Telemedicine refers to providing health care services at a distance using information and communication technologies (ICT). Telemedicine involves providing some kind of health care service to a patient, such as an online consultation between a patient and a doctor, remote patient monitoring through medical devices, or consultations between two doctors to arrive at a management plan for a patient case. The term “telehealth” is a broader umbrella term which encompasses providing health services at a distance (telemedicine) as well as other health system activities like health provider education (eLearning), research and evaluation (online questionnaires), health administration activities. In light of the Covid-19 pandemic, providing health care via telemedicine has become a necessity. The goal of this training is to orient doctors and hospital administrators to the field of telemedicine so they can effectively use telemedicine in their day to day practice or incorporate it into their health organization. This training is open to doctors and health administrators from Asia, Africa and the Middle East.
OBJECTIVES
This training will cover the following topics,
1. Definition of telemedicine
2. Modes which can be used for telemedicine – audio, video, chat, store-and-forward
3. Pros and cons of telemedicine
4. Legal basis of telemedicine
5. Considerations for which drugs can and cannot be prescribed over telemedicine
6. Patient safety and informed consent in telemedicine
7. Advances in telemedicine
8. Demonstration of the Intelehealth platform
9. QnA session
TRAINERS
Dr. Bimal Buch, Chief Medical Officer. M.B.B.S., M.B.A. (H.M.), F.C.G.P., F.P. Consultant, D.H.R.D., P.G.D.H.R.M., P.G.C.H.M.,P.G.C.HIV/AIDS, Dip.T.D. Orange belt Six sigma (MSME), PGC QM & AHO (Post graduate certificate in Quality management and accreditation of Hospital organization), Dip. C.M.H. (NIMHANS)
Hand hygiene is an important component of infection control. Frequent hand washing is extremely important to protect yourself on the job. The following videos explain the proper techniques for hand washing using soap & water and hand rubbing using sanitizer as per the WHO guidelines.
Don’t have running water at your health facility/home – use this simple innovation called the Tippy Tap!
Hand washing is one of the best ways to prevent the spread of COVID-19. But not everyone has access to running water at all times. The tippy tap is one simple and safe way to wash your hands that is especially designed for areas with no running water. This video produced by WHO Regional office for Africa shows you how!
In light of the spread of Covid-19, we are dedicating a series of articles to the use of PPE and other personal protection measures for healthcare workers of all cadres – doctors, nurses, midwives, community health workers, sanitation staff, lab staff to name a few.
This article assumes little to no background in infection control and Personal Protective Equipment (PPE).
HOW INFECTION MAY SPREAD TO A HEALTH WORKER & PRECAUTIONS YOU CAN TAKE
As Covid-19 is an infectious disease which spreads through droplets and fomites, wearing PPE by health care providers is vital for their own protection. When an infected person coughs, droplets spread in the atmosphere, which is why they should wear a mask. But those who are undiagnosed or asymptomatic, they may be spreaders of infection. So health care professionals need to take extra precautions to protect themselves.
Droplets from infected persons may come in direct inhalation during breathing in. So a health worker needs a mask. The average person has 3000 droplets in a single cough that travel at 150 kmph for upto 1-2 meters. Hence, by keeping at least 1-2 meter distance from the patient, you can minimize the risk of getting infected through droplets.
But touching infected surfaces, direct contact with body, belongings and body fluids of patients are real threats to workers. So proper hand washing after each contact with either soap and water or hand sanitizer, as per the situation, is necessary even with all precautions. Even if you have worn gloves, it is recommended that you wash your hands according to hand wash guidelines after removing gloves.
VARIOUS TYPES OF PERSONAL PROTECTIVE EQUIPMENT (PPE)
1. Masks: There are two types of masks available. Triple layer surgical mask and N95 respirator. Both are good for their situations.
1.1. Triple layer mask: The common surgical mask has 3 layers of fabric that is water resistant. This mask can be used for 8 hours. If it gets wet, it has to be removed. Once removed, it has to be disposed of as biomedical waste.
How to use: The mask has a hard metal string on the upper side, which is malleable and is pressed against the nasal bridge to adjust to shape. To cover a large area of face, mouth and nose, it is pleated. On the outer side, these pleats should open downwards, so that there is no pocketing which can lodge droplets near the nose and make the wearer even more vulnerable. Tie the strings behind the head, or there are elastic loops, wear around the ears. Make sure that there is very little space, if any, between mask and face. The mask is not sterile. You can touch any surface when wearing the mask, but once you are ok with it and have started working, you should not touch the front surface of the mask as it is potentially infected. Maneuver the mask with strings. When removing also, touch only the strings.
