Part two of the interview with Dr. Lazarus Momanyi from the Ministry of Health. Dr. Momanyi is the team lead behind the team of doctors manning the ministry’s call center which is hosted by Safaricom. In this article he tells us about the crucial role that Telemedicine is playing in the fight against COVID-19, and its role in medicine in general going forward.
With the call center idea, we are talking about Telemedicine. Have you encountered patients who are reluctant to embrace this?
Telemedicine basically involves handling a patient who is not in front of you. It is members of the public who call in and the doctors do what we call triage. They dig further, take their history, when the symptoms started, how they’re feeling, and their concerns. The Ministry of Health has issued what we call a case definition which the doctors use to see if the call fits COVID-19 or not and then take appropriate action.
Most of the callers are willing to share information about their health and symptoms so I’d say they have embraced Telemedicine. The feedback we have gotten from the doctors is that callers really appreciate even just having a chance to talk to a doctor because remember, some of them are calling from very remote areas and have never had the privilege of speaking to a qualified doctor.
It is also therapeutic for callers because with the COVID-19 pandemic there’s a lot of anxiety, so even just hearing from a doctor saying that what they have doesn’t sound like COVID-19, plays to their peace of mind.
You are only dealing with respiratory complaints, right? People being people, are they calling for other medical issues?
Yes. If you actually look at our data, up-to 80% of our calls are non COVID-19 related. We have had people calling with all kinds of symptoms and even labor and heart related conditions for example. Because people know that when you call and you’re able to talk to a doctor, they’re calling for totally non respiratory symptoms.
When they call we do not dismiss them. We don’t tell them that this line is for COVID-19 only because they’re human beings and health is an all-round matter. COVID-19 does not occur in isolation. We usually go ahead and advise them on what they can do.
How about mental health issues related to COVID-19? Does the call center have a wing or department for that?
As mentioned earlier, we refer those ones to the psycho-social counselors who have been really of great support because we do get a lot of those callers and medical doctors might not have the capacity to handle some of those cases.
We have gotten most of the mental health related calls from people in the quarantine centers. People who are dealing with issues like isolation from their families, living in conditions that are not so good, and then being made to pay for their time in isolation.
So yes, we have come across so many distress calls from the quarantine centers and if you saw the other day, someone even wanted to jump off from the roof at one of these centers.
The other thing I’d like to mention is that we’ve gotten other people who are willing to assist in such cases. Like we have a volunteer from Kenya Airways who does coaching for people in distress and they offered to have some cases referred to them.
In your opinion, how crucial has Telemedicine proven to be in this time of COVID-19?
Very crucial I’d say. One, because having a call center that is manned by doctors and anybody from any part of the country can call and get medical advice does away with myths and misinformation about COVID-19. With this call center they’re able to get factual information.
Two, callers are able to get real time links to county teams where they can get assistance.The other thing is that we’re also talking about social distancing so having a virtual way of getting medical assistance really comes in handy.
Telemedicine has also played a very important role in coordinating responders because other than the Rapid Response teams in counties, we are also referring callers for psycho-social support teams and sometimes even the police.
During curfew times when there are road blocks we’re able to call the police and inform them of people who’s cases need to be facilitated in hospitals. The police have really been of assistance when it comes to this.
How crucial will Telemedicine continue to be post COVID-19?
COVID-19 is a game changer and so even for medicine, some of the innovations like the 719 centers that have come through including Telemedicine will definitely continue to drive convenience.
From my perspective Telemedicine will have a big role to play even beyond COVID-19 period.
How far can Telemedicine go? At what point are symptoms beyond Telemedicine and require the patient to see a doctor?
Remember traditional medicine is where a patient comes to see me as a doctor, I put on my gloves or pick up my stethoscope and examine the patient. Then send them to the lab or to get an X-Ray.
But now with medical advances we know that with even a video camera, we’re able to look at things like skin lesions or the throat for example. With Telemedicine we also know that there are advances like remote radiological examinations so that someone can be able to take a CT scan in one hospital and results sent to another doctor even outside the country. They then look at it and give a report.
However, there are some limitations in that a good part of a medical diagnosis still requires physical examinations without which we’re really limited in terms of diagnosis. If a child comes to me coughing for example, it could be TB, Asthma, pneumonia, or just a flu. So I need to examine the throat for inflammation, get a feel of the breathing and touch the abdomen.
So even as we make advances in Telemedicine, 80 to 90% role is left to seeing the patient physically.
You’re doing video links? Are these incorporated in the current Safaricom call centers?
No. We’re currently only doing voice. But in other hospitals you’re able to consult a doctor maybe via Whatsapp video. So yes, video is usable sometimes.
Are you seeing use of wearable devices like Fitbits to get vitals from callers?
Yes. As we talk about Telemedicine, there are these devices we call non-invasive devices that can really help. Like now we also have even digital thermometers and automatic blood pressure machines. Even diabetic patients are now able to take their sugar levels from home. So those small bits of devices really come in handy in symptom gathering.