Telemedicine is here to stay even after the pandemic

The idea was to bring healthcare to people living in remote, isolated places. A team of five entrepreneurs developed a digital platform to make it happen – at a time when technology enables higher outreach at a cheaper price.

In December last year, when they sought permission of the health directorate for providing telemedicine services through the platform, a lack of policy became a barrier. 

Three months later, virtual healthcare services emerged to be an undisputed way to contain the spread of Covid-19. And Doctor Dekhao got the go-ahead from the ICT ministry along with many others. 

Now, more than 20 such telemedicine service providers are listed by the ministry on corona.gov.bd. 

They provide healthcare in different capacities: some for free, round-the-clock, while others charge patients for services.  

Telemedicine has never been more popular in the country. It is probably the best option for doctors to continue providing healthcare and patients to get their services now while keeping Covid-19 at bay. 

If the new momentum brings changes in healthcare practices, the post-pandemic time will depend on service providers' ability to gain the trust of clients and regulatory bodies' overseeing their operations to ensure quality healthcare. 

However, socio-economic realities and the highly incapable healthcare system make a convincing case for telemedicine.

A heavily-pregnant woman living in a village far away from city centres in Gaibandha might panic over the baby not moving in her womb for a while, and her journey to the nearest hospital can be exhaustive during odd hours, for example.

A phone call to a doctor at the time can save her energy and money if she has nothing to worry about. If she is advised to get medical attention without delay, her life can be saved. 

The pandemic also made pregnant women, children and elderly patients more vulnerable. They are a majority of those seeking virtual visits now, said Dr Mohammad Nayem, head of operations of Doctor Dekhao.

"Our key objective was to set up a referral system which is now absent in the healthcare system here," he said. 

In a typical Bangladeshi scenario, with or without Covid-19, a patient decides where to get treatment and from whom. 

With no idea about medicine, a patient goes from one doctor to another. Doing so, he may run out of money and end up getting no healthcare. 

Explaining the benefits of the referral system, Nayem said, in most cases, general practitioners can prescribe treatment for simple health problems, and can refer patients to specialised doctors when necessary. 
 
"It saves a lot of money if one pays a visit to a general practitioner first for any health issue." 

Doctor Dekhao has a pool of in-house doctors who play the role of general practitioners in virtual visits. They are available round-the-clock by rotation, and each visit costs Tk100.  

To use the platform, one has to download the application on a smartphone and fill in personal details before requesting video calls. 

Since March, a thousand phone calls were made through the platform on an average every month. 
 
Experts think telemedicine cannot replace the traditional in-person visits, but it can help reshape the health system for the better. 

"The efficiency of telemedicine depends on how the man behind the machine is working, if he has the appropriate training," said Professor Ridwanur Rahman, former head of the medicine department of Shaheed Suhrawardy Medical College and Hospital.

Many people living in villages do not have access to healthcare. Virtual visits through phone calls, audio or video calls can be a solution to that, lowering the misuse of drugs, and the mortality rates of mothers and children, Ridwanur added. 

Narrowing down the healthcare gap between rich and poor, and rural and urban populations is the motto of the social business Digital Healthcare Solutions, another telemedicine service provider under the Grameen Telecom Trust. 

It partners with different organisations to take the service to the most disadvantaged population ofsociety and makes health financing accessible through micro health insurance.

"The biggest challenge for telemedicine has been that of adaption. Covid-19 has helped fast-track the practice," Sajid Rahman, chief executive officer of Digital Healthcare Solutions, said.

Praava Health, a healthcare and diagnostic facility, also seized the opportunity like Doctor Dekhao.

Operating since August 2017, Praava has shifted its focus to telemedicine from face-to-face services. Its brick-and-mortar existence caters to a small percentage of clients now amid the fear of infection.  

More patients are now interested in seeking treatment from home, by phone, instead of in-person, said Kutub Uddin Kamal, head of communications at Praava. 

Doctor Dekhao is now receiving calls from individuals from across the country. 

To reach out to more people, it is engaging agents, who set up pharmacies and have been in the drugs business, to connect patients with the platform. 

The platform has agents in 15-20 districts, and targets covering the other districts soon, Dr Nayem said. 

The platform has recently welcomed specialised doctors on board as some people prefer them over general practitioners, he said.

"The appointments are made when these doctors agree to spare some time besides their regular job." 

For medical examinations, patients are advised to go to the nearest trusted facilities, and the test reports can be uploaded online to a secured place. 

Doctor Dekhao issues e-prescriptions and stores patients' personal history and health records.  It also reminds the patient when to take medicine through text messages.

Praava has separate teams to collect samples from home within Dhaka and send reports by email. Patients can check their test reports and other data on thePraava mobile application.

Whether telemedicine will hold onto its current momentum remains to be seen. But the service providers believe it will.