As hospitals work double-time to serve COVID-19 patients, doctors all over the country face a tough challenge: How can they can keep treating their patients when their clinics are closed?
Technology provides a solution: teleconsultation, which minimizes the need for travel and face-to-face contact, thus protecting both the patients and health professionals from exposure to health risks.
Among the doctors now engaged in teleconsultation with her patients is Dr Corazon Mata, who handles the obstetrics and gynecology hotline for the Telekonsulta Service of the Northern Mindanao Medical Center (NMMC). For the first time in her 30-year practice, Dr. Mata is attending to patients remotely, fielding queries from ob-gyn patients all over Region 10, which covers the provinces of Misamis Oriental, Misamis Occidental, Bukidnon, Camiguin and Lanao del Norte.
In Davao City, Davao Central 911 has also set up a call center that facilitates over-the-phone consultations for people who cannot go to the hospital. Patients can directly speak with an emergency medical technician or on-call doctors for free, within the safety of their own homes.
The Center for Mental Health and Psychosocial Development’s HOFFEN Clinic of Adventist Hospital Davao also launched HOPE Line to offer free psychological first aid via phone calls from PUIs or PUMs and their families through a special hotline.
To support teleconsultation efforts in Mindanao, PLDT wireless arm Smart Communications, Inc. (Smart) has extended communications support to the NMMC, Davao Central 911 and HOPE Line.
Smart has provided NMMC with LTE phones capable of unlimited texts and calls to all networks and data connection. Each phone was assigned to doctors handling a specific field of specialization, such as pediatrics, obstetrics and gynecology, surgery or internal medicine.
Smart also provided load and call conferencing service support for Davao Central 911, as well as a special number for HOPE Line’s telepsychology services – 0951-815-HOPE (4673).
“E-health is among the pillars of the new normal. We are grateful for this opportunity to enable hospitals and local governments with technologies and digital solutions that will help them respond to their customers and constituents faster and more efficiently,” said Alfredo S. Panlilio, PLDT Chief Revenue Officer and Smart President and Chief Executive Officer.
Underpinning these solutions is PLDT and Smart’s fixed and wireless network. As of end-March, Smart has increased the number of 4G/LTE base stations nationwide to 26,000, up 6% from end-2019 and 60% more than end-2018. PLDT’s fiber infrastructure, which supports Smart’s network by providing high-capacity links to LTE base stations, is now at 338,500 kilometers nationwide, 5% more than end-2019 and up nearly 40% from end-2018.
In April, Smart further increased the capacity of its LTE network by reallocating its assigned 1800 Mhz frequency from 2G to 4G/LTE. As a result, 3,785 2G base stations of Smart are now also providing additional capacity for its LTE network.
With the rapid spread of Covid, other health cases have been overshadowed, with many hospitals like NMMC recording a significant drop in patient consultations at the emergency room and out-patient clinics. The NMMC is a tertiary public hospital and one of the Covid referral centers in the region of 5 million.
“This is why we started the NMMC Telekonsulta Service,” says Dr. Aris Austria, Telekonsulta project leader. “We were concerned particularly for our patients with chronic conditions requiring long-term medical care. Every healthcare facility should not focus only on handling the Covid-19 crisis but also consider minimizing ‘collateral damage’ on non-Covid patients.”
The NMMC Telekonsulta Service targets noncritical cases and aims to provide a venue for patients to directly consult medical professionals through their mobile phones.
Since the start of the project in late March, the NMMC doctors have collectively handled more than 400 consultations, sent out almost 200 electronic prescriptions and facilitated around 50 referrals. They have also set appointments for actual clinic consultations for cases where a clinic visit is absolutely necessary.
Meanwhile, Davao Central 911 has been receiving an average of 200 calls daily since it started. The consultations are also primarily for regular/non-Covid patients. However, if a patient has Covid-like symptoms and has recent travel history or exposure to a PUI, the case is endorsed to Davao Covid-19 Task Force for proper handling.
‘Do your part’
Dr. Vernna Dee Marie Guille-Familiar from the Emergency Medicine Department of Southern Philippines Medical Center and a volunteer doctor of 911 Telemedicine believes that it is best for people to stay at home. “The virus does not move. People do. The spread of the infection depends on the people’s ability to understand that staying at home will help. Doctors, nurses, health care workers — we are but your last line of defense in the fight against COVID. We continue to work for you, despite the risks of getting infected. So, do your share, stay at home. It helps us a lot,” she said.
Amid the Covid-19 health crisis, people may also experience anxiety, depression, and other mental health issues. At present, the clinic’s HOPE Line accommodates 3 to 4 phone-in patients per day.
“Symptoms of anxiety and panic attacks are similar with that of COVID-19. They panic, thinking that it’s a respiratory complication. We are able to help them with this kind of platform to address their concerns and their fears. We feel that while talking to them, we can be the voice that they can depend on. We will be here for as long as we are needed,” says HOPE Line Project Manager and Center Program Head Chris Del Monte.
Dr. Ramon Yap, an internist-gastroenterologist, says doctors have to adapt to the times. “A good part of diagnosing a patient is doing a complete physical. But I believe the majority of patients can be safely managed through teleconsultation, albeit some patients may really have to be seen by a doctor in a clinic or referred to an appropriate institution like NMMC,” he said. “The threat (of Covid-19) is very real. We also have to think about protecting ourselves and our families, aside from trying to give comfort and healing to our patients.”
Despite limitations, doctors are finding ways to cope. Dr. Austria, a pediatrician, has been working more and more with the parents during teleconsultation. “[Parents have to] listen to the child’s breathing, feel their skin or pulse, touch the tummy, and describe what [they] find,” he said, adding that this is not the ideal way of examination, so doctors should also be cautious in using information drawn from a teleconsultation to diagnose a patient’s condition.
“Teleconsultation should remain an option for patients to hasten medical interventions, and to keep NMMC accessible to all the people in Region 10,” Dr Austria said, adding that unhampered communications and back-and-forth exchanges of information enabled by Smart’s network have been “a huge advantage”, allowing doctors to attend to as many patients as possible.
“With Smart, out-patient department services are just a phone call away in this time of crisis,” said Dr. Peter Quiaoit, NMMC medical training officer.
“Smart is committed to providing innovative communications solutions that help fight the Covid pandemic. The NMMC and Davao Central 911 are using technology to enable their doctors to treat patients despite the current restrictions. That’s why we are quite happy to support their initiatives,” said Mon Isberto, Smart Public Affairs head.
With the Covid-19 pandemic far from over, interventions such as teleconsultation are here to stay as part of the “new normal”. As access to the internet and data-capable phones increase, huge improvements in teleconsultation results and lowered risk of misdiagnosis are also seen.