1.2. N95 respirator mask: This is better in terms of particulate filtration. Fits a bit tightly on the face. May have an expiratory valve and tight texture so that it will not collapse and balloon with respiration.
2. Face shield and goggles: To protect mucous membranes of mouth, nose and eyes from sudden splash of infective material. These also will protect from inadvertent touching eyes, nose and mouth with contaminated fingers.
3. Gloves: When you touch a contaminated surface with bare hands, your hand is likely to be contaminated as well. But this does not replace hand sanitation. Instructions for wearing gloves do not differ. Sterilized gloves are not needed. Usual guidelines for gloves prevail.
Gowns: Body cover is needed to protect the entire body. They are required for workers working in close proximity (less than 1 meter). They have laces to tie from the back. They are akin to surgical gowns used in OT. They are to be used based on risk of exposure.
4. Shoe covers and head covers: As airborne droplets tend to settle, they can catch feet/shoes as well as head.
HOW TO WEAR (DON) AND HOW TO REMOVE (DOFF) PPE PROPERLY
It is extremely important to don and doff PPE properly in order for it to be effective. Hand hygiene is an important aspect of proper PPE removal. Here is a short video explaining the proper sequence as a quick and handy reference. You can also refer to some of the longer videos below.
A short video on the proper sequence of donning and doffing PPE – By Diwakar’s Multispeciality Hospital https://www.divakarshospital.com/ As a healthcare wor…
Authors: Dr. Bimal Buch, Dr. Bhishmaraj Shrivastava and Neha Verma
NGOs that provide essential services like healthcare, food, water, housing, sanitation need adequate infection control measures in place to make sure their staff and volunteers stay safe while also providing their beneficiaries the right information. This online training for health workers/volunteers/field workers offers them adequate knowledge about COVID 19, it’s transmission and preventive measures for public or beneficiaries and themselves. With this knowledge they can perform their activity using adequate protective actions and preventive measures. They can discharge their duties confidently and without fear of acquiring disease from their beneficiaries and also offer protective instructions to beneficiaries.
Interested in organizing a training for your organization?
Primary information of virus and disease, mode of spread, clinical features (signs and symptoms), protective measures like social distancing, hand wash, avoid risky touch, cough etiquette, etc. Role of Personal protective equipment, role of isolation and quarantine. Treatment and prophylaxis.
OBJECTIVES
At the end of this discussion, participants will be able to train their staff in activities of Covid-19 epidemic so that they can:
Tell signs and symptoms of novel corona virus/COVID 19.
Undertake surveillance to identify suspected case of COVID 19.
Provide linkage with ASHA/Health workers for further action.
Take up proper preventive measures for them selves.
Wear triple layer mask as per guidelines.
Tell messages of IEC covering all of the points of social distancing, cough etiquette, hand wash and touch care.
Demonstrate ability to give messages on role play settings.
After the training is complete, attendees will be sent a post-training quiz. Certificates will be issued to participants on successful completion of the quiz (scoring 80% or higher).
Courtesy: Canva
TIME
1.5 hours
TRAINERS
Dr. Bimal Buch, Chief Medical Officer. M.B.B.S., M.B.A. (H.M.), F.C.G.P., F.P. Consultant, D.H.R.D., P.G.D.H.R.M., P.G.C.H.M.,P.G.C.HIV/AIDS, Dip.T.D. Orange belt Six sigma (MSME), PGC QM & AHO (Post graduate certificate in Quality management and accreditation of Hospital organization), Dip. C.M.H. (NIMHANS)
UPCOMING TRAININGS
Interested in organizing a dedicated training for your non-profit? please fill out our contact form and we will get back in touch with you: https://www.intelehealth.org/contact
Download this poster pack of Covid-19 precautions and put up in your premises, courtesy of Canva
Intelehealth is a telemedicine & case management app that supports patients and frontline health workers with a digital assistant called ‘Ayu’ for triage and risk assessment. It connects them with remote doctors over telemedicine (audio/video calls) in order to provide care for patients in hard-to-reach situations. We have set up several telemedicine projects in countries like India, Philippines and Haiti.
