, which was then dropped for political reasons.

The medical world is also changing

I think it's important that a world is changing. I'm not referring to the conflicts that were brought up in the preceding interventions, but from what I see, as a simple doctor serving the population, whatever the country, the continent, or the language may be, the world is changing in the medical domain, because the populations are aging, be it in Europe, in America, or in the Middle East. What is the immediate consequence on public health? Chronic diseases which used to affect only a few, will see their incidence triple, if not quadruple.

For example, a recent study given to the Health Ministry found that if the government of France--but it holds for all the governments in the world--did nothing to fight obesity, 25% of the population will be obese in less than 30 years. Obesity means many chronic diseases, including diabetes. Already now, 7% of the French people are diabetic; 6.2% of the Germans; 5% of the Chinese--if you multiply 5% by 1.3 billion, that's a lot of people. So, the aging of the population is a factor of change.

Another factor in new social practices is everything that has to do ``tele,'' such as tele-work, and domotics. That means sitting at home in an armchair and simply pressing a key on the computer and everything is done automatically. I don't do anything anymore, I just take my siesta, eat, so I become sedentary, which is the second relatively important factor of change.

Unfortunately, because of the crisis in Europe--in southern Europe, in particular--we have less and less money. So we need what I call pragmatic and practical approaches.

We also have technical and scientific developments in information and communication technologies, be it through land-based networks or satellite networks, such as nanotechnologies or bio-captors and bio-sensors. This will lead to the emergence of new services, new trades, new jobs. And medically speaking, in France, Spain, Italy, and a number of other European countries--I don't know about Germany--we have a ``demedicalization,'' that is, fewer and fewer doctors and nurses, which will be problematic. So it is absolutely necessary to include deliberations on public health among these changes, and you will see what space can contribute to that.

In terms of new technologies, which are being developed and yield ever more positive results, you have robotics, tele-surgery, and medical imaging. When I was getting my neurosurgery degree in 1970-71, if I had a patient who was hemiplegic, and who had had a stroke, I had no X-scanner, no MRI. How was I supposed to make a diagnosis? It was a bit like being a veterinarian.

So, today, technologies are evolving; information and communications technologies as well. And all this opens perspectives for consultations in remote locations, in personalizing medical treatments, in coaching a patient and in monitoring his health from his home without having to be there.

What does that mean? Essentially, in 5 to 6, or 10 years, for at least those health-care professionals who are interested in new ICTs [information and communication technologies] and transmissions, either land-based or by satellite, the patient will go less frequently to the hospital; instead, the hospital will come to him. Because he [the health-care professional] will have a certain number of captors [data connectivity software] and tools, a whole range of technological systems for monitoring and making diagnostics.

I now come to satellites. Satellites are like rockets, we have to admit it, and face the fact. Satellites, just like rockets, usually meet military needs at the outset. Fortunately, there are people in the space agencies, be it in the United States, Russia, Europe, France, and the German DLR, who are relatively humanist, and who try and find civil applications for the first uses of satellites. I remember the satcoms; the first telecommunications satellite was called ``Asterix.'' This satellite had been constructed secretly, on General de Gaulle's orders, simply because a military man had explained to de Gaulle that this satellite would enable France to listen to and transmit information very, very quickly, whereas we were still in the era of Morse code--that was in 1966-67. That satellite foreshadowed the Telecom 1A, Telecom 1B, etc.

Who developed positioning and navigation satellites (GPS)? The Americans and the Defense Department for the first Gulf War. That was the first time a certain number of global positioning systems came onto the market. Today, the GPS market is enormous, and the Galileo market will soon be.

The latest model, the Earth observation satellite--which was built at the request of the military so that different armies could spy on each other--is used in various fields today, such as agriculture, energy--we saw it this morning in the detection of aquifers in the desert--and tele-epidemiology. I'll give you some examples.

Today, most satellites are built for civilian use, be it observation, localization, or telecommunications. The annual market for services using civilian satellites, outside of the military, is EU100 billion per year, broken down as follows: 75% for telecommunication services, so EU75 billion euros, of which 90% is for TV platforms (CanalSat, Astra, Eutelsat, etc.); 23% for GPS and Galileo (TomTom, banking trade, precision architecture); the remaining 2% is for Earth observation.

