Doctor on call: telemedicine takes its place in a pandemic

Social distancing is one of the major ways to curb the spread of coronavirus. But telemedicine is also stepping up to flatten the curve and aid in communication between patients and doctors

06 May 2020 . 13,101 Views

Nestled in an open-layout call centre in the heart of Westlands sits a team of 14 doctors, whose work is to screen Covid-19 related calls on the government-backed hotline for the coronavirus crisis.

The doctors from Ministry of Health are spread out across the floor, receiving thousands of phone calls per day from Kenyans to screen and detect potential coronavirus cases.

The doctors have been deployed by the government and are hosted at the call-centre set up by Safaricom, where they work with a team of customer care agents who have been trained to answer calls on the specially-created 719 hotline for coronavirus.

For every probable and suspected case that is routed to the team of doctors at the call centre, Dr. Catherine Ngugi, the lead coordinator for the Covid-19 call centre, has a protocol.

“We will go through a history of travel, if you’ve been in contact with somebody who has been diagnosed, or if you work in the healthcare setting, where you’ve interacted with an individual who has tested positive,” she says.

When the symptoms fit the criteria of having Covid-19, they then escalate the suspected case to the Rapid Response Team, who will take over from there.

From the database of data generated after every shift, close to 400 calls have been escalated to the Rapid Response Team.

The unprecedented speed at which the novel coronavirus, COVID-19, has spread around the world and brought the global economy to a standstill is like nothing the world has ever seen and has forced all sectors to adapt to a new normal.

That new normal involves social and behavioural change, social distancing, and adapting to new technologies.

New normal

For the health sector, this has translated into medical distancing, and the new normal is to minimise contact between patients and healthcare personnel, which has in turn sparked a surge in digital and technological-based healthcare solutions.

At the Cardiology Department at the Aga Khan University Hospital Nairobi, patients now have two options when they need to see the doctor.

“A patient may want to come and see me, and they’ll call the clinic’s office to schedule an appointment, and they’ll be given the option to see me in person, or to meet with me through telemedicine consultations,” says Dr Mohamed Jeilan, the Director of Cardiology at the hospital.

If patients are uncertain, they speak to a nurse, who might seek Dr Mohamed’s advice.

Patients who are acutely unwell are advised to go to the hospital but those who are relatively stable or who want to see the doctor because of the onset of a new side effect or to go over test results mostly take the telemedicine option.

Virtual consultation

Much like a physical consultation, the first part of the virtual consultation is with the nurse. The triage process takes a few minutes with a nurse who will request for patients to disclose their blood pressure, oxygen levels, heart rate and weight and height.

The nurse will then go through their symptoms and gather more preliminary information about their visit, which will be relayed to the doctor.

“If there are no physical signs for the patient to report and it’s a patient that I know quite well, then I will go on with my consultation and conversation with my patient. If there are physical signs, then I will examine the symptoms and signs and further advice on what the patient should do,” says Dr Mohamed.

With the pandemic now making telemedicine a stark reality, there have been interesting debates and questions in the medical community: Is telemedicine as good as traditional doctor/clinic visits?

“Telemedicine isn’t being given as an end option, it is being given as a first option. If indeed you are not satisfied with the assessment and evaluation, then you can come to the hospital and we can decide if you should be admitted,” says Dr Mzee Ngunga an Interventional Cardiologist at the hospital.

At Aga Khan University Hospital Nairobi, access to the patients’ information and electronic health records has been the most important factor.

“If patients have visited any facility in the Aga Khan system wherever it is in Kenya, a lot of the data is plugged into a central system where I can access it from any of my devices,” says Dr Mohamed.

Patients also need to be prepared for consultations over the internet because they require essentials such as scales, blood pressure and blood sugar machines, and small devices for checking their oxygen saturation.

At Kenyatta National Hospital, where an Artificial Intelligence system is helping manage Covid-19 patients outside Nairobi, the essential equipment are scanners, a cloud imaging centre and AI diagnosis capabilities.

The system there was launched by Health Cabinet Secretary Mutahi Kagwe as the government rolled out treatment of Covid-19 cases and a raft of measures to limit the spread of the virus.

The new system also has an added teleconferencing system in which medical personnel at the KNH can communicate with radiologists and medics across the country to extend a helping hand through information sharing and diagnostics.

The system enables the doctors to receive X-rays from outside of the Nairobi Metropolitan area to assist them in diagnosing the virus in probable cases in the shortest possible time.

Bringing healthcare closer

Dr Dilraj Sokhi, a neurologist and the section head of Neurology at the Aga Khan University Hospital in Nairobi, has praised the efficiency of telemedicine in bringing healthcare closer to the community.

The hospital has utilised telemedicine for a while now, particularly in cases that require specialised attention.

Using the system, a patient can request a consultation, and the medical personnel and the patient will communicate with one another to assess symptoms or check-up on a pre-existing condition through audio and/or video mediums, make a diagnosis, where necessary, and log information into a confidential hospital records system.

Outreach clinics

Citing telemedicine’s ability to leverage on existing systems, Dr. Sokhi says that doctors are still able to virtually consult with patients who are without smartphones through the hospital’s community outreach clinics.

“A patient can show up at the clinic and the team there, which includes an administrator and nurses, have set up a computer that has video and audio capabilities and from there the patient can call in to speak and see the doctor via telemedicine. And that still avoids them coming into the main hospital and they’re seen in their community… avoiding the risk of exposing vulnerable patients to the virus,” he says.

For the identification of cases in the community, the African Medical and Research Foundation (AMREF) has prepared community healthcare workers to use technology.

Amref has been proactive in teaching and training community healthcare workers to identify, isolate and refer suspected cases through Leap, a robust, scalable, interactive learning solution.

The learning solution is available on basic phones as well as smartphones, which makes it possible for community health workers of all backgrounds to engage with content in audio and SMS form, measure their progress through evaluations, quizzes and practical exams and interact with and share knowledge with their peers through group chats, all at the touch of a button.

“We are training over 60,000 community health workers across the country on Leap. It is supported by the Ministry of Health, Africa CDC and others and it is run on the Safaricom network but it is also able to engage other mobile networks” says Dr. Githinji Gitahi, the group CEO of Amref Africa.

He is confident that Leap is going to be very instrumental as Kenya works to contain the pandemic.

As they continue to deliver essential counseling, information and medicine supply to patients and local communities, pharmacies and chemists may be one of the only markets that come out on the other side of this pandemic unscathed.

With a significant increase in the demand of medicine, vitamins and other pharmaceutical goods, in tandem with the enforced social distance measure, online pharmacies have seen an increase in new customers during the coronavirus pandemic.

Online pharmacy

MyDawa, the only licensed e-pharmaceutical company in Kenya, is leading the charge in delivering safe, authentic, essential medication or other health and sanitary care services such as family planning products and diapers to those self-isolating or practicing social distancing.

“We deal directly with patients and our clients and customers, but this [Covid-19 pandmic] has been a catalyst for people to adopt technology, for both within the healthcare system and those who are accessing the health care system,” says Tom Wood, the managing director of MyDawa.

Through their app or through their website, they provide end-to-end services that deliver prescriptions and products right to your doorstep, with an in-built mobile payment solution and minimal human contact upon delivery.

“Telemedicine has made it so that you don’t need to leave your home or your office or wherever you are to manage your health or to get a consultation… and this will make the healthcare professionals far more efficient, which drives down the cost for the patient and will drive more and more people to use it,” says Tom.

Doctor on call: telemedicine takes its place in a pandemic

Doctor on call: telemedicine takes its place in a pandemic

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