We are keeping a close eye on the Covid-19 outbreak in the countries where we work and are actively planning the impact of this outbreak on the programs we support. From the experiences of countries who are battling the pandemic, we believe that the time for preparedness is now, as a late response can be very damaging, especially for vulnerable communities. In our commitment to support strong health systems, we are reaching out to interested health organizations with technical support for Covid response.
Intelehealth’s unique Covid-19 monitoring and case management solution has three modules:
Identification of cases:
A website for the general public to self-triage and identify if they need to get tested or if they should self-isolate.
Available in multiple Indian languages
Treatment and monitoring of suspected and confirmed cases:
A Telemedicine based home-monitoring solution for patients who are suspected or confirmed of having Covid-19 to guide them through the 14 day period of self-isolation/ quarantine. Provides guidance to the patients for how to comply with home-quarantine instructions and health education messages.
Features,
Allows assigning of health workers to high-risk cases
Allows health workers to securely access patient information, update patient medical records with clinical evidence
Case Management and medical decisions to recommend isolation can be automated, scaled efficiently using mobile platform
Mapping of suspected and confirmed cases
GIS mapping and real-time monitoring dashboards for suspected and confirmed cases to identify infected clusters
Contact tracing module where suspected and confirmed cases can use the app to enter information of the people they have come in close contact with and places they have visited
Benefits for Governments, NGOs and hospitals in launching an effective and timely COVID-19 response:
Real time data for decision making of level of spread – early warning system to identify community spread
Better compliance of patients with home quarantine with less stress
Allows greater efficiency in deployment and use of medical resources, doctors attention when appropriate and necessary when meaningful alarms are triggered
Availability of credible and strategic data and insights into capacity needs of isolation units
Ability to cast a bigger net and have broader reach for COVID-19 response
Can inform contact tracing workflows
If you are interested you can contact us via,
Email: covidresponse@intelehealth.io or submit a request via our contact form (select enquiry type as Covid response solution)
“First, do no harm”. Patient safety and quality is a cornerstone of healthcare service delivery, yet every 5 minutes patients die because of unsafe care. It is important to safeguard the quality and safety of care delivery in all healthcare environments. To err is human, and it is but natural to assume that to “telemedically” err is human too. On the occasion of the first ever World Patient Safety Day we present a quality index for provider-to-provider telemedicine programs.
Telemedicine can connect patients directly with remote doctors (patient to provider telemedicine) or can connect frontline health providers with doctors or specialists (provider to provider telemedicine) when distance and/or time separate the two. It has demonstrated an improvement in access to healthcare at lower costs. The WHO Digital Health Guidelines recommend the use of provider to provider telemedicine as an evidence-based intervention for health systems strengthening in low and middle income countries.
However despite the rapid growt
How we developed this toolkith of telemedicine, there is not much data on patient safety and the quality of care delivered in this setting. Many studies have raised questions about the comparison of quality of telemedicine as compared to in-person visits. Quality assessment and continuous improvement are important in an in-person clinical setting, and have resulted in major gains in patient safety, improvement in patient satisfaction and health outcomes. There are several quality measures that have been developed for in-person clinical settings, but not many in a telemedicine context.
Intelehealth is a digital health and telemedicine platform supporting frontline health workers. We believe in the cause that ‘everyone should be able to access the health services they need, when and where they need them, without facing any financial hardship’. By developing an app & open source telemedicine software, we ensure that the frontline health workers are able to significantly reduce the time, distance, money, and effort spent by patients to access health care. To evaluate the quality of healthcare offered and to understand it’s sustainability, we have come up with an extensive Clinical Quality Metrics for monitoring and evaluating the quality of healthcare at our projects. A major goal in developing this Clinical Quality Index for Telemedicine was to achieve quality improvement, improve health outcomes and reduce preventable harm for people utilizing the telemedicine service, keeping in mind their safety and wellbeing.
These metrics help a telemedicine program to:
Provide an objective standard for measuring the program quality and achieve continuous quality improvement
Measure and record the efficacy and effectiveness of the system or process
Establish & monitor best practices for patient safety to reduce preventable harm
Left – Intelehealth Director of Programs, Vibha Bhirud Right – Intelehealth CEO, Neha Goel
Globally, the public healthcare systems have monitored and planned several targeted (vertical) interventions for specific diseases like tuberculosis, malaria, anemia and for certain disadvantaged groups like women and children through primary healthcare programs. These vertical programs have resulted in a number of big wins, one such example being a global reduction in maternal and child mortality. However, health systems have become more complex over time with a number of such selective programs for many health areas – like maternal health, child health, non-communicable diseases, communicable diseases. Often there is very little connection between these health programs and each operate in its own way. Several groups of people are also frequently neglected like those with disabilities, needing mental healthcare and the aging (geriatric) population.
