With Patan hospital as the hub, the government of Nepal has started
telemedicine service in 25 Himalayan districts including Acchham, Sindhuli and
Khotang. Without doubt, telemedicine will prove to be useful in increasing
public’s access to health facilities. Lack of road connectivity and poor
infrastructures in general, and lack of good hospitals and trained doctors in
particular, will be addressed by telemedicine. However, with the example of
Nangi clinic, this article will point out the problems that telemedicine might
have to face in Nepal. I assume Nangi clinic in Ramche VDC of Myagdi is more or
less representative of other clinics with telemedicine service in the hilly and
mountainous districts of Nepal.
The Nangi Clinic
Nangi private clinic, which is under
the management of Himanchal Education Foundation (HEF) is an initiative of
Mahabir Pun, a Roman Magasaysay winner for the community leadership he
demonstrated in Nangi. Telemedicine service started in Nangi clinic nearly a
decade ago, and the clinic provides the facility to this day. The register
maintained by the clinic shows that 80 patients have benefited from the
facility until January 2013. Nanda Bahadur Phagami of Nangi developed a pain in
his knee, which was diagnosed to be a pilo by Dr Saroj Dhital of Kathmandu
Model Hospital via telemedicine. It was successfully operated in the clinic by
health workers with supervision from the doctor. Phagami is happy to have saved
time and money. Similar is the case of Uddima Tirada who was successfully
treated for itching. According to Rupa Pun, a health worker in the Nangi
clinic, in addition to benefiting the locals, the presence of telemedicine has
also increased the confidence of the health workers. They feel backed-up by
qualified doctors available to guide them when necessary.
 |
| Telemedicine Center in Nangi Clinic |
| However, according to Raman Pun, the
principal of Himachal Higher Secondary School (HHSS), “the flow of patients in
the clinic asking for telemedicine service was particularly high in the initial
days, but it has decreased now.” Not a single entry in the register since
September 2012 proves Pun’s claim. “It has become a showpiece, the performance
has not been satisfactory as expected,” Dev Kumari Garbuj, a primary teacher of
HHSS, expressed her disappointment. The Problems |
There can be several reasons for the
decreased flow of patients requesting telemedicine service in Nangi clinic.
Lack of infrastructure is still the most important setback, while constant
power cuts and unreliable internet connection are the other hindrances.
According to Lila Pun, a health worker in Nangi clinic, battery back-up has
solved the problem of electricity, but the problem of internet connection still
exists. There are several cases where patients had to be turned back from the
clinic because of error in internet connection.
The other reason behind the
underperformance of telemedicine is the lack of trained professionals to
operate the service. There is a dearth of health workers who are familiar with
telemedicine hardware and can work with computer and internet connections. The
internet connection in Ramche Health Post (a government health post) didn’t
work for almost eight months between 2011 to 2012 until Kishan Pun, a computer
teacher at a local school, repaired it.
Similarly, lack of awareness among
the people about the working of telemedicine creates lack of faith in the new
technology, leading to reluctance in availing of the service. “I don’t know how
telemedicine works and how the quality of treatment is maintained by the use of
telemedicine, even though I am a teacher” says Rama Pun, a teacher of Shree
Deurali Lower Secondary School in Ramche. She pointed out the need for an
awareness campaign about the advantages and effectiveness of telemedicine.
Finally, “the lack of medical and
communication skills in low-ranking health workers, due to which they are
unable to communicate with doctors in the hub, has also been a problem,”
stresses Elsa Sallenave, a nurse from France volunteering in the clinic.
Ways Ahead
The problems discussed above are
relevant to all the telemedicine centers in Nepal. Problems in internet
connection in Pyuthan are already in the news. Similarly, services were
obstructed in Khotang, Jajarkot, Sankhuwashabha, etc because of lack of trained
personnel who can operate telemedicine. Likewise, the decreasing number of
patients who request telemedicine will soon raise the question of patients’
faith in the system. Also, since telemedicine is available only at district
hospitals, people living in rural parts of the hilly and mountainous districts
will find it difficult to make it to telemedicine centers, which will also
hinder the effective implementation of the service.
In order to achieve the desired
level of success in telemedicine in mountainous districts, the government
should immediately supply technicians to operate the service. Similarly,
problems related to electricity and internet should be solved. Moreover, the
people should be made aware of the benefits of telemedicine. The most important
aspect of the awareness campaign should focus on generating faith in the people
regarding the service. Finally, in order to ensure good service, heath works in
the districts should be given medical and communication training.
Published in Republica (25 June,
2013). Available in http://myrepublica.com/portal/index.php?action=news_details&news_id=56745
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