This August the VSee team returned to the Philippines on a new medical mission provide free telehealth and in-person doctor visits to the underserved. We worked with a local nonprofit Soup Kitchen Cainta which serves scavenger children and elderly of Cainta Rizal in the eastern Metro Manila. We served 153 patients over 2 days.
In addition to free doctor visits, we gave patients free medications, vitamins, rice and canned goods. We had learned that many families often shared a single toothbrush, so we provided free toothbrushes as well.
A big thanks to our generous partners who supplied us with free medical devices, satellite broadband, physician volunteers, medications, vitamins, foodstuffs, and toiletries:
How Does a Telemedicine Clinic Work?
We held the two-day telehealth clinic outdoors both for space and COVID precautions. The first day was at Kabisig Elementary School’s covered basketball court where we cleared one classroom for conducting ultrasounds for pregnant mothers. The next day, we moved to a covered basketball court.
Each day we set up 5 stations to keep our patients flowing and organized:
Station 1: Take-A-Number Registration
Unlike the US, most health systems in Asia use a take-a-number waiting line model. So upon arrival, patients were asked to sign in with their name and date of birth and were given a stub for queuing. We also handed out raffle tickets at this time to help keep patients engaged and invested in the event. (Many patients came to the event from far away places – and would likely lose that day’s income.)
Station 2: Patient ID and Vitals Screening
Next, patients would be called by VSee staff to have their basic health information and vitals taken down on their registration stubs. We had brought portable, digital wellness devices to do this including digital blood pressure cuffs, no-touch thermometers, pulse oximeters, and digital weighing scales.
Patient Identification – The Problem of Name Variations for the Same Person
Also included at this station was the creation of a unique patient identification (ID) number for each patient. To do this, our staff used the iRespond iris scanner which generates a patient ID number tied to the patient’s unique biometric data.
This made verifying patient identity from station to station much easier, especially for foreign staff, who were unfamiliar with the many name variations Filipinos might use to introduce themselves (similar to the way someone in the US may interchangeably use their given name or nickname). In addition, this unique ID can now be easily retrieved and reused for future follow-up visits, telehealth clinics, and other humanitarian events patients might participate in.
Station 3: The Telemedicine Consultation
There are several pieces to doing the telemedicine consultations, so let’s break it down into the three main pieces: the physical onsite setup, the remote physician setup, and the consultation workflow process.
Physical Setup (Onsite)
For the consults we set up four telemedicine tables each manned by a volunteer staff. Each table had a laptop or tablet loaded with the VSee Clinic software in the Remote Medic configuration. This configuration allows the “remote medic” (VSee staff and volunteers in this case) to search for existing patients, create new patient profiles and submit visit data on behalf of the patient without actually logging in as the patient. We also set up the VSee Clinic to send an alert to remote providers whenever a patient in the waiting room is tagged as “Ready to start call.”
For every two stations we provided a telemedicine kit containing a set of medical streaming devices including:
- general exam camera
- iris scope
- ultrasound probe
Our pool of volunteer physicians were mainly offsite and came from KonsultaMD, Ateneo School of Medicine and Public Health, Dr. Jarone Lee, and Dr. Kim Tranquada from Healthcare Alliance for an Equitable World. They had been trained to use VSee Clinic before the event. Ateneo also brought one to two onsite supervising physicians to oversee their remote interns who would be doing the virtual consults.
Virtual Consultation Process:
- When patients came to this station, the volunteer staff would verify the patient’s ID and enter the patient’s chief complaint as well as previously collected vitals information into the VSee Clinic intake form.
- Once this was done, the volunteer staff would start the virtual call by clicking a button to enter the virtual waiting room.
- Our remote physicians would receive a VSee notification of a new patient entering the waiting room. The first available remote physician would call the patient.
- During the call, physicians would direct the volunteer staff to perform any needed physical maneuvers such as the kidney “punch” test to check for kidney inflammation.
Remote Physical Exams with Medical Devices
Many of our elderly patients also came for eye issues (e.g. cataracts, pterygiums), where we used the iris scopes and general exam cameras to stream clear, real-time images of their eyes to our virtual physicians. One physician was able to determine that a pterygium was advanced enough to require surgical removal.
We also used USB stethoscopes (thank you MobilDrTech!) to help diagnose several cases of bronchial asthma.
One of the highlights was using the portable ultrasound to provide a 4-month pregnant mother with her very first ultrasound! For many moms across the Philippine archipelago, ultrasounds aren’t easily accessible or available. In fact, only 10 to 20% of women in rural regions of the Philippines get an ultrasound before 24 weeks of their pregnancy. This contributes to the high maternal mortality rate of 121 deaths per 100,000 live births in the country.
- Physicians would enter in the diagnoses, prescription, and treatment plan into the VSee Clinic SOAP notes, which had been specially configured for this telehealth clinic. Once the notes were submitted and the consult was completed, patients went on to the next station to collect their prescription.