How can these differences be explained? I have an explanation, which I experienced personally for some years at the CNES: When we defined these satellites, they always corresponded to social needs voiced by potential users, farmers, urbanists, people who were going to use them, and who understood why the satellite would be advantageous for their problems. But for Earth observation, it was the DLR, the CNES, the ESA [European Space Agency] which sent their engineers, who worked mainly on imaging techniques, and once they were developed, they put them on platforms, and we ended up with satellites over our heads, without really knowing what to do with them. That is the sad reality of the GMES program (European Earth Observation Program).

1997 was an important year for the CNES, for my colleagues, because the minister in charge of us was Mr. Claude Alle@aggre [Education and Research Minister], who was interested in a certain Mammoth* [footnote], as my French colleagues will remember. He asked the head of the CNES to answer the following question: ``Can satellites be of help to public health, yes or no? Submit a report in 6 to 9 months.''

So the president of the CNES asked me, as the only medical doctor, to set up a task force. I had two possibilities: I could either set up a group called PUSH, i.e., with engineers from the CNES, ESA, and the DLR with which we collaborated, or take users, that is representatives of doctors, surgeons, nurses, patients. I chose the latter and those people chose 4 themes, and today I will mention two of them.

Teleconsultation and Tele-epidemiology

The first is what is called teleconsultation in isolated, remote areas, the second is tele-epidemiology. The other two, education and home monitoring, only concern transmission of data, or gathering and transmitting automatic data.

Teleconsultation is what health care is called in isolated areas. What can communications satellites contribute to that? First of all, what do we mean by isolated areas? These are remote areas geographically: the depths of the Amazon, the middle of the desert, the hinterland of Nice, which is very isolated because to get an emergency ultrasound, you need to wait between seven hours and twelve days! And that's only 100 km from Nice. Or French Guyana, which has about 250,000 inhabitants, of whom 122,000 live some two hours by helicopter away from the nearest hospital. The same is true of the Brazilian Amazon. These are geographically isolated areas.

Areas can also become isolated because of a natural or industrial catastrophe. I experienced that myself in Toulouse when the AZF fertilizer plant blew up, killing 33 people and wounding 37,000, which meant that many hospitalizations in two days. One whole district of Toulouse was razed. We are surprised there were not more deaths. During the first two days, the only way doctors could communicate with one another, and rescue workers could communicate with the hospitals, and so on, was by satellite. So, that was considered an isolated area. In the event of an earthquake, a tsunami or even a coup d'etat, the first things that go are the land-based telecommunications systems. With telecommunication or positioning satellites, things work out well.

(By the way, that is why Hugo Chavez managed to escape seven or eight years ago, when he was kidnapped by the CIA and the Spanish police: he had a GPS system in his pocket, a gift from his wife, so he could be locateed very quickly.)

Other isolated sites are ships, planes, and civilian or military expeditions. An Airbus 380, for example, or certain charter company planes, have 1,052 passengers. During a 15-hour non-stop flight, a medical problem will always come up, which the flight attendants can't solve. And the doctors can't solve it either, because when a doctor hears the question: ``Is there a doctor on board?,'' at least in France, he pretends not to hear, or he goes to hide in the restroom and doesn't come out, for liability reasons. Because on the question of medical liability onboard a plane, the French stupidly copy-catted the Americans.

And then, as I mentioned for Nice, there is a lack of medical and paramedical professionals in geographically remote areas, and sometimes in metropolitan areas.

Let's look at some health-care tools that were developed thanks to space. This one was developed with funds granted by [the previous speaker] Didier Schmitt. It is an ultrasound system, with a probe placed on the stomach of a patient, or elsewhere on the patient's anatomy, and it's moved remotely by a ``joystick'' located 100, 1,000, or 15,000 km away, or just in the room next door. This is remote ``tele-ultrasound.'' These tools exist already. In France, three small and medium-sized companies were created to produce this kind of instrument.

This is another product. It's just a van with a satellite antenna on top, which can transmit images and data, and relatively heavy files from wherever the van is located, toward the hospitals. These are emergency tools, because when a natural catastrophe occurs, the first things that are disrupted or disappear are telecommunications, and the tools deployed by the French Civil Protection Services (emergency preparedness). Here you see containers that were used in Haiti two years ago in January. It's a small tool, which has been further miniaturized today, which has a computer, electrocardiographic systems, measurement of arterial pressure, and these medical parameters are collected and transmitted automatically to the hospital.