We at Intelehealth, do our bit by using/developing technology to deliver comprehensive primary health care to underserved communities in remote and far-flung areas. We work to integrate technology and comprehensive primary healthcare supported by digital health tools. Last week, a part of our team visited Umerga and a few other villages in Osmanabad (Maharashtra, India). It was a routine baseline survey but in the end, what we experienced in these rural areas, deeply moved each one of us. Here are five of the most touching stories from the field that, in a way, shaped our thinking of what introducing comprehensive primary health care here would mean to them.
1. Comprehensive care means addressing the underlying social issues that lead to poor health
“Can you tell me what’s wrong with her?” pleaded an upset middle-aged woman as she pulled her daughter closer to come and sit with us. “Take a look at her. She can’t even walk properly and she gets irritated so easily. We couldn’t even send her to school, let alone make her stay there. She has been like this since she was born”. The hapless young girl, who looked to be around 16 years old, seemed to have some kind of developmental disability. However, the family simply wasn’t aware of what to do and where to go and get help for her. They had sought advice from their relatives, some doctors, and even faith healers. But in the end, they did not know what to do, condemning the girl to a life of isolation.
The problem solved- Social issues like lack of awareness of stigmas prevalent about mental illnesses is a major barrier to seeking care. Health promotion and awareness is a part of CPHC that would have positively impacted the life of such people with disabilities
2. Comprehensive care means focusing on early diagnosis and prevention and not just cure
“My wife has a lump in her breast from the past 3 years. But I think the treatment will be too expensive and tedious. From where do I get the money? And who would look after my wife in the hospital? So we haven’t gone to see any doctor,” said a poor farmer as his wife curiously peeked in from the kitchen.
Just a few houses away, a young woman, we interviewed, shared how she recently attended a screening camp for cervical cancer and menstrual abnormalities. She was screened positive for a possible lump in her uterus and was referred to a hospital for further investigation. “My family didn’t want me to go. They said there was no need as I was perfectly fine. But I didn’t listen to them and went anyway.” Further tests showed she did not have cancer and the lump was benign. But she was proud that she stood up for herself.
The problem solved- Women usually face a lot of social and cultural barriers and because of which they don’t speak up for their health. Screening programs, part of CPHC, can help promote positive health-seeking behavior in disadvantaged communities.
3. Comprehensive care is sensitive to the needs of all age groups, including neglected groups like the elderly
An 80-year old lady sat down next to us, and not realizing we weren’t doctors, began to pour out her heart on her ailment, i.e. how she was having a lot of difficulties during swallowing. “I even went to a big hospital in Pune. But the doctor said he would have to put a big tube down my throat and check! I got so scared I never went back. Now I am finding it so hard to swallow.”
The problem solved- Lack of education and awareness often hold people back from seeking the treatment they need, and especially in the elderly. Additionally, it becomes very difficult for them to travel far and they are dependent on other family members for tending to their needs. Also, being uneducated, having deep-seated cultural biases and the dearth of public health programs for the geriatric population, makes matters worse. Health education and promotion helps such people to understand their ailments and how to help themselves out.
4. Comprehensive care includes lowering out-of-pocket expenses for patients
“I had kidney stones, and we spent close to Rs. 18000 for my treatment, but I still have a lot of discomfort and still sometimes in pain. I may have to go back but I am worried about the toll it would have.” The farmer we were talking to, ran inside his house and came back with a new insurance card under the Pradhan Mantri Jan Arogya Yojana (Ayushman Bharat scheme). “I made this new card. But I do not understand it. What do I do with this? Can I use this for my treatment? I went to a hospital but they said they don’t accept this card. Can you help me understand this?”
The problem solved- Often financing schemes do not reach beneficiaries or they may not know how to access them or in this case, how to use it. A health system that focuses on comprehensive care also looks into how care can be made affordable. However, education regarding insurance have still not percolated through the rural masses and could be a training point.
