Earlier this month, Ashwin Kumar, a 31-year-old labourer in the Lahaul and Spiti district in Himachal Pradesh, experienced sudden shortness of breath and pain in the chest. He was rushed to the district hospital at Keylong, the administrative centre of the district. Things could have gone out of hand but fortunately the centre has a telehealth centre, which the junior doctor used to consult senior specialists in Chennai.
Within seven minutes, a Chennai-based cardiologist checked Kumar’s vitals and recommended cardioversion, a procedure that uses electric current to bring down heart rate in emergency situations. But the junior doctor did not know how to do it and the specialist used telehealth to guide the doctor to stabilise Kumar’s condition using minimal medical equipment. Once his condition stabilised, Kumar was moved to a bigger hospital.
Over the past year, telehealth centres at Keylong and Kaza in Himachal Pradesh have saved over a 100 patients. Thanks to the difficult terrain and weather, people travel between 20 and 50 km for primary health care and at least 250 km for secondary care. Moreover, it is hard to find doctors despite the state striving to appoint at least 10 medical professionals for the district and willing to pay specialists up to Rs 25 lakh a year, which is almost three times of what is normally paid.
To meet the shortfall, the National Health Mission has opted for emergency telehealth under the public-private partnership (PPP) model in Himachal Pradesh. Apollo TeleHealth centre is a first-of-its kind in such a remote location anywhere in the world. The centres in Keylong and Kaza were set up about 15 months ago and the two facilities offer regular clinical care apart from emergency aid. The centres have facilitated more than 3,000 tele-consults and provided emergency care to at least 200 people.
Under the PPP model, all expenditure - capital and operational - is taken care of by the state and the private player is responsible for the setting up and functioning of the centres. Apart from saving lives, telehealth also saves cost. In Himachal Pradesh, Apollo’s estimates show that the community would have saved nearly Rs 15 lakh spent on travel and other expenses.
Though telehealth has been around in India for at least 16 years, it has been put to fruitful practice only over the last two to three years. Connectivity issues, interrupted power, lack of trained people to manage the centres, and the preconceived notions of the prospective users -- doctors and paramedical staff – come in the way of successful implementation.
The biggest impediment, however, is the resistance to change.The first step to success, therefore, is to convince local doctors that technology would complement their services. The knowledge and experience of local professionals is irreplaceable because they are most familiar with the geography, demography, available facilities and medicines. Without the complete commitment of the all concerned parties, technology would be defeated.
Sangita Reddy is the joint managing director, Apollo Hospitals Enterprise Limited