The DIABSAT project comes from the words ``diabetes'' and ``satellite.'' In France, in Spain, in Italy, in many European countries, there is an increasing number of diabetics. 80% of them don't know they have it, and they only realize it when a complication comes up. Four complications are very serious: The patient can become blind, can have a heart attack or a stroke, can lose the use of his kidneys, and can lose all sensation in the lower limbs.

To get an appointment with an opthalmologist, a neurologist, a cardiologist, or a nephrologist, is a real obstacle course. To see an opthalmologist in Paris, you have to wait at least 6 months, in Toulouse, between 12 and 15 months. So, what did we do? We put all the examinations corresponding to these four specialists in this van. It's not driven by a doctor, but by a nurse, and it travels around rural areas. We began a study three years ago, and it ended with a cohort of 2,000 patients. Since then, all the structures responsible for public health care on the regional level in France have ordered between 1 and 3 such vans for their regions.

So we have an example of something using satellite techniques to collect and transmit data, between 12 and 18 o'clock toward the Toulouse hospital, which is highly beneficial. The cost of the four exams [to the patient?--nbs], including paying off the van and the nurse's salary, is EU105 euros. Four specialist exams for EU105 euros, and no need to travel--knowing that one of the reasons for the ``hole'' in the French public medical insurance system is the cost of the patients' medical travel.

DIABSAT is a van with five types of tests: the eye fundus, artery pressure, sensibility [in the lower limbs], foot ulcer risk, and kidney function. This is not screening for diabetes, but of diabetic complications, which is different. The entire population should be screened for diabetes.

What were the results? It began in October 2010 and ends in December 2012. By June 2011, we had 1,000 cases, and more than 3,500 tests. What is extremely interesting, is that about 240 cases led to an emergency hospitalization. That means the person was becoming blind, had severe kidney failure, had an angina pectoris, an artery was getting clogged up, had a hole in the foot which wouldn't heal. So this was extremely beneficial, and responds to a relatively important need in the population.

Here are the pathological results:

  • retinopathy: 19%,
  • nephropathy:
  • micro-albuminuria 27%,
  • lower limbs arteriopathy: 21%,
  • neuropathy lower limbs: 15%,
  • foot ulcer risk: 17%.
and the costs:
  • investment ( van, medical devices, satellite communications: 124000 [euro],
  • functioning (over 12 months, full-time nurse): 145000 [euro].

The other example I want to give concerns what I call ``mosquitology,'' a Catalan speciality. This concerns all the diseases related to flying vectors, such as mosquitoes or birds.

You should know that there are 3.5 billion people on the planet who are in the ``risk population'' group as regards four diseases: haemorrhagic coughing and fevers, malaria (2 million deaths per year, half of them children), meningitis, and cholera. These four diseases are called ``environment dependent,'' which means they are related to environmental changes in the relevant country, mainly climatological changes, and whatever has to do with water: rainfall, hydrometry, temperature, are factors promoting the emergence of mosquito populations.

This morning, a speaker mentioned irrigation projects in Egypt between the Suez Canal and the Sinai [Hussein?--add reference]. Well, two years after these projects were carried out, the Rift Valley Fever emerged, a fever which is imported by bovines, camels, and sheep, and it came from Mauritania via Sudan into Egypt.

Through a change in the environment, mosquitoes were able to transmit this disease from animals to man. Until Easter Sunday of last year, there was only one Department in France at risk for mosquito-related diseases. Now, the journal {L'Officiel}, at the request of the Health Ministry, has published the names of four other Departments. At first, it was only the Alpes Maritimes, but the Var, the Vaucluse, and the Bouches du Rho@afne were added, so it's in the entire southeast of France where we're beginning to see the premises for what could become, in 7 to 10, or maybe 20 years, a subtropical climate, with the multiplication of vectors favoring these kinds of diseases.

The population is growing, and 50% of the population is exposed to diseases associated with climatological changes, so we see the reemergence of a series of pathologies with relatively acute epidemics. Such reemergences, for all diseases, provoke 4 to 5 million deaths, of which half are children, which is quite high. Animal mortality is 10 to 15 million per year. This is only the data for malaria. So the climate change impact is great.