5. Community health workers (CHWs) can be a powerful medium to deliver comprehensive care
“I saw this young pregnant woman who was very weak. While she had been at her mother’s home, she was being well taken care of. She would regularly come to the Primary Health Center for her checkups during pregnancy,” said a midwife (a type of CHW in India). “But after she came to her mother-in-law’s home, she was prevented from coming for her regular checkups. I went to her house and told her mother-in-law that she needed to care for her daughter-in-law like her own daughter. I told her I would bring the village elders to her home and make sure she was held responsible if anything happened to her daughter-in-law.” We realised that CHWs can be a powerful force to address underlying social issues like these.
The problem solved- Health seeking behaviour i.e. preventive medicine is usually not a part of the treatment process and the patients usually approach the doctor after exhausting all home remedies and out of fear. The CHWs can effectively promote positive health-seeking behavior through screening, raising health awareness and home visits. CHWs bring the health system to the doorstep of patient, and are an agent for change in the way the community perceives healthcare.
True Story: A few years ago, I was a lone Medical Officer for a health related CSR project in remote rural villages in Gujarat. One day, as usual, more than a hundred patients and their relatives were sitting outside my make-shift clinic, braving the hot sun. All of a sudden, a man stormed in midst of my consult and accused me of taking too much time (I was seeing >20 people in 1 hour, with one health worker and one nurse to assist me). People started to gather around, curious to know what was happening and how events would pan out. I had heard stories of attacks on doctors. I knew about the mob mentality. I was frightened! What was better, fight or flight? How do I approach the situation?
But what happened next changed my perspective forever. Read on.
The safety of doctors has been an issue since time immemorial. Earliest studies of violence against doctors from the USA date back to the 1980s. 57% of emergency care workers in the USA have been threatened with a weapon, whereas in the UK, 52% of doctors reported some kind of violence.[2] In India, according to the IMA, at least 75% of doctors have reported as being exposed to assault (verbal, physical and psychological) [3] during duty hours. The incident that recently happened in Kolkata was a (yet another) wake up call in this direction. In India, where the allopathic doctor-patient ratio is low (1:11082) and not many doctors want to practice in the government or rural sector, doctors could be considered as a rare commodity and every effort should be made to protect them! [4]
So let us see what exactly happens. When a patient is no more, it is very natural that the patient’s relatives would grieve and try to console and counsel each other and form a support system. Some of the patient’s close relatives also look outward for support and to make sense of the profound loss. A popular theory about stages of grief according to the Kubler- Ross model are denial, anger, bargaining, depression and acceptance. Another popular theory (see pic) shows two possible outcomes of grief or a life-changing event – shock and denial or anger and bargaining. [4]
So when necessary support is not received by the patient in the first three stages phases, it leads to a crisis in grief management which can then lead to a violent outburst by the patients or their relatives. Also, there are several other factors leading to frustration which in turn cause violence. Few are listed here and may include:
Patient frustration factors
Doctor-Patient interaction times around the world. Source: Times of India
Long queues and wait times
No proper sitting, toilet or canteen facilities
After hours of waiting to meet the doctor, only 2 minutes or less time with the doctor
Inability to understand the doctor’s notes or their own condition
Expensive tests or medications prescribed by doctors they consider to be ‘money minded’.
Out of pocket expenditures forcing people to empty their savings or utilize money kept aside for a better life.
No sympathy or empathy and a very mechanised ‘assembly line’ delivery of healthcare.
Doctor frustration factors
Long working hours
Poor resources and infrastructure
Organizational pressures to accommodate more patients in a fixed amount of time
Better job opportunities, facilities and incentives elsewhere (in urban areas and private setups)
Patients doubting their ability and prescription and violent outbursts from relatives
Other causes include irrational behaviour and personal vengeance. Also politically or economically motivated violence against healthcare institutions and doctors is not uncommon. For instance, Yi Nao, which literally means healthcare disturbance, started in China and is now a worldwide phenomenon, where self-proclaimed ‘do-gooder’ gangs extort money from hospitals alleging malpractice and share the profits with the patients.
Coming back: I gathered courage and informed the people that I am doing the best with the resources and the infrastructure available and empathized with them for their patience, which was seconded by the community health worker. When the man refused to budge and stood towering before me, I politely informed everyone, the reasons why further consults are not possible due to the looming danger. What happened then surprised me! The health worker and the local people told me not to worry, got together and ushered the gentleman out. He was asked to seek healthcare for himself and his family elsewhere. They even involved the local bodies to keep the entire family away from me and the premises.
