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Imagine you are 100 million kilometers from Earth on a mission to Mars. Your only contact with home is through radio signals. Six months into your trip, you get a bad case of gallstones and require emergency surgery. On the long flight to Mars, there is no in-flight ER with a complete medical staff at the ready, and no quick turnaround for an ambulance ride back home. In remote and isolated locations like this, surgery may have to be performed by crewmembers with minimal medical experience.

Remote-care scenarios like this are the focus of an international research team comprising doctors, astronauts, and robotics engineers from the Canadian Space Agency (CSA), McMaster University, and U.S. agencies NASA and the National Oceanic and Atmospheric Administration (NOAA). NEEMO 7--the NASA Extreme Environment Mission Operations No. 7 mission--promises to help astronauts on future space missions and others with medical problems in remote places. Yet for scientists interested in developing international collaborations there is a more immediate payoff: This month's mission provides a lesson in how to make international collaborations work.

Complex medical care given by people with no medical training

Led by Canadian veteran astronaut David Williams, NEEMO 7 is demonstrating innovative telerobotic surgical technologies and techniques in an underwater habitat where conditions are extreme and similar to those found in space. The main goal of the seven crew members from Canada and United States will be to figure out whether people with little or no medical training can perform complex emergency diagnosis and medical care in remote locales like deep space or Canada's far north.

The test lab will be an underwater complex named Aquarius, which, at 13.7 meters long and 4 meters in diameter, is similar in size to the International Space Station's living quarters. Aquarius is located 5 kilometers off Key Largo in the Florida Keys National Marine Sanctuary and rests about 19 meters beneath the surface.

While training for the NEEMO project, one of the biggest challenges Williams and his crewmates faced was figuring how to bring together all the key players in government agencies, academia, and the private sector scattered throughout North America.

"It's actually a pretty exciting mission from the perspective that it is a partnership between major U.S. agencies [NASA and NOAA] who are then in turn collaborating internationally with the CSA and the Centre of Minimal Access Surgery at McMaster University," says Williams, Canada's sixth astronaut to fly into space. "Getting all of these folks together to make something happen has been a definite challenge."

The highlight of the mission will be when Williams, a trained physician, and his teammates carry out surgery--no, not on each other, but on a state-of-the-art mannequin equipped with life-like synthetic organs. Mehran Anvari, director of the Centre for Minimal Access Surgery in Hamilton, Ontario, and world leader in telemedicine, will use two-way telecommunication links to guide the aquanauts through diagnosis and surgery ("telementoring") on the mock patient inside Aquarius. Another simulation will use virtual reality control technology to guide a telerobotic arm to perform surgery on the mock patient.

NEEMO 7 came to life when Anvari and McMaster approached CSA to see if it was possible to do an underwater mission to test their long-distance health care system. CSA then formed a partnership with NASA, who in turn approached NOAA for use of their unique underwater habitat. Soon after, corporate partners like Cisco Systems and Bell Canada got on board, working closely with the university and government agencies and providing the telecommunication and network hookups necessary for the robotic and remote systems.

"It's kind of like a big triangle with all these partnerships extending out, but it's all basically brought together through an integrating body called the Mission Management Team, which has representatives from each organization," says Williams.

One of the biggest challenges in a far-reaching project like NEEMO, according to Williams, is getting big agencies to come together and work on a focused effort. Williams believes that NEEMO's success is due in large part to the worldwide partnerships established to support construction of the International Space Station (ISS). Despite language and technological barriers, over a dozen countries from three continents pulled together to create the space station, the largest, most complex engineering project ever attempted. "The ISS clearly demonstrates the possibility that large government agencies from all over the world can get together in highly complex technical projects and succeed in doing things that any single country, on its own, wouldn't be able to do."

Canada: world leader in robotics and collaboration

NEEMO crewmate and NASA astronaut Michael Barratt says that Canada has distinct advantages for a project like NEEMO, both in the technology and on the administrative side. Canada is recognized as a world leader in robotic research and has a reputation worldwide for creating effective international agreements and partnerships. "There's something about Canadians and space robotics," says Barratt. "They're legendary."

Canada also has a history of successful collaborations. There are many cases in Canada of government agencies, universities, and the private sector working together on a new piece of technology. Barratt points out the Canadian Osteo project looking at bone tissue cultures that flew on the space shuttle in 1998. "That is a great demonstration of the effectiveness of a partnership between the government, the University of Toronto, and a small company called Millennium Biologix in Kingston, Ontario."

What advice do these veteran aquanaut/astronauts have for early-career scientists looking to bring together an international project of their own? Seek out counterparts in other countries who are doing similar research either through meetings or direct contacts. NEEMO started out in that way, with an initial inquiry from McMaster University. Williams can trace his own connection to the NEEMO mission to a real-life surgery experience during his 1998 Columbia shuttle mission.

Don't shy away from cold calls and introductory letters to agencies and societies, seeking help tracking down contacts within the research community. "That kind of networking takes a little courage to do at first but then again, if you don't do it, you're not going to make any headway," warns Williams. The key to international collaborations is to be open and willing to learn, adapt, and be flexible. Williams believes that it is precisely these qualities that brought together the space and medical communities on the NEEMO mission.

"What's really neat is if you can use these opportunities to create technology accelerators and create international collaborative teams, then you can go forward and do great things," explains Williams. "You can see the excitement in everyone's eyes and it doesn't matter where they come from. Everyone is thrilled to be a part of this thing!"

Williams has been involved with NEEMO since the very first mission almost a decade ago, and he sees evolution and growth in both experimental complexity and team capabilities as talented people from a range of organizations work together more effectively, pushing the technological envelope a bit further with each mission.

"Pulling together all the elements of this mission not only demonstrates and evaluates new technology, but challenges the skills of the researchers involved and the people who are providing the operational work, so that next time around we can push the edge of the envelop even farther," says Williams.

For the latest updates on the NEEMO 7 mission now under way off the coast of Florida, including daily journals and live Web cam images, visit their Web site.

Andrew Fazekas is Canadian Editor at Next Wave and may be reached at afazekas@aaas.org

Andrew Fazekas is a correspondent at Next Wave and may be reached at afazekas@aaas.org.