The doctor is on screen

The building is still being constructed,the OPD will take a few more months to begin but Dr Sabah Siddiqui is at work. Its 10 am on April 25 and the telemedicine room at Raipur AIIMS,the newest AIIMS in the country,is packed with specialist doctors. They are staring intently at a big screen in front of them,at images of patients visiting CRPF camps in Narayanpur and Sukma,two of the remotest districts in Bastar division of Chhattisgarh. At the CRPF camps,patients are connected to doctors at the telemedicine room through Skype in areas where Internet is available or telephone. The doctors at the camp help patients explain their condition to specialists,who prescribe medicines and further treatment.

11 am. Its already been an hour into the days telemedicine OPD,held twice a week on Mondays and Thursdays from 10 am to 1 pm. Siddiqui,who joined AIIMS only the other day,is excited. A general medicine specialist,his new assignment is challenging. He looks at the screen as Dr Vijay Kumar Yadav,Medical Officer,39 Battalion CRPF,the camp doctor at the district headquarters of Narayanpur,introduces another patient,a 50-year-old woman. She fumbles when asked for her name. Saguni, says the camp doctor. Haan,bataiye, Siddiqui says. She complains of lower back pain. He asks her a few questions. She doesnt reply,probably doesnt understand Hindi or is simply reluctant to speak to this distant image flickering on a screen. Siddiqui discusses her condition with the CRPF doctor.

Its a curious treatment. The doctor is 250 km away,sometimes 500. All contact he has with the patient is a grainy image on screen. Or a breaking voice on telephone. He cannot check her pulse or breathing. He cannot even diagnose if this is a specific ailment or general fatigue. Siddiqui isnt satisfied with the diagnosis and asks the camp doctor to examine her again. Use lita kar fir se dekho.

Narayanpur is home to Abujhmaad,the liberated zone of Maoists spread across 6,000 sq km,and Sukma is the district where,exactly a year ago,Maoists had abducted then collector Alex Paul Menon. In these areas,villagers sometimes have to walk over 50 km for their monthly PDS and the nearest primary health centre an equal distance away. One OPD session typically covers three CRPF camps of Bastar and examines around 20 patients. Its a relaxed pace. Each patient gets enough time and a doctor maintains a register of the patients examined.

Most of the patients are poor tribals or belong to backward communities and have probably only met village quacks before. Besides,the idea of talking to a screen is as alien a concept as any. Also,since many of them cant speak Hindi,many like Saguni cant effectively talk about their condition to the camp doctor,let alone to the doctor at AIIMS. What are the chances of the patient getting the right treatment in this two-tier method?

Nothing is lost in translation, Siddiqui insists. The camp doctor has already done the primary diagnosis. True,they cannot get their advance tests done immediately, but we can always ask CRPF to bring these patients here if required. Patients with chronic ailment and complications,who cannot possibly be treated through telemedicine,will be airlifted by CRPF to AIIMS.

Whenever Siddiquis voice trails off,doctors around him ask him to hold the microphone closer. At times when his image goes out of frame and the patient cant see him,another doctor adjusts the web-camera. Patients continue with their fumbling explanations,doctors listen with patience. Its a comforting sight. Despite the physical distance and the other barrierslanguage,technologysome of the best doctors spend three hours in a room,their gaze fixed on a screen or their ears glued to the telephone,trying to listen to people whose voice rarely gets heard.

Meanwhile,Dr P N Solanki,Chief Medical Officer,2nd Battalion CRPF,Sukma,is trying to connect through Skype. His calls flash on screen. AIIMS Medical Superintendent Ajay Dani tells the Narayanpur camp doctor that their time is up,he can now examine patients on his own and if there are serious cases,he can connect again.

Many of these patients probably have never been examined by a doctor, Raipur AIIMS Director Nitin M Nagarkar says. He hopes that this mechanism will spread the word about the premier institute and it will soon become a referral point for Bastar residents. Its the first-ever instance of any AIIMS providing telemedicine facility to tribals, he says.

A joint venture of CRPF and AIIMS,the idea of a telemedicine OPD in Bastar region came up during a recent conversation between CRPF IG Chhattisgarh Zulfiquar Hasan and Nagarkar. The central force made people living near their camps aware of the OPD,even took doctors to some of the most interior areas of Bastar to familiarise them with the situation.

Still,the situation has more challenges than one can imagine. Its noon. Siddiqui has already examined nearly 10 patients in the last two hours. Another hour to go. The Sukma camp is now online and suddenly,there is a power cut at AIIMS. The institute is yet to get generator back-up but doctors stay on in the room. The treatment will continue on phone. Hello8230;yes8230;ji bataiye8230; The patient has an eye ailment. Over to ophthalmologist Dr Ankur Srivastava.