Covid positives: Telemedicine and awareness

As the World Health Day was observed on Friday with the theme “Health for All”, Covid-19 reared its head again with cases rising. The focus is back on doctors who were at the forefront of the pandemic, when it first struck, and risked their lives. But what Covid taught and explored successfully was the use of online services.

“See, the life of a doctor has changed a lot after the pandemic,” says Rohan Krishnan, president of Federation of All India Medical Association (FAIMA), a national voluntary organisation of young Indian doctors.

“The two things we got acquainted with were telemedicine and psychological stress. In telemedicine, we don’t see the patients physically. A lot of patients and doctors, especially seniors, are focusing on this nowadays. As for psychological or mental stress, we suffered a lot of it during the pandemic as many of us lost our relatives and colleagues. During Covid duty, it wasn’t just us who faced the risk but also our family members, who could possibly get infected. It became dangerous for our families,” he said.

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Dodul Mondal, Associate Director, Oncology, Max Super Speciality Hospital, Saket, agrees.

“After Covid, ‘Online Healthcare Facility’ emerged in healthcare. During Covid and lockdown, all activities became online. We checked the patient via video or WhatsApp. As a result, today, many activities in health are online, which we couldn’t imagine before. So, our traditional healthcare system has changed and it is clear that online healthcare is accessible and not as bad as we thought.”

Mondal says that ‘care gap’ is the focus on this World Health Day although it has thankfully shrunk from what it was earlier.

“This World Health Day also focuses on the ‘care gap’ between doctors and patients. During Covid, this gap increased because patients were unable to access the doctors, but now this gap is shrinking.”

Growing awareness

Awareness has also grown and doctors are panicking less nowadays in the face of Covid.

Manish Jangra, a Delhi-based dermatologist and founder of FAIMA, recalls the initial stages of Covid and compares it with how things have changed now.

“Three years ago, when the pandemic first came to light, and we heard about the first few cases — five coronavirus patients had been admitted to Dr Ram Manohar Lohia Hospital’s (RML) Covid ward, we were scared of even passing by the ward for fear of coming into contact. When we first went on Covid duty, it felt like we were going to war. We lived in quarantine and heard news of doctors dying on duty. After 10 days, we felt anxiety and depression during duty.”

But things have changed now.

“We have now started to take Covid as a normal flu. People have become aware of the disease and started to take precautions, so awareness has grown, and they don’t feel any fear,” he says.

Jangra wants the government to focus on building efficient health infrastructure.

“On this World Health Day, we suggest that the ministry should try to make health infrastructure efficient. Our doctors are very talented and if the government provides them with good facilities, they will do better and not go abroad.”

India’s healthcare infrastructure remains grossly inadequate and falls short of the minimum World WHO requirements. WHO recommends at least five beds for a population of 1,000, 10 times more than what the country has accomplished since its freedom.

More challenges

And since Covid pandemic, over the last three years, the health sector has faced further challenges.

“When the first wave of Covid was subsiding, for a moment I thought that people will start taking the efforts and work of medical personnel a bit more seriously. We were taking personal risks every day even before Covid came into picture. We were exposed to multidrug resistant TB, extremely drug resistant TB, HIV, Hepatitis B, Hepatitis C and other infections that could be fatal. Covid just brought all this to the focus of public discourse,” says Dr Siddharth Tara, General Secretary of Progressive Medicos and Scientists Forum.

And it is not just the risk of infection. The work drains them emotionally.

“We have an isolated life of labour. We lose our youth in pursuit of knowledge and skills required to save human life and improve its quality. Doctors have first-hand experience of seeing morbidity and mortality of others closely. We have the highest risk of suicide compared to any other legal profession. And on top of that, there’s risk of violence at workplace. I thought Covid-19 would bring all this to light.”

Dr Tara was left disappointed and disheartened after the second wave in 2021. He believes things haven’t improved.

“When the second wave hit, it became clear that all the taali and thaali adulation was just a distraction. Neither policy makers nor public in general learned any lesson from the first wave. And I still see no real change.

