Traditional functioning of healthcare sector, just like every other sector, has been hugely impacted by Covid-19 pandemic. People are scared to approach healthcare centres for the fear of catching infection from other patients. Overburdened healthcare workers and institutions do not find enough time to organise camps, mobilise people and provide healthcare services to the needy. Quality of service in doorstep delivery of healthcare too has suffered as healthcare providers have become burdened with COVID related containment, surveillance and vaccination activities. Telemedicine offers a ray of hope in these circumstances.
Parallel to traditional mode of healthcare delivery, there are other modes of healthcare delivery using tele-medicine. The passive mode entails setting up a helpline or an application that enables either a call or registration to access services of healthcare providers. However, often these helplines are too burdened and not reachable or application is poorly built, not providing a satisfactory consultative experience. As a result, too few people, out of the already few who know about the existence of such platforms, are able to access these services.
Mixed mode of healthcare delivery using telemedicine happens when patients can approach certain nodes located close to them, say, a PHC, which is connected to a hub with high-speed connection. While healthcare experts sit in the hub, certain minimum level of services like pharmacy, computer expert, nursing staff etc. are available at the node. Through this mode of telemedicine, while patients still have to leave comfort of their homes, they are able to get access to healthcare close to their location. However, what is available in terms of infrastructure for this mode is rudimentary at best. To truly realise the potential of this mode, there is a need for dedicated WAN networks that can transmit good quality images supported by digital scopes and other instruments required to capture health characteristics of patients at nodes.
Lastly, there is active mode of telemedicine. In this mode, healthcare provider actively calls patients to provide consultation and advise or to take remedial action if required. However, active telemedicine cannot be made available for all the diseases all the time. It needs to be a specific disease-based facility.
It was with this last mode of telemedicine that some experimentation was done in Bhavnagar during this second wave of COVID-19. It is well known characteristic of COVID-19 that majority of patients do not need high medical supervision and can be treated in home isolation itself. During the second wave, however, as people found it difficult to get beds in hospitals, many patients needing oxygen support were also staying in home isolation. It was essential that their health be monitored continuously. Local healthcare system was too burdened by surveillance, containment and vaccination related activities to take care of such large number of patients every day. There was a need to come up with an alternated system.
During peak of the second wave in Bhavnagar, at any point of time there were four to five thousand people living in home isolation or home quarantine. A team of 140 teachers was created. Each teacher was given the responsibility of calling and checking up on a certain number of patients. They were provided every day with latest updated list by health department. It was ensured that every patient received call from the same teacher during entire duration of treatment. For every ten teachers, an MBBS doctor was appointed, total being 14 for 140 teachers. These ten teachers called a certain number of patients and prepared a short list of those who needed medical consultation. This short list was handed over to the doctor who then called and provided necessary consultation. In case any patient needed in-person attention, their information was passed on to District Nodal Officer who instructed field teams to visit the patient, provide necessary care or shift them to a healthcare facility as required. While field positions could not manage thousands of visits every day, such filtered number of visits made their day more productive.
Between May 01 to May 07, total 32490 calls were made in this manner. Approximately one percent of these were found to be in the need of medical attention. List of these patients was passed on to the doctors for providing medical consultation. After consultation, doctors found it necessary that 57 of these patients should be visited physically by health care workers and passed on their details to District Nodal Officer. Following the visits by field teams, all of these patients were shifted for treatment to various COVID care centres in the district. Apart from this, patients who received calls from teachers developed a bond with them and started calling in case their near and dear ones developed symptoms or if they needed medicines or any number of reasons. Teachers started going beyond call of their duty and coordinated with field teams to get them medicines, get their relatives tested or sundry assistance to make patients comfortable. The ease of accessibility to healthcare through teachers would have given great mental comfort to the patients, something which a single overburdened helpline could not have.
Going forward, such active mode of telemedicine can be used for any number of specific ailments. In the aftermath of the pandemic, as more and more people start suffering from mental disorders, such proactive approach of calling and speaking to patients can help to comfort them and prevent them from hurting themselves or their near and dear ones. As patients with co-morbidities, like AIDS, become more and more cautious regarding visiting healthcare facilities due to risk of catching infection, such proactive approach will make them comfortable while protecting their privacy. Pandemic has been difficult for a number of reasons. But it has also brought to fore solutions which in any other circumstances would have taken years to emerge.
This apparently small intervention made by Varun Kumar Baranwal in engaging the teaching staff to resolve a major issue of over-burdening of medical personnel demonstrated his out-of-the-box thinking. He made it happen through an innovative approach that is eminently replicable and scalable.