TELE-MEDICINE IN SERVICE OF HEART PATIENTS

Prof Dr. (Major General retd) M.M.H Nuri, S.I., (M)

Technology with digital revolution has invaded practically all aspects of contemporary life. Tele-medicine is now in vogue in many developing countries and is also now being tried in Pakistan.

It is convenient, less costly, speedier and effective. By reducing healthcare costs, raising care accessibility, and even helping to improve patient outcomes tele-medicine is essential.

Nearly a half century ago, Dr. Martin Luther King, while addressing the May Day workers highlighted the role of essential service of workers, laborers, doctors and caregivers — who generally remain un-recognized, invisible and undervalued.

After the global COVID-19 crisis in late November-2019 and still ongoing it has become imperative that we shall have to rely more on technology in the management of other chronic diseases as well, besides Corona virus.

In fact, other major diseases are part of the health landscape and get exacerbated with the virus: heart conditions, diabetes, respiratory and many others, impairing human body’s immune system.

Creditably, during this current crisis, Pakistani doctors, nurses, paramedics and caregivers have been in the ‘frontline’ while coping with the deadly virus — thus earning gratitude and good will of the Pakistani nation.

Why there is now a pressing need for adopting tele-medicine?

The sudden, rapid outbreak of COVID-19 has over-whelmed health infrastructure, including hospitals, trained doctors, nurses, para-medics and equipment. While the avoidance measures taken during the ongoing Covid-19 virus through segregation/ quarantining are important, other serious health -related conditions cannot be ignored. This makes employment of tele-medicine service a dire need.

It is often said that desperate situations call for desperate remedies. Earlier the suspension of transport services, businesses and partial lockdown of public places, restricted timings in hospitals, curbs on travel and public gatherings –- all made easy access to hospitals difficult. Particularly, patients from the rural areas were hard hit when faced with pre-existing chronic medical conditions. The situation continues to date.

Moreover, travel and commuting restrictions enhances vulnerability to the virus and exposes them to contagion; even waiting and assembling in hospitals for consultation poses a greater risk. So, the economic constraints and difficulties of travel and gathering need to be minimized. Repeated visits are to be avoided, unless very necessary.

As for use of tele-medicine, clinical records of patients are properly maintained, a contact is made for an appointment. This contact reviews progress, makes alterations in medicines, if needed, and addresses any complaints or queries.

It makes the doctor- patient contact active through mobile (now available to many), reassuring patients who face seclusion under the lockdown. Albeit not perfect, it is experienced that short conversation with a doctor on his/her condition is very therapeutic and gratefully appreciated. It relieves anxiety, depression and uncertainty. This is also true for the near and dear ones of the patient in the household.

If any further tests are required they can be done and medicines required are suggested. Hopefully with the end of lock down, if and when it occurs, they could travel and have a follow up in person meeting.

The recent illnesses and death of doctors during Covid-19 crisis and nursing staff are unfortunate incidents; tel-medicine and provision of anti- virus personal protection equipment (PPE) to doctors, nurses, medical and administrative staff can protect them against infection.

-The procedure runs like this: A cardiologist/ heart specialist with record of heart patients at the hospital makes an appointment for free consultation with the patient / family through the hospital staff. The patient is approached on-line and narrates his/ her condition, maintenance medicines and complaints/anxieties, if any. To this, the doctor responds with suggestions combined with counseling.

-Tele- counseling experience has proved to be very therapeutic. Under isolation, a conversation with a caring doctor is reassuring and, in fact, uplifting to many patients. Most of the patients are elderly, men and women who need approachability and assurance that they are still looked while confined in their homes.

-It is less costly as patients can avoid gathering in large numbers: they are satisfied in lesser time, avoid travelling, and waiting for appointment.

-As experienced, besides the specific medical issue, it is the gnawing fear, uncertainty and lack of communication. Alienation often compounds the disease. When normal business activity hopefully re-starts they can always physically come and discuss their cases.

Having empirically observed the positive effects of tel-couselling along with medic care, the results have been very encouraging. Granted, it cannot substitute for the physical proximity and close physical examination but under the circumstances it is very beneficial for patients.

Verily, lack of education and health facilities are going to remain as future challenges after the covid-19 crisis: the brunt shall be however faced by developing countries. Besides un-employment, food insecurity, plummeting economy, disruption of supply chains and low production — will be compounding health issues.

Health care has been neglected in Pakistan, barring the well-endowed few who can easily afford; unfortunately, the virus has aggregated the adverse effects of chronic ailments. But, hopefully, these systems are being streamlined by improving tele-medicine infrastructure, training and equipping of staff, improving capacity-building and streamlining the SOPs.

For this, a sine qua non is the medical staff’s humanity, dedication and expert care. Adhering to Hippocratic oath, but more importantly, imbibing values of True Islam, is the care for the old, sick and under-privileged sections of the society.
The humble contributions made by the state-of-the-art charity hospital, Tahir Heart Institute, Chenabnagar, Jhang, is blazing a new trail. For the last decade, it is rendering humanitarian medical services to the poor, needy and the sick, especially in the impoverished regions of central and southern Punjab. Together, the affiliated Pakistan Humanity First, a welfare organization, is also working with committed corps of workers in Thar on medical and poverty-alleviation programs. Ventilators are made, personal protection equipment is locally made, masks sanitizers and food provided through volunteer contributions. Overtime, this is envisioned to expand to other regions in the country.

Ending on a philosophical note: Things are constantly changing during the Covid–19 pandemic, yet two things remain the same. First: the quiet assurance of a beautiful sunrise over river Chenab, and at night, the brightly- lit stars; secondly, the prompt medical response to cardiac emergencies in Tahir Heart Institute (TTH) and the unstinted care of its devoted staff.
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—-The writer is presently Executive Director of Tahir Heart Institute, Chenabnagar–Rabwah, District Jhang, and former Commandant, Armed Forces Institute of Cardiology (AFIC), Rawalpindi. He is also Chairman of Pakistan Chapter of The Humanity First.

-Tahir heart Institute (THI) is a charity hospital run on private donations from by Pakistanis.

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Date: 5 May 2020

Thanks for,

Muhammad Aslam

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