Challenges and Sustainability
Although many countries have attempted diverse methods to overcome the challenges imposed by the pandemic, there is lack of evidence on establishment of patient helpline systems in a low-resource setting. Implementation of patient helpline systems in a low-resource context involves unique challenges, including financial, logistical, administrative and technological4-8.
Orchestrating the massive communication process was a challenge due to unpreparedness of doctors, chaotic situation created by the increasing number of cases and deaths on a daily basis, uncertainties of the disease condition itself and fear psychosis created by the media. Patients were distressed not only by their own illness but also by the potential plight of their family members. The entire scenario created the highest possible challenge in communication8.
Training a diverse group of volunteers to work in a complex system was a major challenge. Doctors were trained via an online training programme and motivated to share knowledge among them through a dedicated social media platform. This was a display of connectivism; the learning paradigm of digital era10.
Sustainable coordination was a major concern. Doc call 247 service consists entirely of volunteers ranging from specialists to medical students. They can tune into the system as per their convenience by ‘opting in’ or ‘opting out. There is a roster system in place as well to ensure that a particular number of doctors are available at a particular time. Number of expatriate medical professionals also rendered their services as volunteers to sustain the helpline transforming this operation to a global telemedicine project5,6. Operating a SMS gateway for patient prioritization needs a dedicated medical team stationed at an operational room to respond to the SMSs received.
Therefore, this integrated system was a unique example of medical voluntarism. People displayed global empathy; compassion and collaboration for the benefit of people whom they have not met or were not responsible for.
There were some concerns regarding confidentiality of medical information sharing on the web and data security. The issues of liability, jurisdiction and malpractice where medical advice without face-to-face consultation or clinical examination took place, were raised. Some healthcare professionals were reluctant to adapt to new ways of working, resistant to a change in mind-set about the use of technology to deliver health services and lacked willingness to work in multi-disciplinary teams or to ask for a second opinion.