You can now make a ‘house call’ to a doctor

Telemedicine, the practice of caring for patients remotely via telephone, has not had much success since its introduction to South Africa in 1998.

However, as the government and the medical field scramble to contain the spread of the coronavirus pandemic, remote medical services are on the rise again and private and public sectors are joining forces to help reduce the number of people turning up at hospitals and clinics for fear they may be infected.

One such collaborative effort is the Doctors on Call helpline launched recently by the KwaZulu-Natal Doctors Healthcare Coalition (KZNDHC), Usizo Advisory Solutions and Vula, with backing from Nedbank.

Professor Morgan Chetty, head of the KZNDHC, told The Citizen this week that the public are anxious, fearful and uncertain as this virus has a propensity for morbidity and mortality, and appears as the flu.

“These are also mainly the poorest of the poor with no access to healthcare and who just need assurance, advise and to be pointed in the right direction. This [Doctors on Call] is an important service … it helps avoid running around looking for answers when we are in isolation and practicing social distancing,” Chetty says.

Although telemedicine is considered by many to be a useful service in easing the Covid-19 pressure on walk-ins at clinics and hospitals, the Health Professions Council of South Africa (HPCSA) stands firm on its guidelines when it comes to such services.

While not available for comment, a statement on its website syas: “The HPCSA does not regard telemedicine as a replacement for normal face-to-face healthcare but an add-on meant to enhance access to healthcare for South Africans who are disadvantaged and outside of the health services reach, such as specialists.”

The HPCSA says it calls upon registered healthcare practitioners providing telemedicine to do so in line with the HPCSA’s General Ethical Guidelines for good practice in telemedicine.

In its guidelines the HPCSA says: “Healthcare practitioners’ conduct should be ethical and professional at all times, even when dealing with patients remotely”.

Making clear the role of Doctors on Call, Prof Chetty maintains this is not a treatment program but an advice helpline. “So, we have no ethical backlash from any group,” he said.

Already up and running, the tele-health advice line took under a week to set up with some 450 volunteer doctors from around the country coming on board in under 72 hours.

“When we started, we only expected 10 to 15 doctors to join. The message I sent out was passed from group to group and within 48 hours we had hundreds of doctors signing up,” project leader Doctor Anuschka Coovadia has told The Citizen.

She says the turnout and sheer generosity of the volunteer doctors has been so remarkable that it actually brings her to tears.

“I never expected our doctors to be so forthcoming. Not one asked about compensation and each of them offered to do multiple slots, and many of them come to our rescue when the calls are more than what we can manage.”

So committed are the doctors that some of them often call people back, at their own expense, when the caller’s airtime runs out.

Doctor Coovadia says they are also working closely with the doctors’ networks and associations across the country to ensure that callers who have their own doctors are referred back to them, “as we don’t want to come between any existing doctor-patient relationships”.

Although the service is mostly focused on health-related queries about Covid-19, she points out that the psychosocial components of the outbreak are unavoidable. “We are working closely with a group of psychologists and psychiatrists to develop a referral pathway to them so we can make sure that we also address the bio-psycho-social aspects of the disease. This is a work in progress,” says Coovadia.

“Defeating this epidemic will require unprecedented support from all stakeholders in South Africa, both public and private. This support demonstrates good corporate citizenship and contributes towards protecting our employees, customers and the sustainability of business, in our country,” Chetty says.

“Support for this program could help flatten the curve, save our health system from being overwhelmed, protect our economy and ultimately save lives,” according to Coovadia.

Acknowledging that this is a time of heightened anxiety for all South Africans, Nedbank says they are committed to using their money and expertise to do good by supporting relief measures and endorsing steps to ease the burden on society.

“We support this initiative because it seeks to make a tangible difference to society during the Covid-19 pandemic. Our support of this initiative is in accordance with the call by our president, the health minister and scientists advising them on doing all we can to limit and contain the spread of the coronavirus,” says Craig Evans, Nedbank’s Divisional Executive for Retail and Business Banking.

The South African Medical Association (Sama) says as strategies are put in place to help reverse the Covid-19 pandemic, priority consideration should be given to telemedicine.

In a recent statement on their website, Sama chair Dr Angelique Coetzee said: “Telemedicine has emerged as a crucial element of the response to coronavirus in many countries, and enables patients to contact health providers from their homes, and get appropriate medical advice based on the development symptoms, without endangering healthcare workers, and other patients.”

Noting how the current telemedicine guidelines of HPCSA make no room for such consultations, and only provide for face-to-face interaction between patient and practitioner, Dr Coetzee calls on the department of health as well as the HPCSA to advocate in favour of telemedicine as one of the mitigating strategies government must employ to contain the spread of coronavirus.

“We believe such a move, which will be subject to all ethical rules and recommended record-keeping, is a strategically sound one, and may ultimately present more solutions than barriers in this fight,” she says.

When using the service, which operates on weekdays from 8am until 5pm, callers pay the normal cost of a call but don’t pay to talk to the doctor.

All calls are documented and reported using the Vula App, and referrals are made to the NICD for testing. The results are captured on the Vula app, which the team say is vital in tracking both the spread of the virus and particular outbreak areas.

All Covid-19 related data will be stored by the NICD after the pandemic is over and studied to look for patterns that may assist if a similar event happens in the future.

When to call the helpline on 087 0550 234:
• You have symptoms of coronavirus;
• You have a travel history and feel you might be exposed;
• Been in contact via any other means;
• To get additional information about coronavirus.

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