key: cord-0800336-9bwdu6ms
authors: Rastogi, Sanjeev; Singh, Neelendra; Pandey, Preeti
title: On the brighter side of COVID-19 induced Lockdown: Devising the collateral methods to provide Ayurveda consultation during impasse
date: 2020-05-08
journal: J Ayurveda Integr Med
DOI: 10.1016/j.jaim.2020.05.001
sha: 7fe8b08975a831994a51521c5aed794b58cb1bc1
doc_id: 800336
cord_uid: 9bwdu6ms

Abstract COVID-19 pandemic and subsequent measures to mitigate it have presented the world with certain unprecedented situations. Lockdown with effective closure of all services including routine health care services has tested the nerves of health care providers for finding novel ways of providing services without getting into the risk of exposure. Telemedicine had been an ideal option for such situations allowing all channels of communication that leverage Information Technology platforms, including voice, audio, text and digital data exchange as a help to diagnosis, prescription and follow up evaluation. Unfortunately this versatility of Telemedicine as a patient –physician interface could not be harnessed well for its technical complexities and unpreparedness of institutions and individuals. Smartphone based video calling using whatsapp messenger has been proposed as a feasible Telemedicine application to provide outpatient services in this scenario. A pilot run of outpatient services during lockdown period through whatsapp facilitated video calling at Ayurveda Gathiya Clinic, State Ayurvedic College and Hospital, Lucknow has shown a way forward of running such services with a mass appeal, ease of operation and high interface gratification among users and service providers. Within its limitations related to the quality and quantity of information sought, this comes as a viable method of patient –physician interfacing during the phase of lockdown.

…………………………………………………………………………………………………………………………………………… Notwithstanding the havoc caused by COVID-19 across the world, there are occasional enlightening sights too embedded deep within its ugly face [ 1] . Besides the direct trauma and panic created by the pandemic, its aftermaths have been highly disruptive to the social order [ 2] . Measures adopted to mitigate the disease and to stop the cross contamination fell harsh on various segments of people. Social distancing, stoppage of conveyance and lockdowns have come as miserable measures for many for whom movement was essential either to earn the living or getting a relief from a health care problem [3, 4] . The lockdown related closures of routine health services went tough for many who had been suffering with chronic ailments requiring regular monitoring of their clinical status to keep their conditions under control. Hypertension, diabetes, joint and musculoskeletal diseases, neurological diseases, ophthalmic disease , dermatological diseases and many others have formed the bulk of patients facing unprecedented sufferings due to sans access to health care services [ 5] .

Lack of physical activities added with imposed restriction of movements has given unforeseen swings to the clinical stability of such patients who had been doing well through a course of drug, diet and ambulation related interventions previous to lockdown. Net health related impacts of all mitigatory measures adopted to prevent COVID-19 may be noticed quantifiably only after the threat of pandemic is over. Their detrimental effects on patients are however pervasive and easy to sense [6] .

Health care providers, unrelated to COVID-19 management faced some unique challenges in this scenario. There was a challenge to provide health care services to the needy people within the regulation of imposed restrictions in running outpatient clinics. Those who were connected with their patients through digital ways of communication suddenly faced a heavy influx of messages, calls and mails although at times unsolicited and untimely. At speciality care centres the challenge was faced by adopting the standard telemedicine facilities operated by a dedicated server and by designated panel. Resourceful Individual practitioners have taken the respite in internet based physician-patient interface providers [7] .

In the absence of high tech communicative facilities, resuming the health care services during on-going lockdown was however a bit over demanding for AYUSH related health care facilities in the country. Since AYUSH related facilities in the public sector have neither been exposed to the distant consultation related practices nor are resource rich to take up such novel ideas, it was inevitable to keep the medical consultation at bay until the lockdown is Although not supported with adequate data, this initiative of smartphone app based consultation through video calling had been highly gratifying for patients and physician for two reasons. From the perspectives of patients this is the ease of operation and live connectivity with the treating physician which build much of the gratification. This echoed the observations earlier reported as the factors signifying the patient's satisfaction during tele-consultation [9] . From the perspectives of physician, this was the patient's recognition and possibility of indirect examination of joints and their mobility by focusing the camera on particular joints. which formed larger part of the gratification. Once the consultation was over, one team member who was engaged with record keeping (PP) was handed over to explain the treatment to the individual patients. All patients were handed over with a snapshot of a written prescription send to their phones. For the purpose of better record keeping , a feedback record is also generated now for recording the feedbacks during the follow-up calls . The exercise was also gratifying for the team members who were assisting the whole process. For their actual involvement in the process and their availability during the interrogation and examination of the patient as well as during prescription generation, the process simulated a real OP clinic operated in a distant mode having all essentials of learning except direct clinical examination.

Although gratifying from the perspectives of providing instant connectivity between the patient and the treating physician, during the periods when physical consultation is not possible, this novel intervention should be viewed essentially within the context of its This guideline provides answers to many legal issues and suggests the practitioners to follow the standard guidelines to avoid any subsequent legal hassle. The guideline clearly suggests that if it is a patient initiated call to seek consultation, as it was in our case , the consent is implied and is not required to be taken separately.

What more important is to keep the record of all such consultations in the form of call logs, chat records or images. In our pilot experiment we generated a hand written prescription after every consultation by one of our team member (PP) for sending its image through whatsapp to the caller once the call is over. The prescriptions were subsequently kept preserved for the record purpose.

This would have been interesting to see how much effective this intervention technique was comparing to the conventional physical OP based consultation process. This was however impractical to be attempted now owing to the absence of conventional OP based consultations.

Mobile applications as a convenient form of telemedicine are already a common utility at many speciality health care settings across the world. Studies reveal the patient's compliance and satisfaction through such interventions lesser or comparable to the conventional consultative process although it largely varies within medical and surgical specialities [11 ] . Such comparisons nevertheless are possible only when conventional OP based consultations are also available. This pilot experiment of running video call based OP clinic through smartphone in an Ayurveda setting has a mass appeal for its ease of application and has enormous potential of its replication in resource and technology deficient public health setting including those of modern medicine [12] .

COVID-19 and its aftermath has come with many inevitable eventualities. By all means, it however also came as a great learning to the human society clearly demonstrating the human ability to keep well with bare minimum needs. It also has given us a great opportunity to devise the collaterals by utilising the less utilised resources. This pilot testing of distant consultation through smartphone based video calling had a great meaning for Ayurveda and has a potential of playing significantly in promotion of accessible health care through Ayurveda during the time of peace also if it is adopted and practiced suitably as per the actual needs. This should however be clearly understood that such distant consultation approaches have their limitations and can never be considered as a substitution to the normal OP based physical consultation. Technology should came as a helping hand at the time of need and to the needy but should not be served as a bypass to some ordinary yet crucial components determining a social order [ 13] . Generating a clear idea about who can be served better with such tools and where a conventional OP based consultation is essential may be most crucial in this regard.

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