Dr. Milan Thapa
In April 2021, just when Nepal was trying to get back to normalcy after the first wave of COVID, the second wave hit the country. The hospitals were overwhelmed due to a large spike in the number of COVID19 cases and within a week, life-saving resources such as oxygen and ventilators became inadequate. Many people in need of hospitalization were compelled to stay at home due to the scarcity of hospital beds. The terror and panic spread everywhere.
In the meantime, Health Foundation Nepal (HFN) started a telehealth project in collaboration with the Ministry of Health and Population for the COVID-19 patients where the patients could get telephone-based consultation from the NMC certified doctors for free. I enrolled in the project and became a part of the team. Telehealth was a new adventure for me. During my medical training and clinical practice which were face-to-face interactions with patients, I was able to build strong relationships with them and better understand their problems. I knew using a virtual medium for consulting would be a challenge and I needed to learn new skills. Initially, most of the calls I received were panic calls where patients or their families would ask desperately to help them arrange hospital beds, ventilators, or oxygen. I still remember a call from a middle-aged man who was frightened due to his mother’s low oxygen saturation which was below 90%, and he was not able to find a hospital bed for her. He requested us to help him arrange an oxygen cylinder so that he could save his mother’s life. We gave him the contact numbers of the local oxygen suppliers who could help him. The next day, I called him and found out that he was able to manage a cylinder for his mother and she was being cared for at home. I prescribed some oral medications for his mother and told him to contact us when needed. As I received more similar panic calls, fear grew within me. I started to think about what would happen if I were in a similar situation as my clients and how I would be able to care for my near and dear ones. I felt helpless and frightened at the chaos the pandemic had brought.
Few weeks during the peak of the second wave every day was a nightmare due to frantic calls from patients and families asking for help, ever-increasing numbers of sick patients, and many deaths due to the illness. Slowly the number of infections started to decline, and the pattern of teleconsultation calls changed as well. I started getting calls from the patients regarding home isolation, vaccination, test result interpretation, etc. One day, I got a call from a patient from Mugu, one of the most rural parts of Nepal. He had been having viral symptoms for a few days and wanted to know if he should test for COVID-19 infection. After listening to his symptoms, I advised him to get tested for COVID. The PCR testing facility was not available at his nearby health center. He had to visit a designated COVID center to get a nasal swab, the specimen was then sent to the district hospital for the test. It took him 4-5 days to get the result which came back positive. I prescribed him medications and advised him on symptomatic management and necessary precautions. The timely test and support he got helped him to detect his condition early and prevent it from transmitting to his family members and people in his locality. This incident made me realize how difficult it is for people in rural places to get access to healthcare and how telehealth could help fulfill those gaps.
During the second week of June, HFN conducted a community-level rapid antigen testing campaign in the Gulmi district, one of the rural districts of Nepal. I was appointed as a focal person to provide telemedicine service to the patients who tested positive in the campaign. Several positive cases in the community were detected during the campaign and their contacts were identified and tested subsequently. The telehealth team contacted the positive cases and provided them proper counseling and medical care. While being involved in the campaign I realized that the second wave of COVID-19 was much different from the first one. It was not limited to the cities and crowded places only, it also had spread extensively in the rural communities. The published statistics were just the tip of the iceberg while the magnitude of the problem was much worse.
By the fourth week of June, the rate of infection came down significantly. As the number of calls seeking help from our service decreased, reflecting a decline in the impact of the pandemic, I took a sigh of relief and asked myself, "Did I make a difference during this pandemic?" Deep down in my heart, I knew I did. I was able to contribute to the best of my ability and I look forward to doing the same in the future.
Dr. Milan Thapa,