Younten Tshedup 

Seven days into the nationwide lockdown, Karchung and his wife Lhamo were growing anxious. The couple is expecting their first child.

The 28-year-old was in her second trimester and she was worried about her antenatal care (ANC) visits to the hospital.

“We were very worried when the lockdown was announced. More than the food essentials, we were worried about our child.”

Anticipating such situations, the health ministry introduced the teleconsultation (remote contact) services to reduce risks for pregnant mothers.

The teleconsultation services for the mother and child health services including immunisation were planned even before the nationwide lockdown with line-listing of all the pregnant women across the country.

The health ministry has so far been one of the well-coordinated agencies handling the lockdown and the pandemic in the country. Besides the containment efforts of Covid-19, the ministry continues to deliver all essential services uninterrupted across the country.

Health ministry’s senior programme officer, Pema Lethro, said that during a lockdown, people can use the maternal, newborn and child health (MCH) as movement cards and visit hospitals.

  Prime Minister Dr Lotay Tshering during one of the press briefings also said that pregnant women don’t need separate movement cards from authorities and that their MCH cards would suffice.

Pema Lethro said that all mother and child care services during the pandemic and especially during the lockdown should be availed on an appointment basis.

“The number of contacts between health officials and pregnant women will not differ. Only the mode of communication has been changed given the situation,” he said.

He said that to minimise the risk of exposure during the pandemic, ANC visits to hospitals were scaled down. “Health officials would call the expecting mothers and check on their condition without the mothers having to come to the hospital.”

In a normal situation, a pregnant woman makes a minimum of eight ANC visits to hospital before the delivery.

Pema Lethro said that during the teleconsultation if there are risk factors, the health workers would immediately facilitate a one-on-one appointment with the patient. “At the end of the day, the objective is to not compromise the health of the mother and her child.”

At the national referral hospital 

The largest health care centre in the country has also devised a similar arrangement as an interim measure during the lockdown since August 14.

JDWNRH Medical Superintendent Dr Gosar Pemba said that with the outpatient department treatment (OPD) suspended due to the nationwide lockdown, they introduced the teleconsultation services.

Dr Gosar Pemba said that people with any health-related issues could contact the numbers (two numbers each for a department) and consult the respective doctors.

He said that based on the consultation if the patient needed to come to the hospital, the doctor would send them an SMS. “We already have arrangements with the thromde and police for movements during such emergencies.”

For those who don’t require hospital visitation, the doctors prescribe medicines and facilitate delivery to their homes.

Besides publishing the numbers of the respective departments online, they are also made available through the hotline centers – 112, 2121 and 6060.

“There are some doctors stationed at the hotline centres and they can directly provide general consultation,” said Dr Gosar Pemba.

On average, each department receives around 45 to 60 calls every day between 9am and 5pm. Initially, there were over 200 calls when each department had only one number.

The medical superintendent said that besides the teleconsultation, essential services like chemo and radiotherapies including dialysis have been provided regularly throughout lockdown.

“For these services, because the timing is fixed, we cannot push it to a later date. The protocol of the respective treatment has to be followed.”

Meanwhile, with the government initiating the ‘unlocking’ phase, Dr Gosar Pemba said that the teleconsultation services would be running until today.

“We already have one consultation room functioning at the hospital and given the situation, we don’t think many would visit the hospital.”

Prior to the pandemic, the national referral hospital saw about 1,500 OPD cases daily.

However, he said that between September 4 and 6 as public transportation would be made available, more consultation rooms would be open. “But for this, we need to see the trend and prepare accordingly.”

After September 7, he said that all services at the hospital would resume. “But should there be subsequent lockdowns, we would restart our teleconsultation services.”

Dr Gosar Pemba said that although the government had plans to introduce a full fledged telemedicine service at the national referral hospital, it could not pick up given several challenges.

However, he said that the Covid-19 pandemic has, in a way, paved the path forward to embrace and take up such technological avenues.

“It’s already happening with some many online meetings and webinars.”