“Because Covid-19 duties were considered too risky especially in the beginning of the pandemic, policy-makers knew that given the pathetic state of our public health and medical infrastructure and lack of safety resources, they can only deploy the kind of labour that will not mutiny. That kind of labour was available only in medical colleges and teaching hospitals in the form of resident doctors pursuing academic courses, who are always fearful of losing their hard-earned PG seats. Thus, most of these teaching institutions were converted into dedicated Covid-19 centres overnight.”

Dr Tara adds that since most of the hospitals, dedicated to Covid-19, were government-run and public-funded and the only option for the poor, patients with other illnesses suffered.

“Those patients, who had other diseases but weren’t Covid positive were turned away from these government hospitals where they have been patients for years or were awaiting important procedures. Thus at least in the beginning the strategy to fight COVID-19 was not only exploitative for resident doctors but also discriminatory towards the poor of this country,” he says further.

According to him, the meaning of healthcare has been restricted to medical care only and that tends to ignore the education, sanitation and nutrition part that deals with prevention.

“That worsened during Covid. People forgot about Anganwadis and Asha workers and the resources they needed in the fight against Covid. With Covid-19, it was the education and prevention that was most important. Panic and fear kept people from reaching out for care that they needed. And it is there that the existing system failed,” concludes Dr Tara.

Helpless doctors

Krishnan says that the doctors found themselves helpless as the health infrastructure had collapsed.

“We all were helpless. The entire health infrastructure in the country had collapsed. Patients were also suffering — surgery, dialysis and other ailments were also there. It was not only in India but a worldwide phenomenon. A little bit of distance was created between the doctor and the patient. But now, it is rebuilding, after multiple counselling,” says Krishnan.

Krishnan adds that the focus of FAIMA would be work on violence against doctors as well as mental stress which has been aggravated due to Covid.

“Many associations work on different levels on ‘World Health Day’. FAIMA will work on violence against doctors and mental stress among healthcare workers. India has the highest suicide rates among doctors. We seriously need to think about that,” Krishnan concludes.

Mondal says, “Because the doctors were at the forefront during Covid, their lives were impacted adversely. Their physical and mental health were badly affected. Those who were in emergency ward or Covid duty, they witnessed thousands of deaths. They were helpless in saving lives and that was a big mental issue for them. Often doctors would fail to arrange a bed for their Covid-affected family members even in their own hospitals.”

Mondal also says that many doctors lost their jobs which contributed to the pressure.

“Many doctors lost their jobs and some were forced to take voluntary retirement or salary cuts. These stories couldn’t come out (published anywhere) but it happened. They badly impacted the mental health of the doctors.”
Karan Juneja, member of Indian Medical Association’s (IMA) standing committee for Junior Doctors Network feels that the doctors were ignored completely during the pandemic but now the patients are more aware and conscious now.

“During lockdown in the pandemic, all citizens had lived with their families but we doctors were separated from our families for around a year. The government didn’t do anything for the doctors who had died in Covid. Some of the deceased doctors are not in the death list of the government even now. But IMA has helped them. After Covid, all the doctors have been turned ‘Covid specialists’ since they were all on covid duty irrespective of their departments. Even emergency surgery was put on hold,” says Juneja.

The positive impact

But Juneja says one of the positive impacts of Covid was that people have become more conscious and aware of the ailments and diseases. “If anyone feels a minor problem in the throat, he will try to go to a test to confirm whether it is normal or whether there are Covid symptoms!” adds Juneja.

“Also, before going to the doctor, they search about symptoms and ailments or watch videos on Youtube. It means, there is health awareness.”

Juneja adds that the respect for doctors and awareness has increased among patients but the focus has shifted to Covid at the cost of other diseases and ailments.

“The government should encourage children to wear masks, wash hands and create an awareness programme at school level. The IMA will organise a programme on World Health Day on April 7. We will burn candles and do other health awareness activities for good health for the country,” concludes Juneja.

Mondal wants the government to reduce the waiting period and bring it to the level of private sector. “I think our healthcare system is going to depend more on the private sector. The government should reduce the ‘waiting period’. I think awareness is the key to success in cure.”