"The woman´s condition was serious but the doctors were helpless," Dr Amit Pokhrel, a doctor at the hospital, said. He said that the dilemma before the hospital at the time was whether to refer the patient to the nearest referral center, which is more than eight hours away by an ambulance. The hospital refers complicated cases sometimes to a nearby hospital at Pithauragadh, India, but on that day it was already dark and the border was closed.
Some health workers suggested that the child be pushed back and then pulled out using hands. "But we decided to take medical help from gynecologists at Patan Hospital," said Dr Pokhrel. He said that a gynecologist at the hospital cautioned them not to intervene in the process and asked them to wait."
"The child itself pulled its hands in and came out normally after 24 hours," he said, adding, "We saved both mother and child by the advice of consultant doctors."
Likewise, Bir Hari Rai, an auxiliary health assistant at the hospital shares an experience he said he cannot forget. He said that a man working as driver in India came complaining about backache. The man told them that he came to the hospital as he had heard that the doctors at the hospital treat patients using computer.
"We conducted X-ray and other examinations but could not diagnose the problem," said Rai. Later, doctors took him to a room fitted with a camera for consulting senior doctors at Patan Hospital about his problem.
Dr Pokhrel said that telemedicine service has proven a boon for the ailing people in the far flung areas, where doctors hardly stay and consultant service is a far cry. Hundreds of patients have benefited from the service. All patients cannot afford treatment at big hospitals. "With the start of the telemedicine service poor patients have been getting huge relief.
They have been getting consultant services at district hospitals," he added. People from some of the remote villages of Darchula walk over four days to reach the district hospital. Doctors, who used to refer patients to big hospitals, have halted the practice after consulting doctors through telemedicine service became possible.
Likewise, Tara Sunuwar of District Hospital, Sindhupalchowk said that health worker at the hospital, too, have direct access to consultant doctors of Patan Hospital since the hospital was linked with the telemedicine service. "The service has boosted the confidence of health workers like us," said Sunuwar.
Dr Gyan Kayastha, chief of Telemedicine Service at Patan hospital said that even the junior doctors serving in far flung have been getting benefit from the service as it is mainly meant for doctors and health workers. "They can contact us and ask about the problems," said Dr Kayastha. MBBS doctors do not know everything and they may want advice to minimize risks. "In that case, they contact us and we instruct them," he added.
Senior doctors of Patan Hospital sometimes use video chats to interact with doctors and patients of remote villages.
He said video chatting is very effective as doctors can have two-way communication with patients.
"We ask the doctors to bring patients before camera and give them instructions," said Dr Kayastha. Doctors at Patan Hospital, however, urge their counterparts working in remote regions to transfer the patients to big hospitals immediately if they find anything serious. Every day a senior doctor of six major departments of hospital serves in telemedicine center, which is inside the hospital.
The center said that 30 remote district hospitals have been linked to the service and three of them have video conference capability.
District hospitals of Humla, Mugu, Dolpa, Solukhumbu, Darchula, Bhajang, Sindhuli, Sindhupalchowk, Rashuwa, Bajura, Kalikot, Aachham, Jajarkot, Rukum, Rolpa, Gorkha, Pyuthan, Okhaldhunga, Mustang, Manang, Sindhuli, Taplejung, Sankhuwasabha, Dolakha, Jumla, Solukhumbu, Khotang and other three have been linked with the service. The center said that hospitals in Darchula, Sindhupalchowk, Gorkha and Rukum are the most active ones in making use of the service.
"Each day, 10 to 15 calls come from these districts," said Keshav Pradhan, a public health inspector at the center. He said that over 4,500 people have already received services from the center in the last 15 months. Pradhan said that expensive referrals to the regional and sub regional hospitals from district hospitals have been significantly reduced after they were connected with the center. "People in the districts have been feeling huge relieved from the service," he added. The center said that efforts are under way to have telemedicine services in all the districts.
Dr Gyan Kayastha, Chief, Telemedicine Service Center
How effective is the telemedicine service?
Huge number of patients from remote villages have been getting consultant services from the center. Even ailing people in the capital have to wait to see consultant doctors but we have been providing care every day to patients from far flung areas. They can have easy and direct access with consultant doctors. Thanks to technology, we have been providing clinical care through telephone and internet. Patients can put their queries in ´hello health´ hot line number. We answered their calls and tried to resolve problems. Junior doctors and health workers serving in district hospitals and remote villages are finding telemedicine service quite useful. They can easily contact us and ask us about the problems. Several doctors and health workers said that the service raise their confidence level. Several lives in remote villages have been saved and risks have been mitigated after the service came into operation. Over 4,500 people received telemedicine service from the center and each day over 200 people contact "Hello health."
What are the challenges to operating the service smoothly?
Bad internet service is a major hindrance in establishing proper communication. We are working to connect with NTC´s ADSL service. We hope that the services will be much more effective after the internet becomes faster. I´d like to urge the government to arrange fast internet service so that we can directly chat with health workers and patients.
With introduction of video conferencing facility, district hospitals find it easy to consult with experts. This facility should expand to all districts. The telemedicine service is currently available only in 30 districts but we are expediting works to link all the districts.
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Autor(en)/Author(s): Arjun Poudel
Quelle/Source: Republica, 29.05.2013
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