Fred Ezeh, Abuja
Coronavirus (COVID-19) pandemic has introduced some significant changes in the lives of the global population, almost without exception. The heat is still on, from the developed countries to the developing countries. The negative effects are evident in peoples’ lifestyle, social interactions, economic engagements, security, general governance and several other ways.
Nigeria joined the global response against COVID-19 on February 27, 2020, when the index case was confirmed in Lagos on an Italian citizen. On March 9, the second case was reported in Ewekoro, Ogun State, on a Nigerian who had physical contact with the index case.
Since then, life and living in Nigeria has not been the same, just the way it is across countries of the world. Peoples’ lifestyle has changed in virtually all ways. Many conventional lifestyles were changed as measures to avoid the spread of COVlD-l9.
Information and Communication Technology (ICT) was introduced to virtually every area of life to keep the world going. In Nigeria, ICT infrastructure hitherto abandoned were resuscitated and put to use in schools, worship centres, corporate meetings and in medical services (telemedicine).
The World Health Organisation (WHO), in its preliminary studies indicated that COVID-19 presents similar symptoms like malaria, which is endemic in Nigeria. The mode of spread and speed of spread too, caused serious panic and fear among the people, particularly the medical professionals who began to contract the virus early in the fight against the global pandemic.
Many doctors were said to have contracted the disease in cause of attending to some “ignorant” patients who visited the health facilities for medical attention, not knowing they were COVID-19 positive. The situation forced doctors and other health workers to turn back some patients from the hospitals, thus introducing the option of online interactions (telemedicine) to limit physical contact with patients that could expose them to the virus.
Telemedicine is simply defined as the exchange of medical information from one location to another using electronic communications platforms, which improves patient health status. Telemedicine makes it possible for physicians to treat patients or make prescriptions irrespective of distance or location.
A Professor of Otorhinolaryngology (study of diseases of the ear, nose, and throat) at the University of Abuja Teaching Hospital (UATH), Titus Ibekwe, admitted that telemedicine has become part of the “new normal” forced on the world by COVID-19 pandemic, because of its effectiveness in breaking the chain of COVID-19 transmission.
He confirmed that telemedicine is the offering of medical services from a distance using various available and efficient digital platforms, and the essence is to reduce the usual crowd in hospitals, which hitherto, encouraged the spread of COVlD-l9:
“Telemedicine has proven to be convenient, time saving and strengthen doctor/patients relationships. It also opened the window for new stream of income. Like before, patients do not need to travel from different locations to the health facilities for attention. With telemedicine, patients can be in the comfort of their homes and get the same medical services they would have gotten visiting the hospitals.
“In answering the frequent questions that people asked about availability of efficient and reliable digital device, manpower training, patients attitude, payment platforms, among several others, I always allay their fears and assure the health care professionals and patients that such issues would be corrected with time.”
Ibekwe said that telemedicine has three arms; treatment, investigative and educational. He said presently, Nigerian health care system cannot afford full deployment of telemedicine, maintaining that both the conventional and telemedicine will run side by side pending significant improvement in ICT infrastructure in Nigeria.
On the contrary, President, National Association of Nigerian Nurses and Midwives (NANNM), Abdulrafiu Adeniji, admitted that such medical service is good but not applicable in nursing services, because of the peculiarities of the services that nurses render in any given medical facility:
“Telemedicine is not new in medical services especially in developed countries where there are adequate ICT infrastructure for such services to work efficiently. But telemedicine is new in Nigeria. In that regard, we need to settle down to properly study the emerging trend in the application of the digital platforms for efficient medical services, to help contain the spread of COVlD-l9 in Nigeria, particularly in the health care facilities.”
He made reference to WHO which stated that the best form of health care system is the one that reaches the end user wherever they are with safety and less danger, and does not reduce the quality of care: “So, it will amount to deception for us to claim to be providing health care in Nigeria that does not meet the health needs of the patients. Doctor’s prescription can be easily conveyed through telemedicine than what could be done in nursing services.
