Telemedicine is gaining popularity, but is it enough?

Kamarun was feeling feverish and had a sore throat. Having these symptoms, especially during a pandemic, are not good signs! She got scared and called the national hotline number 333.

As the number was unreachable, she tried calling 16263 and found the line busy for three consecutive days. Three days later, she could finally talk to a doctor. 

"The doctor was nice and he listened to me patiently. However, before he could give me some advice, there was a call drop," Kamarun said disappointedly.

"As I did not know the doctor's name, the next time I called the hotline, I had to tell my sufferings all over again."

The doctor prescribed her some medicine and advised her to get herself tested for Covid-19.

Soon after the Covid-19 outbreak in Bangladesh, telemedicine has become the only resort for the mass people to get treatment as most of the doctors' chambers are closed.

But is telemedicine service enough for patients and doctors?

Kamarun was lucky as she was not a serious patient and later tested negative to Covid-19. However, serious patients and patients with eye, nose and ear problems are the worst sufferers during this pandemic.

Dr Afrin, a consultant at Shastho Batayon, said there are some problems which cannot be treated without seeing a patient's condition physically e.g. eye, ear and nose problems.

"Usually, to treat these patients, we need to see the x-ray report or the condition of the problem physically. Without these, you cannot treat anyone. When people with these problems call us, it becomes difficult for us to treat them."

Asif, a patient suffering from toothache, said, "I have been suffering from tooth infection for the last five months. I was undergoing root canal treatment. Now the treatment has been halted as my dentist's chamber is closed due to the pandemic. I communicate with my doctor over the phone, but it is not helping much. I need to complete my root canal."

Apart from this, call drop and technical issues also hinder telemedicine service.

Moeena, mother of an eight-year-old child, made an appointment with an ear specialist regarding infection in her son's left ear. She paid Tk500 through bKash.

"My son's appointment was at midday. I opened my Zoom app at 12 sharp. I was sitting in front of the screen for around half an hour. The doctor was not showing up," she said.

"Later, I called the help desk. After talking to the doctor, the help desk informed me that he had lost his internet connection. After waiting for another 15 minutes, she could finally see the doctor. But he muted his microphone and could not understand how to unmute it."

Moeena kept talking but he could not answer her. Then, a few seconds later, his teenage son came to his rescue. The boy unmuted the microphone and at last, the doctor could talk.

Timing is a big challenge in telemedicine. Rohini, a private job holder, made an appointment with a doctor for a teleconference at United Hospital. She paid the bill in advance.

Her appointment was at 11am. She waited for 45 minutes for the doctor's call on WhatsApp. The doctor called her after 45 minutes, but she had a meeting to attend. So, she could not talk to the doctor.

When she asked for a refund, the help desk said they do not have a refund policy.

Even though there are complaints – internet connection disruptions, call drops, unclear voice, technical issues etc – regarding telemedicine service, the service is getting popular. A lot of patients are satisfied with this facility during this pandemic.

"My wife was pregnant and her delivery date was nearing when the pandemic began. Her gynaecologist gave her full attention over the phone. We could call her anytime for any kind of emergency. She always answered our calls. She was like a guardian angel for us," said Sadiq, the new father, with satisfaction.

Another reason why telemedicine service is gaining popularity is that going to hospital is very risky now.

Currently, telemedicine service is offered by 18 government institutions, including Bangabandhu Sheikh Mujib Medical University, National Institute of the Diseases of the Chest and Hospital, and National Institute of Cancer Research and Hospital. Besides, many private hospitals, clinics and doctors are running telemedicine service on their own initiatives.

The national emergency hotline has received 17,024,379 phone calls so far regarding Covid-19 and other health issues. There are 35 doctors and 10 healthcare workers actively providing service in two shifts.

Not only patients, doctors are facing challenges, too.

"Thousands of people call the national hotline number and almost 40 percent of the calls are fake. We always try to be responsive and welcoming to our patients," said Shastho Batayon's Dr Afrin.

"Sometimes some people call and say we just wanted to test if the number is valid and working or not. Some even call and ask if they can sing a song on coronavirus for us."

These fake calls disrupt the service. 

"Some people do not understand the names of the medicines over the phone. So, we send them prescriptions through message or we often send the pictures of the prescriptions to the patient's number," said Dr Monzur Hussain Chowdhury, who is providing telemedicine service at Bloodman.

"Many of them cannot operate the phone and face difficulty in reading SMS or checking WhatsApp. They call repeatedly and we have to explain all over again. It kills a lot of time," he said. 

Some patients also talk about irrelevant stuff. Dr Monzur said some patients start describing their medical history from 20 years back while some share the problems of other members of the family.

"No matter how many times we tell them to be precise, they do not understand what we are saying. Some people also hang up right away if they do not like the treatment.

"For instance, a patient called me and said he has a cold. When I suggested gargling with hot water, he just hung up on me. They do not want to spend their money on the advice they already know," the physician added.