Time for treatment from afar

SM Mominul Islam Mukut, who works at a bank, went to a private hospital in Uttara on March 21 after suffering from fever and low blood pressure.

The doctors at the hospital refused to treat him and suggested he go to a government hospital which provides coronavirus treatment.

"The doctors heard that I had a fever and refused to examine or treat me," said Mukut.

"I was getting worried as I continued to weaken."

So, what do you do if you have a medical need or emergency when many hospitals are allegedly turning away patients with symptoms of regular flu or fever as doctors don't have enough PPE? When a transport shutdown is being enforced and you also don't want to risk going to a hospital where there are too many people?

You may not be able to physically visit your doctor and vice-versa, still a "visit" is possible via phone or videoconferencing.

Though telemedicine is yet to be popular in the country, some medical organisations do provide remote consultation for general ailments and offer medical advice over the phone and digital platforms.

Daktarkhana, for example, is a platform of 80 young general physicians who are currently providing a free telemedicine service.

With the help of an acquaintance, Mukut came to know about Daktarkhana. With the prescribed medicine and regular advice of a doctor through the service, he was soon feeling better.

"When I called the doctor, he first took my medical history and symptoms. He then prescribed some medicine, gave some advice, and asked me to update him about my health condition over the next five days," he said.

Abul Ala Al Mesbah, an internal auditor at a private company, said he had a dry cough since he returned from a work trip in Dinajpur a couple of weeks ago.

"I wouldn't have been anxious if the coronavirus outbreak hadn't happened."

Common symptoms of COVID-19 are fever, tiredness, dry cough and breathing difficulty.

He called a doctor through Daktarkhana and took the medicine and medical advice he was prescribed. The experience prompted him to share his experience on social media so that more people are aware of services such as this during this time.

Following the coronavirus outbreak, Daktarkhana started the telemedicine service through six phone numbers from March 19, said its founder Dr Ratindra Nath Mondal.

From March 27, it started providing telemedicine services from doctors in all 64 branches in the country.

Till March 30, the organisation has served 396 patients over the phone. Patients can also communicate their health condition over direct message on Daktarkhana's Facebook page.

The service has mostly been getting calls about the seasonal flu symptoms, which share some similarities with coronavirus symptoms.

Olwel, a Finland-based startup aiming to bring healthcare services to patients' doorsteps by sending doctors to their home, has also started a video consultation service from March 21.

Every day, on average, it has been serving at least 15 patients.

Patients call the hotline first and later, a video call is arranged with an internal panel of doctors, consisting of both general practitioners and specialists.

"To get consultation from general practitioners, a patient needs to pay Tk 200. For specialists' services, patients have to pay between Tk 400 and Tk 800 through bKash," said Dr Farzana, medical officer at Olwel.

Eminent physician Dr ABM Abdullah opines that such services are commendable -- especially when people with quite general health complications are panicking at this time.

"I recommend these services continue during this crisis."

HOSPITALS JOINING IN

After seeing a decline in the number of outdoor patients and absenteeism of doctors due to lack of protective gears, the government hospitals too are turning to telemedicine and tele-consultation.

Brig Gen AKM Nasiruddin, director of Dhaka Medical College and Hospital (DMCH), said they are going launch the service soon through a hotline number.

"Doctors of surgery, obstetrics and gynecology, pediatrics, cardiology, emergency, and the administration's numbers will be linked to the hotline number so that the patients can choose who to talk to. It will be a 24/7 service," he said on Wednesday.

If they receive positive feedback, they will expand the service in the future to all departments, he added.

Bangabandhu Sheikh Mujib Medical University (BSMMU) has also started a telemedicine platform recently, said Vice Chancellor Kanak Kanti Barua.

"We have already promoted the service through press releases and television scrolls," he said. The hospital aspires to involve 200 physicians in this service.

For the past two weeks, 10 doctors of the Satkhira Sadar Hospital have been providing healthcare services over the phone. In addition, the Bangladesh Medical Association (BMA) of Satkhira also made public the numbers of seven of their doctors recently. 

Md Shahinoor Hasan, a medicine and neurology specialist, has been on-call over the phone on behalf of both Satkhira Sadar Hospital and BMA Satkhira. He has attended daily calls from patients, mostly related to viral fever, regular flu, and asthma.

"We are telling them to stay home, prescribing medicine, and giving advice. If they continue to suffer for more than two or three days, we suggest they visit our outpatient services," he said.

"For those with severe flu symptoms, we suggest they come to the flu corner of the Sadar Hospital."

Mugda Medical College Hospital in the capital has started the service with three dedicated numbers from March 26. They have received between 80 and 90 calls per each eight-hour shift.

Besides, a number of private hospitals have also initiated telemedicine and video consultation for their patients.

On March 28, United Hospital set up telemedicine service for those with urgent medical needs or those needing routine follow-up.

After taking an appointment by calling at the hospital hotline numbers, a patient is connected with their preferred consultants via Skype. Patients can also take pictures and share their records via Skype or email prior to a session.

Labaid Specialised Hospital initiated telemedicine and video consultation services with three consultants from March 28. The response rate has been promising, said Chowdhury Meher-e-Khuda (Dip), public relations officer at Labaid Group.

"Although we were yet to promote it through mass media, to our surprise we even got calls from the northern part of the country," he said.

Popular Medical College Hospital started the service with four consultants from Wednesday, and received eight calls about viral fever and flu on the very first day. "They are calling us driven by panic," said Dr Ishtiaque, hospital coordinator of Popular.

However, a phone call, message, or video-conferencing may not work for patients with medical emergencies and with health issues difficult to diagnose without firsthand examination.

Telemedicine can only be applicable for the primary step of healthcare, said Dr Rashid-E-Mahbub, chairman of the National Health Rights Movement Committee.

"Since most patients are reassured when they talk to a doctor about their health problems -- from this perspective, this is surely a positive thing," he added.