My phone rings.
“Namaskar! My cough is really bothering me. What should I do?” says a middle-aged man.
“Namaskar! I am Astha Prasai. I am here to help you. Please bear with me while I ask you your problem in detail,” I answer.
Mr. Kafle from Kathmandu is worried about this nagging cough he has, and it has been a month since he has tested positive for COVID- 19. After talking to him and counseling him for a while, he is happy to hear that it is a sequela of COVID-19 and will improve with time. Asking him to call back if it worsens, I end the call.
The phone rings again.
“Namaskar! I had talked to a doctor yesterday about my father. I am worried his oxygen saturation is 87 percent,” says Ms. Gurung in a quavering tone. I quickly search his details entered by my colleague yesterday and find he is an eighty years old hypertensive man and had tested positive a week ago and had mild symptoms until yesterday. I ask his current symptoms and teach the daughter an accurate method to use a pulse oximeter. While I am on the phone, I ask to retake the saturation.
“Oh! It is 95 percent. Thank God.” Her voice is much calmer. I ask her to monitor her father, teach her about awake proning, and ask her to call back when needed. I hand over the detail to my colleague, who would later follow up on the patient in the evening shift. We present the case to our attending in the evening huddle and follow up with the patient as we discussed.
Mrs. Nepali from Far Western Nepal calls.
“It has been a month since I tested positive. I was admitted to the nearby center and received oxygen and steroids two weeks back. Now, my eyes hurt, and I have chest pain. I am worried I have mucormycosis,” she says.
After taking her history in detail, reviewing the reports she had sent to our Facebook page, it was obvious she did not have mucormycosis but instead was anxious and worried due to the increasing cases of mucormycosis she had heard about. Every day she messages us on our official page, updating us about her symptoms. Members of our team follow up regularly to make sure she is doing well.
Every telemedicine duty day starts and ends with many such calls from nooks and corners of Nepal, even from places where health care accessibility is a struggle. My fellow doctors and I hear several such stories of people in fear, despair, and confusion. Some with multiple comorbidities and high risk need close monitoring or hospital admission, some are curious about when to break isolation as they have tested positive even a month after symptom onset, some are worried about re-infection, and some are worried about their child as they hear the third wave is going to hit hard. We lend an ear to their concerns and, utilizing our medical knowledge to the best of our capacity, guide them on appropriate steps they can take.
“Please, convey my thanks to all the team members for helping us. Having someone listen to my concerns and talk to me for just a few minutes on the phone relieves my worry,” said Mr. Dahal, whose family of eight is all COVID-19 positive and is in isolation.
I believe we as a team have been able to help many patients like him. Telemedicine has become a bridge between the sick and the health care system, helping to triage the patients at their homes.
Currently working in a COVID ICU in a tertiary center in Kathmandu, I have experienced how difficult it is for the health system to manage the patient load. A month ago, ICU beds were fully occupied, ventilator alarms would set off time and again, indicating low flow as the hospitals faced shortages of oxygen supplies, emergency rooms were over-occupied, and patients waited in queues to receive oxygen or just to be checked up by a doctor. At such a desperate time, telemedicine is a noble initiative. I thank my patients who taught me more than just mere medical knowledge and my dedicated fellow volunteer doctors who teamed up in this project to help the nation in these dire times.
Astha Prasai is a physician in Nepal.
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