For patients who lack options, a virtual visit can mean the difference between going with or without care
“Right now, I can see all my patients through my mobile phone,” says Prakash Paudyal, a pulmonologist and member of the Rotary Club of Jawalakhel, Nepal. Paudyal uses a Kubi device to turn a tablet into a “mini-robot” for remote monitoring of his COVID-19 patients who are in isolation at Nepal National Hospital. Paudyal learned about the Kubi and other telehealth practices during a vocational training team trip to the San Francisco area last year. “I do one round with all my [protective] gear on, and then I see all my patients through this mini-robot,” he says, thankful that the Kubi helps protect him from exposure to the virus.
The doctor on call In rural Nepal, it can take a day’s walk to reach a medical provider. That limited access to doctors inspired Prakash Paudyal, a pulmonologist in Kathmandu, to offer teleconsultations so he could assist more patients. “You can have a hospital in a rural area, but who is going to treat the patient?” he wonders, citing the lack of critical care doctors and other specialists in those remote regions. With support from his club — the Rotary Club of Jawalakhel — Paudyal started a hotline that offers free medical advice for people seeking basic care. It has proven invaluable during the pandemic, which has taxed Nepal’s health system. “At the COVID-19 hospitals, the ICUs are almost full,” Paudyal says. He also helped found the newly chartered Rotary Club of Kathmandu Health Professionals; his wife, Kavita, who works for Nepal’s Ministry of Finance, is its first president.
Illustration by Viktor Miller Gausa
The use of telehealth has surged worldwide during the COVID-19 pandemic. In the United States, a study by McKinsey found that 46 percent of consumers are now using telehealth, up from 11 percent in 2019. Broadly defined, telehealth includes everything from virtual visits with a doctor to remote monitoring of a patient’s vitals to mobile health technologies.
The rapid increase in examining and treating patients remotely because of stay-at-home orders has not only helped in the fight against the coronavirus; it has also prompted a conversation about what the future will look like. What are the benefits of telehealth, and what controls for safety and privacy should be in place? One clear benefit is making health care more accessible to more people. For patients who lack transportation options or who live in remote areas, a virtual visit can mean the difference between being able to consult a doctor and going without care.
Telemedicine, typically defined as a virtual exam with a physician, requires access to the internet, which about 40 percent of the global population still lacks. But with the proliferation of smartphones, that’s becoming less of a barrier. Barbara Kiernan, a member of the Rotary Club of Catalina (Tucson), Arizona, has been working on a global grant project to bridge the distance between doctors and underserved patients in Sonora, Mexico, by supplying the equipment and technology needed for telemedicine, including solar power and internet access. They found that once community health care providers received the equipment and training, they were able to work with doctors located in bigger villages, allowing them to treat patients remotely. “Before, [rural villagers] really only got medical care during a crisis,” Kiernan says. With telemedicine available, “it’s shifted to preventive care.”
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James Gude, a California physician who founded a telemedicine practice called OffSite Care, says that when a doctor conducts a video consultation with the assistance of an on-site nurse and with access to a patient’s records and diagnostic test results, it can be nearly as effective as seeing a patient in person. “With a nurse there to help me examine you, I can order and look at everything I need,” he says. There are also sophisticated “robots” that allow a doctor to see a patient via videoconference and even send instrument readings, allowing the doctor to listen to a patient’s heart through a stethoscope, for example. (A Canadian TV show once followed Gude around as he conducted virtual rounds via a robot he controlled remotely.)
From his workstation, James Gude can review data and offer medical advice to health care professionals around the world.
Gude started OffSite Care in 2007 to help rural U.S. hospitals improve their quality of care by providing virtual access to specialists, who are often concentrated in bigger urban hospitals. He expanded his vision of dismantling the geographical barriers to quality care when he teamed up with members of the Rotary Club of Sebastopol Sunrise, California, to create Global OffSite Care — a nonprofit that provides educational and consultative services to hospitals around the world.
“We started by contacting Rotary clubs where Dr. Gude thought there might be an opportunity [to improve a hospital],” says Mikel Cook, a member of the Sebastopol Sunrise club. “The mission of Global OffSite Care is to promote Rotary club-sponsored telemedicine projects. We bring together Dr. Gude’s medical expertise with financing, stewardship, and advocacy among Rotarians.” Cook says Rotary clubs have sponsored the equipment needed to get a hospital started conducting telemedicine, which includes a tablet and a Kubi device that transforms the tablet into a web-controlled mini-robot that can pan and tilt, allowing the user to look around the room. Local doctors are trained on the equipment and can then participate in weekly online “Global Grand Rounds” with Gude’s team to continue their education. They can also consult with experts on difficult cases.
The Global Polio Eradication Initiative (GPEI) uses another aspect of telehealth: mobile health, or health care supported by mobile electronic devices, to make progress toward a polio-free world. Mobile phones have been used to track the number of polio vaccine doses children have received, and geographic information systems have helped health workers create detailed maps of their immunization activities.
Examples of telehealth
Live video
A two-way audiovisual link between a patient and a care provider
Store and forward
Transmission of health records to a health practitioner, usually a specialist
Remote patient monitoring
Continuous monitoring of a patient’s condition from a distance, in real time or not in real time
Mobile health (mHealth)
Health care and public health information provided through mobile devices
When the World Health Organization’s African region was certified free of wild poliovirus in August, Christopher Elias, president of the global development division at the Bill & Melinda Gates Foundation, said technology was a contributing factor. One example is how surveillance improved when community health workers were trained to use a mobile app called Avadar (Auto-Visual AFP Detection and Reporting) to report possible polio cases through their phones. Sharing this information electronically allows for quick intervention, preventing outbreaks.
Patricia Merryweather-Arges, a member of the Rotary Club of Naperville, Illinois, predicts that telehealth will continue to expand. “There are lessons we can learn from this,” says Merryweather-Arges, who runs an organization called Project Patient Care and recently secured a Rotary Foundation global grant to distribute more than 200 tablets to residents of Chicago-area nursing homes. The tablets will allow physicians to assess patients via telemedicine, and families to visit with their loved ones via videoconferencing.
Telemedicine is direct health care services to a patient, often over video.
Telehealth is broader and covers education, public health, and provider-to-provider interactions as well as telemedicine.
“There will have to be some quality assessment, and feedback from patients,” she says. “But the benefits are that telemedicine saves the patient time and lessens their exposure to others, so patients are more likely to make appointments.”
A survey of patients in Asia, Europe, and the United States by the consulting firm Accenture seems to back up her prediction: 60 percent of patients said they wanted to use technology more for communicating with health care providers and managing their conditions.
Gude thinks this presents an opportunity to increase the capacity of underresourced hospitals around the world: “I want Rotary clubs to know that wherever they are, if they want to help a local hospital, if they have $5,000 or if we can raise it from elsewhere, it’s done. We are at a point in the curve where we can go straight up.”
• This story originally appeared in the December 2020 issue of Rotary magazine.
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