‘Doc, you’re wanted online for consultation’

‘TV-wala doctor’ is how the villagers in Kundli Nadi describe the consulting doctor who appears on the screen during a telemedicine session. Sipping tea at a stall near a health and wellness centre in Sawai Madhopur district of Rajasthan, a group of villagers, mostly elderly ones, talk about how this new facility has transformed healthcare in the village ever since the sub-centre was converted into a health and wellness centre.

Earlier, for even the smallest ailment, the villagers had to trudge to the nearest Primary Health Centre (PHC) in Bharoti, six km away. Now, routine checks are carried out at the centre and the TV-wala doctor hears them out and prescribes a treatment.

Ninety-three-year-old Hari Narayan recalls that he had been suffering from chronic constipation and did not know what to do. “I got relief within three days after taking the medicine prescribed by the TV-wala doctor.”

Optimum use of innovation

The Kundli Nadi centre is equipped with a ‘Swasthya (Health) ATM’, an IT enabled, automated three-in-one healthcare system that includes consultation with the doctor through telemedicine, basic diagnostic tests, and a vending machine for medicines.

It is one of the many health facilities in Rajasthan (these include PHCs, Health and Wellness centres and sub-centres) that are run by the Wadhwani Innovation Sustainable Health Care Foundation (WISH), in collaboration with the State government. The objective is to improve the overall quality of rural health in the remotest of villages, reduce ‘out of pocket’ expenses and give “a sense of satisfaction” to the beneficiaries by making optimum use of innovations, says the CEO of WISH, Rajesh Ranjan Singh.

Take the case of 20-year-old Kunji Lal. He walks into the state-of-art facility complaining of a headache that becomes more severe in the evenings. He has been to the centre earlier and his history is already stored on a tablet. Lal is addicted to gutka . His vitals are checked by the General Nursing and Midwifery (GNM) professional, including weight, blood pressure, body temperature, pulse rate and pulmonary function. He has low blood pressure.

A call is made to the Mahatma Gandhi Medical College hospital in Jaipur. On the screen appears the names of available doctors. The Health ATM operator chooses a general physician.

The lady doctor at the hospital in Jaipur is luckily free from seeing local patients as it is almost nearing lunch time. She appears on the screen and listens to Lal.

Within minutes, the doctor’s prescription comes on a printer attached to the Health ATM. The printout is scanned and fed into a vending machine and the medicines slide out of it. The Kundli Health and Wellness Centre has a dedicated internet connection to facilitate telemedicine. The villagers are happy that they can consult the doctor and get instant treatment without paying a penny.

“Well, it may not give the same feeling as seeing a doctor in person but we are happy with the TV-wala doctor,” says Ram Dhan Meena.

He says earlier they had no choice but to travel to the PHC in Bharoti and as there is no public transport, they had to take a lift from villagers on a tractor or trolley. “ Ab to hum Bharoti jana hi bhool gayen hain” (With this facility, we have forgotten about Bharoti), he says, echoing the sentiments of several villagers we met.

One of the significant features of the PHCs run by WISH is that they are open 24x7 and can cater to accidents, emergency situations and deliveries.

Recalling a recent incident, Dr Tej Ram Meena, Medical Officer at the PHC in Marlana, says that on February 2, he received a call at 3.30 am that a pregnant woman on board an Express train on its way to Mumbai was experiencing labour pains and there could be an emergency situation. The call came from the station master at Marlana where the train was yet to reach.

The doctor immediately rushed the GNM and other staff to the station. There was no time for the woman to be brought to the PHC. A berth on the train was cleared and the PHC staff managed the delivery on the train itself under the supervision of the doctor. Later, the woman and her newborn baby were brought to the PHC in an ambulance and necessary medication and immunisation was done.

Well-equipped facilities

What makes the PHCs more effective is that they are well-equipped. The one in Bharoti not only runs round the clock, but also has a mobile path lab that can carry out 37 tests, including those for kidney and liver functions, malaria, typhoid and lipid profile. It also has an auto tele electro-cardiogram on mobile (ATOM) in addition to telemedicine and other latest diagnostic facilities. No wonder the 13-bedded PHC has an average of 150 to 200 patient visits every day.

“Since the PHC is open 24x7, we get a number of cases of deliveries and accidents (as it is located on a highway) in addition to cases of skin diseases (rampant in the area), pneumonia, flu and other ailments, says Dr Ramphul Meena, who retired as chief medical health officer in the State government before he joined this PHC.

It is for cases of hypertension that specialists are consulted through telemedicine. Sixty-four-year-old Bhanwari Devi complaining of chest pain had been brought to the Bharoti PHC from Bada Gaon. Her ECG was done on an ATOM and the reading Whatsapped to a cardiologist at the Mahatma Gandhi hospital in Jaipur. The cardiologist prescribed emergency medication and directed the PHC staff to send the patient immediately to Sawai Madhopur hospital along with her ECG report and case history. The whole procedure did not take much time and in a matter of minutes, the patient was sent to hospital in a waiting ambulance.

Mukesh, a GNM at the PHC, says in addition to serious cases, it is mostly for antenatal advice and skin diseases that consultations are sought through telemedicine.

He says in case of skin diseases, the picture of the rash or boil is sent online to the doctor along with reports.

The PHC also has a monitoring device called Keyar that can read and record the foetal heart rate, uterine contractions and pulse rate and this is transmitted to DAKSH, a mobile application that generates a graphic record of vital observations (partograph).

Dakha, a GNM at the Bharoti PHC says that the moment a pregnant woman with labour pain is admitted, the monitoring device is activated.

An alarm is sounded if there is any complication or if the mother or the child is in high risk situation. The partograph is made available online to the gynaecologist. The mobile path labs, which can run on solar power, are also taken to remote area in the outreach programme that WISH carries out from time to time.

After running the PHCs for five years, WISH hands them over to the government. The idea is to create a model for the government which can be replicated in its rural health programmes.

The writer is a senior journalist based in Delhi

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