Volume 2, No. 11, November 2020
Editor: Rashed Rahman
Prof Dr Major General (retd) M M H Nuri
Technology, with the digital revolution, has invaded practically all aspects of contemporary life. Tele-medicine is now in vogue in many developing countries and is also being tried in Pakistan. It is convenient, less costly, speedier and effective. By reducing healthcare costs, raising care accessibility and even helping to improve patient outcomes, tele-medicine by now has established itself as essential.
Nearly a half century ago, Dr. Martin Luther King, while addressing the May Day workers highlighted the role of essential service of workers, labourers, doctors and caregivers who generally remain unrecognised, invisible and undervalued.
After the global Covid-19 crisis in late November 2019 that is still ongoing, it has become imperative that we shall have to rely more on technology in the management of other chronic diseases as well, besides the corona virus. In fact other major diseases are part of the health landscape and get exacerbated with the virus: heart conditions, diabetes, respiratory and many others, impairing the human body’s immune system.
Creditably, during this current crisis, Pakistani doctors, nurses, paramedics and caregivers have been in the ‘frontline’ while coping with the deadly virus, thus earning the gratitude and goodwill of the country.
Why is there now a pressing need for adopting tele-medicine?
The sudden, rapid outbreak of Covid-19 has overwhelmed the health infrastructure, including hospitals, trained doctors, nurses, paramedics and equipment. While the avoidance measures taken during the ongoing Covid-19 virus pandemic through segregation/quarantining are important, other serious health-related conditions cannot be ignored. This makes employment of a tele-medicine service a dire need.
It is often said that desperate situations call for desperate remedies. Earlier the suspension of transport services, businesses and partial lockdown of public places, restricted timings in hospitals, curbs on travel and public gatherings – all made easy access to hospitals difficult. Particularly, patients from the rural areas were hard hit when faced with pre-existing chronic medical conditions. This situation continues to date.
Moreover, travel and commuting restrictions enhance vulnerability to the virus and expose people to the contagion; even waiting and assembling in hospitals for consultation poses a greater risk. So, the economic constraints and difficulties of travel and gathering need to be minimised. Repeated visits are to be avoided, unless very necessary.
As for the use of tele-medicine, clinical records of patients are properly maintained, a contact is made for an appointment. This contact reviews progress, makes alterations in medicines, if needed, and addresses any complaints or queries.
It makes the doctor-patient contact active through mobile phones (now available to many), reassuring patients who face seclusion under the lockdown. Albeit not perfect, experience shows that a short conversation with a doctor on his/her condition is very therapeutic and gratefully appreciated. It relieves anxiety, depression and uncertainty. This is also true for the near and dear ones of the patient in the household.
If any further tests are required they can be done and treatment suggested. Hopefully with the end of the lockdown, if and when it occurs, they could travel and have a follow up in personal meeting.
The recent illnesses and deaths of doctors and nursing staff during the Covid-19 crisis are unfortunate incidents. Tele-medicine and the provision of anti-virus personal protection equipment (PPE) to doctors, nurses, medical and administrative staff can protect them against infection.
The procedure runs like this: a cardiologist/heart specialist with record of heart patients at the hospital makes an appointment for free consultation with the patient/family through the hospital staff. The patient is approached online and narrates his/her condition, maintenance medicines and complaints/anxieties, if any. To this the doctor responds with suggestions combined with counselling.
Tele-medicine and counselling have proved to be very therapeutic. Under isolation, a conversation with a caring doctor is reassuring and in fact uplifting for many patients. Most of the patients are elderly men and women who need approachability and assurance that they are still looked after while confined in their homes. It is less costly as patients can avoid gathering in large numbers. They are satisfied in lesser time and avoid travelling and waiting for appointments.
Experience shows that besides the specific medical issue, it is the gnawing fear, uncertainty and lack of communication that takes its toll. Alienation often compounds the disease. When normal business activity hopefully restarts they can always physically come and discuss their cases.
Having empirically observed the positive effects of tele-counselling along with medicare, the results have been very encouraging. Granted, it cannot substitute for physical proximity and close physical examination but under the circumstances it is very beneficial for patients.
Verily, lack of education and health facilities are going to remain as future challenges after the Covid-19 crisis. The brunt however will be faced by the developing countries. Besides, unemployment, food insecurity, a plummeting economy, disruption of supply chains and low production will be compounding the health issues.
Healthcare has been neglected in Pakistan, barring the well endowed few who can easily afford it. Unfortunately, the virus has aggregated the adverse effects of chronic ailments. But hopefully, these systems are being streamlined by improving tele-medicine infrastructure, training and equipping of staff, improving capacity-building and streamlining the SOPs.
For this, a sine qua non is the medical staff’s humanity, dedication and expert care. Adhering to the Hippocratic oath, but more importantly, imbibing values of true humanity enjoins care for the old, sick and underprivileged sections of society.
The writer is presently Executive Director of Tahir Heart Institute, Chenabnagar-Rabwah, District Jhang, a charity hospital run on private donations from the Pakistani diaspora, and former Commandant, Armed Forces Institute of Cardiology (AFIC), Rawalpindi. He is also Chairman of the Pakistan Chapter of Humanity First