Written by: Sandhya Krishnan and Vashita Madan
In India, millions of patients, even today, lack access to basic health facilities for their health needs. The Covid-19 pandemic has only been spreading further. This has forced us to acknowledge the lack of proper health infrastructure and support services for patients. Nowhere is this impact more visible than in the case of tuberculosis or TB — India’s most significant health crisis.
The similar clinical symptoms of TB and Covid-19 present a deadly mix for India’s already overburdened health system. With patients fearful of visiting medical facilities due to the pandemic, they have taken to ignoring their symptoms or delaying routine care procedures. How can the health system help?
For patients of TB, regular follow ups, and constant monitoring and check-ups are important and this poses a unique challenge. Regular in-clinic facilities or visits by doctors thus, must be aided by remote support. How do we understand remote support for TB? The idea of remote support itself is radical for TB programmes, where in-person monitoring is critical in public, though almost negligible monitoring is available in the private sector.
Patients have concerns regarding the availability of services, sufficient nutrition and mental health support — here too, remote support could have a role to play. Additionally, some have travel costs to access health facilities and the lack of resources to do it is an obstacle to seeking care or continuing treatment. Some expressed that they fear making their relatives travel to pick up their free-of-cost drugs from the government centres.
There is a growing anxiety and an urgent need for remote support to TB patients that could be effectively implemented using community-based groups that include TB survivors, since they are credible and relatable to new patients to provide remote peer support and information.
How would this work? Remote medical support could be in the form of a telemedicine service that allows constant monitoring of the patient’s condition using a mobile device and the networks. How can this help TB patients? We know, for instance, on an ongoing basis without oversight from a healthcare provider or a visit, what their medicine intake patterns are, any challenges that are being encountered, and if these need to be resolved.
A secondary benefit is that the collected information can be used by the health system to understand infrastructural challenges and use local machinery to help patients. Effectively using this information will allow the health system to evaluate the information and reorient support strategies for patients. Overall, at this critical time, this allows the system to be more people focussed, data-driven and improve its interventions and strategies.
In these challenging times, remote support comes as a useful tool to fight TB. It gives patients a sense of hope and continuity, allowing them to directly engage with the system. It allows them to report challenges instead of giving up on treatment due to side effects. Most importantly, it can help in infection control, stigma mitigation and management of mental health challenges as soon as they appear.
In short, despite the pandemic, we can inform, guide and support patients through treatment. For patients, it provides treatment and care in a safe environment, creates direct contact with medical staff, shortens response time, improves treatment effectiveness, and provides an understanding of and access to their own medical situation.
At the health system level, it reduces hospital visits or in-person visits by health workers. It relieves the medical staff, raises the effectiveness of various treatments, and provides day-to-day update of patient’s medical information. It also safeguards them, reduces their stress and long working hours and allows them to focus on other issues.
In the current situation in India, there have been little efforts towards remote support for TB patients. While the government has been running a call-center and other efforts, these remain limited. The health workers and medical staff lack sufficient training in remote support, adherence strategies for TB have been delayed and the system lacks innovation and an effective use of digital media.
The pandemic has provided us with an opportunity to address these challenges by initiating remote support and providing patients the much needed-help they need as they battle TB in times of COVID-19.
About the authors: Sandhya is a wellness and mindfulness coach, TB Survivor and associated with Survivors Against TB (SATB), a collective of survivors, advocates and experts working on TB and related co-morbidities. Vashita is a public health professional and writer, also associated with SATB.