THE CURRENT SCENARIO
Several legislations, including state bills, both for and against the doctors and the patients, are already in place [6]. But even with stricter laws in the advanced countries, assault on doctors still happens. Also, in spite of several laws being present on the patient’s side, there is a perception that the doctors are well connected and often get away unscathed. Also, certain media sources present sensational stories where gangs have beaten doctors and have got away with it. All these instances embolden the people to take the law in ones own hands.
WHAT CAN WE DO?
As patients
Doctors enter the profession with a spirit of helping others and always use their best judgement in the interest of the patient. Also, a doctor is just another human being, constrained by his knowledge and experience, trying his best not to make any mistakes, as in this field there are no second chances. Also, you may be dealing with a doctor who is as frustrated and helpless as you (reasons described above). Thus, ideally, in times of distress, one should approach and handle the situation in a calm and dignified manner and take help from higher authorities if things don’t turn out as per expectations or if you suspect any foul play.
As healthcare providers
Doctors should understand that the patient is a stressed person with heightened emotions and is probably worried about the personal, professional and financial toll this ‘mysterious’ disease would bring. Doctors should involve the patient in their diagnosis and treatment process i.e. shared decision making and given the times, take due consent and properly document the case irrespective of severity. Empathy is currently not taught as a subject at med school, and being so important in our daily practice, we should cultivate it along the way.
As healthcare organizations
Healthcare organizations have a statutory responsibility to commit to the safety of patients and healthcare providers, and ensure that their premises are safe and free from looming danger. Periodically reviewing safety protocols, quicker response by authorities, training security personnel and senior officials in managing escalations, using counsellors and better community engagement to build trust, are few of the instances that the institutions can undertake to manage and reduce harm during a crisis.
As policy-makers
Stricter enforceable laws could be implemented. For example, one thinks over a few times before assaulting a police officer as it is against the law to lay hands while he’s ‘on duty’. An extreme example is lifetime punishment, recently given to a South-Mumbai businessman for a hijacking prank on a popular airline. Such laws and its enforcement may deter people from even thinking of hurting doctors as the consequences of their actions are severe.
However, none of these solutions is sufficient by itself, but by working together we can all play our part in improving the safety of physicians.
A community health worker trained by Intelehealth in rural Odisha evaluating a patient.
CONCLUSION
Violence in any form towards anyone is deplorable, as is inciting one towards it. Doctors, patients and policy makers should be aware of the problems faced and initiate a course correction in a dignified and respectful manner. Additionally, such situations highlight the importance of having a trusted community health worker (CHW) by ones side (i.e. as a doctors’ or peoples’ advocate) and it goes a long way in calming down such people or events, as they are at a better advantage since they belong to the same community and the people place their trust and full faith in them to work diligently and have their communities’ best interests at heart.
A happy ending: A few weeks later, I saw a young boy arguing with some of my patients and his toddler brother crying outside my clinic. The health worker informed me that they were the children of the angry man, and the father refused to take them to a physician as he had to go to work, and they were asked to go away. The elder brother had enough of his little brother’s sickness and had tried to sneak him in. He pleaded with me for help. I couldn’t punish the children for their father’s mistakes, I was no judge here, I was just a doctor!
After cajoling the crowd, I managed to let the toddler in, consult and send a note back with a neighbor. I sent the small boy home with a local sweet and a smile on his face that was sweeter
Goodman RA, Jenkins EL, Mercy JA. Workplace-related homicide among health care workers in the United States, 1980 through 1990. JAMA 1994;272:1686-8.
Nagpal N. Incidents of violence against doctors in India: Can these be prevented?. Natl Med J India 2017;30:97-100
Human Resources in Health Sector. National Health Profile 2018. New Delhi:Central Bureau of Health Intelligence, Directorate General Health Services, Ministry of Health and Family Welfare, Government of India; 2018:219
One of the major challenges in the world today that disproportionately affects developing countries is access to good quality healthcare. For example, according to the Lancet, the world average on health spending as a percentage of GDP is 8.7%. In South and Southeast Asia, it is about 4-5%. Consequently, there are less dollars to spend per capita, affecting metrics such as the number of hospital beds and the number of healthcare workers, leading to poor clinical outcomes.
As another example, take India. India has the unique competitive advantage of a demographic dividend, meaning that its working age population largely consists of youth (ages 15-34) and which could deliver greater economic productivity. For India to achieve its potential and thus its ‘dividend’, two pillars need to be strengthened dramatically – healthcare and education. Of these, the need for better healthcare is perhaps more pressing, because if a student is unhealthy, it affects his/her attendance, which in turn could adversely affect educational attainment and thus employment prospects–a vicious circle.
