Dr. Anjan Kumar Basnet
On the fifth day of home-based telemedicine care in Dang, at around 10 pm, I was completing the patients' charts and planning to call it a day. Just then, I received a call. "My cough is getting worse, and I have difficulty in breathing," a male voice said in a very anxious tone. I immediately understood it was an emergent situation after I asked some relevant history. I provided the list of local hospitals and advised Abdul Miya (name changed) immediately to go to the nearby hospital. As he was headed to the hospital, different questions came to my mind: how long will it take for him to reach the hospital? Will he be able to make it in time? I waited for his call anxiously. But even after an hour, I did not get any response. I could no longer wait, so I called Abdul myself. I was relieved to know he was in the hospital waiting for a bed in the emergency room. He described the hospital scene where many patients were waiting for their turn to be seen at the emergency department. Some had been waiting for as long as 6 hours! There was a massive surge of Covid cases in hospitals in Nepal due to the rapid peak in the second wave. Oxygen was rationed because of the shortage of supply. Later, Abdul called and told me he did not qualify for oxygen supplementation and hospital admission despite having oxygen saturation at 90%; many patients were much sicker than him. So, he was given a COVID test and sent home with some prescriptions to continue care at home. In any normal situation, COVID patients with an oxygen level of less than 94% should be on oxygen therapy. Undoubtedly, the Covid pandemic had critically stressed the healthcare system, and many patients were turned down.
Dr. Hari Neupane, Physician, Dang, Nepal
Govinda, a 35-year-old male with PCR positive COVID-19 contacted us on the tenth day of his illness due to continuous high fever. His head was burning with 102 degrees Fahrenheit temperature, his throat was hoarse due to a persistent cough. He could not sleep at night due to severe shortness of breath. Getting up to go to the bathroom was an ordeal due to generalized body ache and weakness. He had lost his sense of smell and taste; his appetite was poor and he was hardly able to eat a mouthful of rice. In addition to his physical illness, he was very stressed and anxious which made his condition even worse. When he called me, he was severely ill and in very poor shape, so I wanted to transfer him to a hospital immediately.
Dr. Shila Neupane, MBBS, Sunsari, Nepal
It was an early morning on the 16th of May, my first day on Telemedicine duty, quite unlike other shifts where I would go to a clinic to see my patients. I was in my study room waiting for my patients. I turned on my laptop, I could hear the ticking of the clock on my wall. At exactly 7 am, my phone rang; it was an anxious male voice saying, "Hello doctor, my mother has been having difficulty in breathing since last night, now she is not even able to talk”. I was prepared for a difficult situation, but this sounded like an emergency. For a moment, there was total silence, I could hear my own breath. Finally, I recollected myself, and after a long pause, I was able to talk. He pleaded, "Please save my mother!" I reassured him and asked his name. He responded in a worried tone of voice - “My name is Ram and my mother, Sanumaya, is 68”. I enquired about Sanumaya and slowly was able to understand the detailed picture. “Okay, Ram, could you please check the oxygen saturation of your mother?” I said. After some time he came back and replied that it was 88%. With severely low oxygen saturation, possibly due to COVID pneumonia, I had to urgently find an ambulance and send her to the nearest hospital. I gave him a list of hospitals that took care of COVID patients. After an hour of frantic search, to Ram's dismay, he was unable to locate a hospital with an available bed. I then gave Ram a list of phone numbers of oxygen suppliers and sent him some prescriptions. Our only hope was to start her treatment at home until she gets a hospital bed. Sanumaya was subsequently kept in 2 liters of oxygen and was kept under close observation at home. I called Ram and followed her regularly. Eventually, she began to feel better; later that day, Ram was able to locate a hospital with a bed and transfer his mother. After few days, I called Ram; I could hear Sanumaya's low voice in the background. She grabbed the phone and began to talk to me, and for the first time, I could hear her voice, soft and shaky "I'm well, doctor, how are you? Thank you for your help." I took a deep breath and sighed with relief, "Oh, finally, she's getting better. All that effort and work helped save her life... " I responded that I was fine as well and assured her not to hesitate to contact us if she had any problems in the future. A few days later, after Sanumaya was discharged, she called me and left a kind ‘thank you’ message. Like many other patients, Sanumaya helped me become a better person and inspired me to continue to serve to the best of my ability to make others feel as good and happy and save lives.