We set up an unusual methodology in tele-epidemiology. We associate a certain number of data gathered from the ground--in a given department, city, region, or country--with data observed from Earth observation satellites, this time on the scale of the country or the continent, in terms of vegetation, rainfall, humidity. And then we combine the data, we put them in a ``pressure cooker,'' and a mathematical modelling comes out, which allows us to establish risk maps. So we can say: ``Dear Ministers of Tourism and Agriculture in Senegal, between the month of February and May 2013, the probability of a Rift Valley Fever epidemic, or of malaria between Dakar and Tambacounda, will be about 80%. So, please set up mosquito eradication means.''

Here is the approach applied to RVF, for example, in Senegal. This is a raw image of a SPOT observation satellite. After processing these data, together with ground data, veterinarian data, customs and traditions, etc., we establish this map. The darkest zones are the ones where one should definitely not go; the red ones are very risky; and in the yellow zones, one can move, as long as he has good anti-mosquito protection. These maps can be drawn up every three days, and are provided to the agencies which request them.

The same holds for urban malaria. Today, we are able, in a city like Dakar, and in other cities of sub-equatorial Africa, to determine where mosquitoes, or female anopheles, are going to predominate and where the risk places are. These maps are also given to the Senegalese Tourist Office once a week. The same thing is true for Burkina Faso as regards malaria in rural areas.

This type of approach took seven years. When I went to see the head of the SPOT program, I told him I thought doctors would be interested in studying Earth observation images for pathologies. I thought he was going to kill me or fire me from the CNES, because he really thought I was crazy, or eccentric. It took us seven years to show that the idea was valid and, today, there are some 22 networks set up in South America, Africa and, Asia. Four companies, small and medium-sized enterprises of 7 to 10 people each, were created to process this type of images. So, it's already a reality which will amplify in the coming years.

In conclusion, I would say that the use of satellites to help medicine, in detecting epidemics, or in the lack of medical care in remote sites, has become reality. It's a good response to the recommendations of the World Health Organization, in particular, as concerns the environment and climate change.

In terms of expanding, we have to transfer all this know-how to all the regions of France, as well as to other countries and continents, without becoming obsessed with the price. In fact, the price of telecommunications via satellite is no longer $15 per 10 secondsm as it was with Inmarsat seven or eight years ago. Today, it's at EU0.5, if we use Globalstar or rather Thuraya. We have to integrate these tools and these approaches into our health-care systems and adapt them to the needs of the patients. They are the ones, together with the doctors, who decide, not the engineers, and certainly not the space agencies.

The conclusion of the conclusion? To establish a new paradigm in terms of space and societal research, we have to innovate. That is the key word in health care. And to innovate is not easy, when you're conservative. We have to change; we have to want to change. To change a procedure, an approach, a mentality. We have to make it understood, as you have discussed it here today, that Iran is in a very difficult situation, because some 5 or 6 people want it to be that way, or heads of state want it so, for reasons that are not really clear.

Then, we need a ``user'' approach. The engineers, the satellite producers, the polytechnicians, and administrative elites in government cabinets should not be deciding; the users--farmers, diabetics, psychiatrists--should, and that has not yet sunk into our mentalities. We need an integrated approach. As I mentioned, all of this exists already, we just need to integrate everything.

We have something really extraordinary, in Germany and France; it's Airbus program. Part of it is produced in England, another part in Germany, another in Spain, and the integration is shared between two sites, Hamburg and Toulouse, and those two cities have had extraordinary economic development. So we should not forget the integrative approach, but we should avoid reinventing what already exists. We need revolutionary ideas. The more revolutionary the idea is, the better it will work. We need to have revolutionary ideas, and not be afraid to voice them.

I come back to the specialist of mammoths I mentioned before. This specialist, and I knew his cabinet very, very well, used to come up with about 10 ideas per day. One per month was acted upon, but that's already very good.

One also has to be authentic and honest. You don't ask for money in order to satisfy the shareholders, but to implement this or that innovation.

If we look at all these data in terms of space applications, I could add to health care and security, and other areas such as resources (agriculture, water, energy), and transportation on land, sea, and in the air. For space techniques applied to health care, as of last July, 47 small and medium-sized companies had been created in France, with 1,250 people, and a turnover of nearly EU1 billion per year. When we use satellites for civil and human purposes, we can do very beautiful things.

Thank you for your attention.