Station 4: Medication & Prescriptions
We needed a separate station for prescriptions because e-prescribe is not widely available in the Philippines. The vast majority of pharmacies still require a physical paper prescription signed by a licensed Philippines physician to dispense medicines.
We had a licensed Philippines physician physically writing out prescriptions for the patients who needed one. When the patient arrived, he would use his phone to look up the patient’s prescription in the submitted VSee Clinic notes. If the patient had been seen by one of the interns, he would first check the recommended diagnoses to make sure it was correct. Sometimes he would also have to “translate” the medication prescribed by our non-Filipino volunteer physician into an equivalent medication that was available in the Philippines.
We also handed out antihypertensives, antidiabetics, and other maintenance medication donated by OnePharma to our qualified elderly patients.
Station 5: Care Pack and Photobooth
At this last station, we completed their telehealth experience, with a living essentials “goodie bag” of rice, canned foods, toiletries and vitamins to take home. We then took patients’ photos and gave it to them as a souvenir to remember this event.
What Worked at This Telehealth Clinic – What Didn’t?
Overall the telehealth clinic went smoothly. For many who came, it was their first teleconsult. Although they were initially skeptical when they realized they would be seeing the doctor over video., two years of COVID and video calling with family and friends had familiarized them with the concept and process. We were pleasantly surprised at everyone’s level of comfort with the technology.
Review Your Surroundings for Telemedicine Noise Pollution
One thing we need to consider more carefully in the future is how surrounding sounds may affect the remote doctor’s ability to evaluate patients’ conditions. At one station, too many patients were getting diagnosed with bronchial asthma. It turned out that the wheezing the physician was hearing was actually caused by the noise of the large industrial fan next to the telemedicine table.
Train Your Telemedicine Volunteers Beyond the Technology
We also learned that it would be best to train non-medical volunteers on how to perform some of the more commonly used physical tests and procedures. While they had been trained to use the medical devices, they usually didn’t know how to correctly perform the procedures that the physicians occasionally requested..
Understanding the Face of Urban Health Disparity– Who We Served
The people who came to the event were Soup Kitchen Cainta regulars–many of them seniors and children from families that struggle to earn enough for their day-to-day necessities. Children as young as four are taught to go through the neighborhood to collect papers and bottles to sell to the local junk shop for added income. This job exposes the children to parasites and illnesses that fester in garbage dumps. The elderly survive by driving jeepneys (colorful mini-bus-like shared taxis) or by taking in sewing–usually earning below the minimum wage of approximately 10 USD (570 PHP) per day.
Photo by Trishhhh
Common Health Problems in the Elderly
According to a 2000 survey by Philippine Health Statistics the nation’s elderly typically suffer from visual impairment, difficulty in walking, chewing, hearing, osteoporosis, arthritis and incontinence. Diabetes, high cholesterol, and hypertension are also common chronic conditions faced by these elderly Filipinos.
Barriers to Healthcare Access
The typical wage earnings of these workers are not enough to feed a family, much less obtain maintenance medication or pay to see a doctor.
Going to a public health center often means standing in long lines and losing that day’s wages to see a doctor. Oftentimes the doctor is not even available because she is at one of the other locations that she is in charge of visiting.
Without easy access to professional medical care, this population often resorts to self-treatment, which usually means taking antibiotics for any kind of illness. This has led to the problem of antibiotic resistance in these communities and even fewer affordable treatment options.
it wasn’t unusual for us to see elderly patients with medication prescriptions…from as far back as 10 years ago!
During the telemedicine clinic, it wasn’t unusual for us to see elderly patients with medication prescriptions which were years old–some from as far back as 10 years ago! We also saw many toddlers who had not seen a doctor since they were born.
How Can Telehealth Improve Public Healthcare?
Dr. Dato, Board of Director of The Philippine College of Emergency Medicine (PCEM) and Dr. Rafael Garcia of Ateneo School of Medicine and Public Health offers some key insights into how Filippinos can leverage telehealth and telemedicine to increase access to healthcare for these barangays (or districts).
One way telemedicine could be used is in the local health centers, which are often the only places where below-minimum-wage workers have access to a licensed doctor. Since one municipal doctor is usually assigned to multiple barangays, telemedicine could enable the doctor to see patients at all his assigned health center locations regardless of where he is located geographically. Patients would be more likely to see a doctor even if a doctor was not actually on site. Even better, patients might be allowed to see a doctor from home or work.
Increased Specialist Care Access Via Telehealth
Another way telehealth can improve healthcare is by offering patients better access to specialist expertise. For example, telemedicine could give an onsite doctor the ability to connect with a specialist either synchronously or asynchronously for further advice. This way, the patient’s next steps and management is clearer and redundancies can be eliminated.
While there would, of course, be many logistical challenges and issues for barangay health centers to overcome, VSee’s telehealth clinic is proof that it can be used to effectively reach the underserved.
Future VSee Telehealth Clinics and Medical Missions
The VSee team will return to the Philippines the first week of Jan 2023 for another medical mission – this time aiming to serve 500 to 1000 patients over 5 locations. Please contact us to support or join us.