Dr. Shila Neupane, MBBS, Sunsari, Nepal
Telemedicine - My reflection
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.
The second day of duty, on the other hand, did not go as planned - I was nervous. The night before my duty, I could barely get any sleep due to the sticky heat, buzzing of mosquitoes, and howling of the dogs on the streets. My alarm went off at 5:30 am without me having a wink of sleep. I answered a follow-up call from Sakuntala, my 59-year-old patient, whose husband was admitted to the hospital due to a high-grade fever. She was worried, and she wanted to know if her husband would be okay. After 20 minutes of counseling, she was reassured and became calm. During follow-up next week, I found Sakuntala's husband had been discharged. They were happy that their life was normal again.
Following patients through Telemedicine has now become an integral part of my daily routine. When following up with patients, it's usually heartening to hear that they're getting better. However, things don't go as planned all the time; Tshering Sherpa 79-year-old male, whom I was following, took his last breath at a hospital following a complicated course of COVID pneumonia. It was heartbreaking to hear that my patient, with whom I was talking a few days earlier, passed away. This situation made me more determined and provided me with a better understanding and acceptance of death in human life. I developed a greater appreciation for life and its beauty as I constantly juggled between the happiness of saving a life and the sorrow of losing a patient. I get a lot of compliments from my patients, which keeps me motivated to be a better me than I was yesterday. "I never knew a doctor cared for a patient to this extent; you have changed my opinion regarding doctors," one of my patients said.
I want to take this opportunity to express my gratitude to Health Foundation Nepal for guiding me to become a compassionate doctor and for assisting me in improving my communication skills. I am not just treating a patient; I am also treating the entire family during the illness. Overall, I am very pleased with what I am doing. Telemedicine, in my opinion, can be used to reach out to many people who otherwise do not have health care access. Healthcare is expensive enough; on top of that, travel costs can be prohibitive. Nepal's hilly landscape and poorly developed transportation infrastructure make travel difficult in many places. In some remote places, a person has to travel 2 to 3 days to reach a proper health care facility or to meet a doctor. To battle this pandemic, I am helping my patients by listening to their concerns and by minimizing their hospital visits, and providing healthcare through telephone breaking all physical boundaries. I have provided care to people from all over Nepal who otherwise might not have the means to visit a healthcare facility. I am delighted to be a part of this initiative and serve people all over the country during the pandemic.
Please note: Names of the patients have been changed to protect patient's privacy.
Dr. Shila Neupane.
Itahari, Sunsari, Nepal