While private sector healthcare has taken off in India, it is by and large an urban phenomenon; rural areas are suffering. Only 20% of doctors are in rural areas, where approximately 70% of the Indian population resides, as per a KPMG and OPPI study in 2016. Also, the private sector accounts for 63 percent of hospital beds, according to a FirstPost article published last year.
Intelehealth, co-founded by Neha Verma and Dr. Soumyadipta Acharya, is a healthcare not-for-profit startup trying to mitigate some of those challenges. Critically, it is focused on improving the last mile problem. They’ve developed a unique low cost and low bandwidth telemedicine solution with four interesting aspects that I’d like to call out:
a. They’ve built a knowledge engine, with care protocols for over 70 primary care conditions.
b. This engine is used to train and empower existing healthcare/non-governmental organization (NGO) workers.
c. Through their software platform, doctors can review cases and submit their diagnoses/findings asynchronously.
d. To help scale, the software works on very low-cost smartphones, which can operate in extremely remote regions where there is woefully inadequate bandwidth.
The team is in the process of executing several projects and pilots across the world – from India to the Philippines to Syria. The results are very encouraging.
Healthcare is a very complex space and it is wonderful to see organizations like Intelehealth tackling these challenges. And I’m very glad to be associated with them as an advisor.
The dusty lanes of the Vidarbha hinterland painted a stark picture and grim reality. Despite the economic and technological advances elsewhere, life is an everyday struggle for existence in this hinterland. Interaction with many panchayat members brought up the age old issues of education, healthcare and livelihood. For such rural communities healthcare availability hasn’t increased much and the affordability has worsened. A health issue could often wipe out the savings of many years and push the entire family towards poverty. This is true not just in Indian hinterland, but in any part of the world which is as deprived. While it is a huge effort to increase the healthcare infrastructure in the long term, small investments in the connecting the unconnected and focusing on the right interventions will go a long way. New innovations in Telemedicine are making it effective at very low cost and low bandwidth and will greatly help the field workers.
Here are a couple of success stories from such an innovative non-profit tech startup – Intelehealth. In remote Odisha, there was a patient with chronic symptoms of kidney stones. The local doctor had asked a huge sum the patient couldn’t afford. The patient comes to the health worker, who using the Intelehealth app initiates a diagnosis with the remote doctor. With the remote doctors advice and help, he gets a surgery arranged under RBSY (Govt. health insurance scheme) at a fraction of cost, thus saving the family from years of debt. A great example of right advice at the right time at the door step.
In another instance, Intelehealth field worker’s 16 year old son suffered on injury to his head that required a major surgery. She sold her jewelry and mortgaged her farm to pay for treatment. Post surgery, her son suffered from frequent seizures and couldn’t join school or work. Debt made it impossible for her to pay for travel and treatment at a city hospital. He was one of the first patients at the teleclinic and the doctor was able to prescribe medications to manage his seizures. He has now joined a job and lives a healthy life.
Intelehealth was part of the first Cisco CSR & N/Core Tech – incubator for non-profit startup cohort. Having toiled for long in this space, I found the approach was refreshingly intuitive. It was proven to work by Dr Soumyadipta Acharya, a doctor turned technologist at John Hopkins and his team. The essence is to take standard medical protocols, codify them into a mind map, which in turn becomes a comprehensive questionnaire which the health worker uses to collect information. The responses get uploaded and summarized to the remote doctor who could provide a diagnosis and a prescription or ask the health worker to collect more information. All this work flow is enabled by a software stack using open-source components where possible. As Dr Acharya says the intent is to provide scientific, evidence based, and dignified care. Partnering him is Neha Goel, doctoral student at John Hopkins, who believes every life is valuable and to lead a happy, healthy life is a basic human right. An entrepreneur, technologist and a social activist all rolled into one she likes to take challenges head on. Together they co-founded Intelehealth as a non-profit along with Amal Afroz Alam and Emily Eggert in June 2016.
When you want to do something good the Universe conspires with you. Fast forward to three years later Intelehealth has built the software stack, and looking to scale its operations in India, Syria, Philippines and has an awesome team that believes in the vision. I am glad and excited to join hands with them to reach the remote corners of the world. While capitalism is widening the divide between haves and have-nots, we shall make every effort to use technology to reduce that divide.
