Asad Ullah tossed in bed with high temperature and body ache, stranded in his room too afraid to seek medical help. He had been employed in the United Arab Emirates (UAE) for the last ten years, and was sharing accommodation with other bachelors in a flat. A lockdown had been put in place due to rising coronavirus cases. His flat mates suspected him of having been infected by the virus. But they appeared to be too scared of him, due to his health condition and a lack of awareness, to be able to help him.
Asad Ullah had been ostracised. The solitude stressed him further.
During that same time, rumours surrounding baseless fears of a poisonous injection (zeher ka tika) based on false conspiracy theories being given to people showing COVID-19 symptoms had started making rounds, both in Pakistan and among the lower-educated Pakistani communities abroad. His family and friends back home kept asking him not to go to the hospital. It had been an entire week since he first fell ill. Then he heard about a telemedicine service offering medical help through phone or online platforms, from one of his relatives. Asad Ullah was unaware of any such facility in the UAE back then. After consulting with his friends, he finally made a call to use the telephone medical service, and spoke to a doctor in Pakistan. He was not only prescribed medicine but was also given courage and hope.
The Young Doctors Association Khyber Pakhtunkhwa (YDAKP) says that during the first wave of coronavirus, hospitals across the province were filled with patients, and a majority of the people tried to stay at home even if they were ill. On the other hand, doctors struggled in the hospitals. They were too busy dealing with cases making their way to the hospitals. Where possible they would try to avoid seeing patients physically. With a lack of protective equipment, doctors say they were unable to ensure their own protection from the virus. They were not in a position to even visit their families. But the burden of unattended patients kept on increasing.
Amid the crisis, doctors in Khyber Pakhtunkhwa (KP) decided to initiate a mobile phone service to provide medical advice to patients unable to visit the hospital while also ensuring less physical interaction with patients during the COVID-19 wave. The mobile phone service was called YDA Telemedicine.
The decision for the initiative was taken after members of the Young Doctors Association (YDA) discussed problems pertaining to the unavailability of medical consultation for patients due to COVID-19 burden on health infrastructure. They decided they must work to provide relief to the patients. At first, they shared specific mobile phone numbers on social media and on other platforms on which patients could call them directly seeking medical assistance. Later, many issues arose, one of them being the volume of calls they would receive on the numbers rendering them unavailable to those calling in. To cope with the situation, the Public Health Association (PHA) provided them with a universal contact number and mobile phones. This streamlined the process.
Dr Rizwan Kundi, president of the YDAKP, says that during the early stages of the first wave they would attend to patients on their personal mobile phones and offer medical advice. They would do this after their routine duties at the hospital, which meant all of this amounted to extra work for them. At the time, he recalls, all OPDs had been closed down due to fear of further spread of the coronavirus. This is why, he says, they decided to rely on telemedicine to cater to those patients who were unable to get medical advice due to COVID-19 fears.
Dr Kundi estimates that 60 to 70 per cent of the patients visiting OPDs require medical consultation for prescription of medicine. These patients, he says, didn’t require any formal visits to doctors, particularly during the COVID-imposed restrictions. But the rest who required in-person or physical checkup or surgery faced many difficulties. To deal with the issue, he says they would suggest and connect such patients to nearby doctors for physical visits.
All facilities which are usually available at the OPDs were provided through telemedicine. Apart from doctors who volunteered for the initiative, duties were divided into shifts (morning, afternoon, evening and night shifts) to ensure the provision of a 24-hour service. The doctors not only facilitated the patients directly, but through telemedicine they also helped other relief departments like Rescue 1122, where a team of doctors assisted in medical-related relief.
President YDAKP claims that through their telemedicine initiative, they attended to 200,000 patients – with records of patients and their medical consultation available with them in voice call recording or on WhatsApp.
Moreover, doctors say the false conspiracy theories surrounding claims of poisonous injections were widespread in the province. Doctors who would come to know of a patient avoiding the COVID-19 test, in a bid to hide their infection, would try to talk to them to encourage them to go for the test while also dispelling their fears. During the process, doctors would identify areas where they felt patients were high in numbers so that the government could accordingly impose stricter measures to avoid the further spread of the virus in other areas.
Dr Kundi says their initiative benefitted people both in Pakistan and those Pakistanis who lived abroad. He says during the first wave he had heard of many people who died of coronavirus in Gulf countries, away from their homes and among people who were too scared of the virus to offer any help to them. He says the initiative offered medical advice and help to people for a good 5 months.
Dr Muhammad Izhar, a nephrologist working at the Institute of Kidney Diseases in Peshawar, when once done with his over 8-hour long duty at the hospital would pick up his phone to listen to patients calling in through their telemedicine set up. He recalls that period being particularly stressful. Physical examination of patients were very difficult requiring him to keep a six-feet distance while clad in protective equipment as part of safety measures. Dr Izhar recalls everyone was anxious at the time, even doctors. While physically examining a patient physically, he says much of the responsibility to ensure safety fell on the doctors and the nursing staff since people would not take it seriously. Doctors, he says, had to keep the patients and themselves safe – an altogether challenging task for them.
Dr Izhar says they had no choice but to keep going. They simply had to keep themselves motivated. Recalling the time, he says frontline healthcare workers only had themselves to keep their motivation going, even when they faced immense personal health risks due to a lack of protective equipment.
In the earlier days of the pandemic, there was an acute shortage of safety kits, sanitisers and even masks. The situation was all the more threatening for doctors and healthcare workers. Dr Izhar recalls they had to get their own safety equipment at first, with little to no assistance from the government in this regard.
Dr Izhar says going into self-isolation was very difficult for doctors. After treating patients in high-risk COVID-19 wards, they were a risk to family and friends as well because of their own high exposure to the virus. It took a lot to deal with this sort of social isolation during the pandemic. But for frontline healthcare workers, there was no other way to deal with the situation.
Along with the telemedicine initiative, doctors available on this platform decided to provide their services of physical examinations to patients outdoors instead of examining the patients indoors. Dr Izhar says healthcare workers understood the risks they faced each day but also realised the significance of the oath they had taken – to protect and serve the people.
Photo by National Cancer Institute on Unsplash
Fatima Nazish is a journalist from KP who has reported on diverse range of issues, including election campaigns in 2018, polio eradication, girls' education in Pakistan, minority rights, among others.