Pakistan is challenged by a markedly disproportionate doctor-patient ratio — one of the main reasons why we have a troubled health sector. At the start of 2018 it was reported that only one doctor is available for every 6,325 people in Pakistan.
We should tend to the roots. Our primary and secondary healthcare chassis (which comprises basic health units, rural health centres and district headquarters) is grossly deficient, both in medical facilities and manpower, which forces an exodus of patients from rural and remote areas to specialised hospitals located in city centres encumbering the overall functioning capacity of these hospitals.
Secondly, out of the many who visit emergency departments of public hospitals every day, only about 40 per cent are real emergencies. The remaining 60 per cent or so are unable to distinguish emergency from non-emergency (OPD) cases and unnecessarily overburden emergency units.
Furthermore, every year hundreds of MBBS graduates are lost to flawed policies or they move to better health systems abroad. The result is a compromise in the provision of quality healthcare in our hospitals because a small number of doctors have to cater for an increasing patient population.
With the vision of decreasing patient load (especially in outpatient and eventually in indoor and emergency departments) and patient anxiety associated with long hospital queues, the doctors’ community of Pakistan has formed a team of specialised physicians from all major cities of the country who provide free online medical services. This initiative is known as ‘Tele Polyclinic’ and like any other online health system, uses the concept of health information and communication technology to overcome geographical barriers and provide standardised healthcare to areas where corporeal medical facilities are unavailable. Electronic communication has revolutionised services like banking, travelling, buying and selling of goods, among others. It is about time medical care in Pakistan also entered the digital world.
In its one year of service, team Tele Polyclinic has treated thousands of online patients across Pakistan. Their biggest achievement so far is the timely intervention and treatment of three potential cases of suicide who reached the team via its online android phone application.
This online approach also takes care of anonymity particularly of female patients with gynaecological issues who do not want their identity to be revealed. Patients who require physical examination are given clinic appointments where the clinic’s doctors provide cost-free consultation.
Indubitably there is a long way before we can see the mildest of forms of online healthcare in Pakistan, but if gave due attention it has the potential of growing into a system where video consultation services, electronic transmission of laboratory, imaging and healthcare informatics between doctors and patients could be made possible. Health professionals present in different locations would be able to view same laboratory and radiological investigations and solve complex medical cases. Patients having lethal contagious diseases, those bed bound and requiring ambulatory services to reach hospitals and white-collar syndrome patients (who avoid hospitals because of anxiety and phobia) would be better managed by the online pathway. Eventually the overall cost of healthcare would be reined in.
Telemedicine softwares allow storage of vast medical records and diagnosis with the help of artificial intelligence. It also enables real-time monitoring of blood sugar level of diabetics, blood pressure of hypertensive patients, cholesterol levels of heart patients who reside far away from specialised hospitals. Thus treatment adjustment can be made as and when required, leading to better disease prognosis.
Usually a patient who visits a basic health unit (BHU) due to chest pain, breathing difficulty or any other major symptom, is referred to a tertiary care hospital. If the hospital is short on beds the patient succumbs to the disease in an ambulance. Having an integrated online system would allow BHUs to direct patients to hospitals which have vacant beds. This way time, resources and most importantly lives could be saved. Lastly, a large population of female doctors in Pakistan have to quit their jobs after marriage. Telemedicine can provide them with an opportunity to restart their careers within the confines of their homes.
The previous K-P government went as far as announcing the formation of an online system of healthcare. The Punjab government took somewhat similar steps in the form of mobile BHUs — which consists of a doctor and a nurse who provide doorstep basic medical care in regions devoid of standardised health facilities. The WHO, in its global observatory for eHealth series, has stated that provision of efficient and effective online medical services is the solution to many of the health problems prevalent in developing countries, like Pakistan. In the developed world, telemedicine is a flourishing industry. Therefore, governmental and non-governmental health organisations in our country should invest in integrated digital healthcare so that the dream of ‘healthcare for all’ could be made a reality.
Published in The Express Tribune, January 4th, 2019.
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