Nepal, a sovereign country located in South Asia with a population of 28 million where the average person has a life expectancy of 70 years, is surrounded by the Himalayas in China's northern territory and flatlands in India's southern part. This country's geography has been distinguished into three regions: the Himalayan region, hilly region, and Terai region. The country's main occupation is agriculture, with about 70% of the total population directly involved; however, it is also dependent upon tourism for economic stability.
In a country like Nepal, where ensuring affordable and accessible community health care is a significant challenge; telemedicine can be a game-changer. As countries worldwide are embracing this model of health care, Nepal is behind but catching up.
A Telemedicine service was launched in 2009 by the Health Ministry, which covered 25 districts of Nepal and was later expanded to 30 districts. Around 25 hospitals within remote Nepal districts were able to consult with the Lalitpur-based Patan Hospital for telemedicine services.
The Ministry also announced that the services would be expanded and rolled out throughout the country. Unfortunately, the services were discontinued due to the concerned agencies' apathy under the Health Ministry. Today, none of the hospitals or health facilities in the nine districts of Nepal's far-western region are using telemedicine service, says Dr. Awasthi, who was then serving as a medical officer at Kolti District Hospital Bajura. At a hospital in a remote region like Bajura, where there was a lack of specialists, the only resort for Doctors was telemedicine, but today that has vanished.
Dr. Mingmar Gelgen Sherpa, a former director at the Department of Health Services, said that "telemedicine services would have been accessible throughout the country and well advanced if they had been continued." Medical officers serving in district hospitals in remote regions used to consult experts of Patan Hospital when necessary. Due to a lack of consultant services, patients living in far-flung reaches of the country are either deprived of treatment or compelled to visit big cities like Kathmandu, often spending thousands of rupees, to seek medical help.
Other known telemedicine services exist as telephone inquiry services. They are in operation rarely because of the miscommunication in sharing health complaints and identifying health vitals essential for a doctor.
The Ministry plans to re-implement the services again in at least a few district hospitals initially before expanding them to primary health care centers. The Ministry of Health and Population is also trying to play a vital role in facilitating those willing to initiate telemedicine services in the country. For example, TeleCareNepal launched on the 1st of October 2020 in Dadeldhura district, one of Nepal's least developed regions. With the facilitation and permission from local authorities of the district offices and hospital, TeleCareNepal started its service center in Dadeldhura named Chamsal village. The village was chosen for telemedicine as that community
did not have any healthcare service bodies and not even a pharmacy.
TeleCareNepal is the first telemedicine service center in Dadeldhura, which aims to serve the locals with essential healthcare services. Currently, there is only one government hospital in Dadeldhura, and not every village has easy access. Chamsal, for instance, is extremely rural and located 12 km away from the district hospital, with no local transport facility or easy access to the hospital. People need to walk an entire day, even for simple treatments, i.e., blood pressure and body temperature measurement.
Dr. Tina Miranda from the United States of America and Er. Madindra Aryal from Nepal came up with an idea to help people from remote places and establish this service center. Both have worked very closely from the ideation phase to set up, and now that the foundation has been established, they are working to make it run smoothly and are trying to take the service center to the next level.
"The concept of global telemedicine is what we are trying to develop in the coming years to provide healthcare services to the people of very remote places on the earth," Miranda said. "With TeleCareNepal, we intend to provide basic healthcare services through telemedicine at different locations of Nepal, and we are also trying to make efforts in making cross border doctors get permission to see patients from anywhere by developing a set of guidelines to follow. After successful initiation from Dadeldhura, we are soon going to set up telemedicine service centers in three different locations this year."
TeleCareNepal is currently providing all the necessary healthcare facilities like identifying vital signs, urgent care, nursing, essential medicines, etc. A nurse in the clinic interacts directly with the patient and records all the vital signs. Then there is a doctor based in Kathmandu who treats the patient online via the data provided by the Internet of Things (IoT) medical devices, some of which were developed by Aryal, and if medication is required, the doctor prescribes medicine to the patient. The pharmacist is also in the clinic to provide the treatment prescribed by the doctor.
Aryal, who is an electronics and communication engineer, said, "Telemedicine in Nepal is the best means to deliver healthcare services to people living in different remote villages. IoT based telemedicine through TeleCareNepal can change the face of the healthcare sector of Nepal as the country has always been facing lack of quality healthcare services due to the least development of infrastructure especially in the mountainous and hilly regions."
The pharmacist also looks for available medicines in the service center and prepares for what medication may be required by the patient. For maintaining a working environment in the service center, the team also has one office helper who makes sure that everything is in good condition and working order.
TeleCareNepal also applied for permission from the government, and the Ministry of Health and Population has permitted this project, giving authority to work closely with the district hospital of Dadeldhura. The Dadeldhura service center team will identify vital signs and whatever they can with the medical devices and infrastructure in place. The doctor in Kathmandu works in real-time with the team of Dadeldhura via high-speed internet and software provided in the office to give the best telehealth services to patients in Dadeldhura. If the visiting patient requires high-grade care in any situation, that patient will be referred to Dadeldhura hospital for further treatment.
For now, TeleCareNepal has the following medical devices:
- IoT based Heart Beat Monitoring Device
- IoT based ECG Device
- IoT based Pulse
- IoT based body temperature
- Pulse Oximeter
- Blood Glucometer
- Blood Pressure Monitoring Device
- Weighing Scale
- IR Thermometer
An Internet speed of 15 Mbps makes the communication efficient for the doctor and patient. In Kathmandu, a doctor uses special software developed by Aryal, which can be accessed only by authorized members. This software helps to record the patient's vital signs (body temperature, blood pressure, pulse rate, and respiratory rate) and medical history of the patient that can be useful for the doctor while treating them.
Currently, doctors visit the Kathmandu office twice a week, and patients in the Dadeldhura service center are asked to visit the center as per the doctor's visiting times. The team intends to make doctors available every day to provide the service for which they work eagerly. For more information, visit TeleCareNepal's official website.
Edited by Maurice Nagle