“Evidently, of all the health care professionals, the attention required for efficient nursing care is 10 times as required by other professionals. That makes nursing more intensive than just listening to people online and telling them what should be done.
“It can only be done in non-critical situations and community base care. In summary, it is difficult to replace the function of a nurse with any other digital device, except in places where technology is advanced and there is infrastructure that will enhance the efficiency.”
Medical Director, Federal Medical Centre (FMC), Umuahia, Abia state, Dr Azubuike Onyebuchi, said telemedicine is the way forward, going by the global trend in every areas of life, including healthcare delivery services: “The main objective of telemedicine is to reduce pressure of inflow of patients in the health care facilities and reduce the risk of community transmission and spread of COVID-19.
“Medical experts have advocated that hospitals should have such services/facilities where patients who are not critically ill could call in and get the same medical advice they could have gotten being physically in the hospital.
“It saves hospitals and the health care professionals from being exposed to infectious diseases especially COVID-19 which is fast spreading across the world. Besides, there are inadequate supplies of Personal Protective Equipment (PPE) for use in hospitals.
“There are asymptomatic COVID-19 patients all over the country, who could, unknowingly visit the hospital and spread the virus there, particularly to doctors or other health professionals that attended to them at the facilities.”
He said plans are underway to set up state-of-the-art ICT facility in FMC, Umuahia, that would fasten the commencement of telemedicine services: “It will complement medical services in the hospital and help us achieve the desired goals and objectives.
“Nevertheless, we have fears that our Internally Generated Revenue (IGR) may significantly drop when we fully commence telemedicine services. Such situation will, undoubtedly, affect the quality of medical services we render to our patients. If a patient visits the hospital, there is likelihood that money will come to our purse. But if a patient consults from home, we may not get such money.”
The immediate past president, Nigerian Medical Association (NMA), Dr Francis Faduyile, insisted that telemedicine has come to stay in medical services in Nigeria, and was fastened by the outbreak of COVID-19: “Telemedicine has been in existence for over two decades. But it has not been popular in Nigeria because some doctors still believe in the conventional way of consultation and medical services. But many of them have been forced by COVID-19 to buy into the innovation.
“Nigeria has, obviously, joined the league of countries that are using telemedicine platform for the management of patients and administer other medical services. Before now, there used to be long queues of patients waiting to see the doctor for one minor issue or the other. Now, it must be a ‘critical’ situation before some doctors could physically attend to a patient.
“Without any doubt, COVID-19 has basically changed the world and its systems. A lot of things that we hitherto regarded as traditional have changed. A touch of ICT has been added to virtually everything in the world.
“With time they will continue to improve on the new trend to align with the global best practices. We should not be in hurry to expect drastic and perfect changes in this regard. With time, all the medical fields will develop the best system that suits their operations.”
He said Nigeria may not have all it takes in terms of ICT infrastructure to successfully deploy the telemedicine services particularly at local community level, but was hopeful that, in no distant time, such facilities would penetrate such rural areas and help in administering medical services. He also neutralised the fear that telemedicine may affect the IGR of health care facilities or negatively affect the personal income of the doctors.
Meanwhile, a patient, Isiaka Wasiu, told Daily Sun that he recently visited one of the public health care facilities in Abuja and was turned back because, according to the officials, his case was not a critical one that requires the physical attention of the doctors: “I had wanted a dermatologist to attend to my skin issues. I was told that the consultant was not on seat and would not attend to patients unless on appointment.
“The only help I could get that day was that the staff gave me his Whatsapp number. He asked me to take pictures of the affected areas and send to him via the Whatsapp platform. I was warned not to call but only send message. I did as was instructed and he responded with prescription.
“At first, I was angry but later saw reasons with the people. Someone there made me to understand that many doctors and other health professionals have contracted COVID-19 and other infectious diseases from patients who are unaware of their status.”
He, however, appealed to hospitals to sensitise people of such development so they would not feel disregarded, disrespected and insulted, when in actual sense, they are being protected from contracting diseases.