When Sobia Khalid lost her husband in a car accident, she was petrified. Widowed and with a kid, the future — so rosy till a few days ago — had suddenly become insecure. Sobia slipped into depression.

“I felt like crying all the time,” she says, describing how she had to leave her job and get her mother to take care of her child. “But then, I received a Telehealth message on my cell phone one day. I got in touch with a counsellor and shared my pains and fears.”

An important initiative in the private sector, the Telehealth service of Aman Foundation, a local NGO, is providing free health advice (medicines are not prescribed) and counselling services over the phone. The service is available round-the-clock and the number (9123 or 021-111-11-9123) can be accessed from anywhere in Pakistan.

“We manage about 800 to 1,000 calls daily, which are attended by a team of health advisors that include doctors, nurses and clinical psychologists. The information received from a patient is entered into a computer programme with a large database on illnesses and their treatment and help is provided accordingly,” says chief operating officer, Aman Telehealth, Altaf Hussain Musani.

For Khalid, Telehealth worked like a charm. Telehealth staff provided emotional support to her for almost three months, during which she was consoled and counselled over how she could return to normal life. “It did work! I got so motivated by these sessions that I have taken up a job now and am raising my son myself,” she says excitedly.

The Telehealth service also maintains a directory with updated detailed information about all health-related facilities and specialist doctors working in the city. Currently, the data is Karachi-specific, but there are plans to add other areas, too.

Efforts are also being made to develop linkages with Sindh and Khyber Pakhtunkhwa governments so that the service could be effectively expanded. According to its managers, a major problem has been to find dedicated and skilled individuals and then to retain them. Winning the trust of callers that they can seek health advice on the phone is another challenge.

Describing Telehealth as a support service that could fill a vital gap between the patient and the health system, its chief executive officer, Dr Junaid Razzak says, “It should be seen as a system that helps clients/patients decide when to seek care and where to seek it. The total impact would, therefore, depend upon many factors such as responsiveness of health facilities where patients are referred to.”

He cited examples of India (Andhra Pradesh and Tamil Nadu), Bangladesh, Mexico and Kenya where such services are successfully working.

But there remain major handicaps in promoting telehealth in Pakistan. “There are several barriers; most people are not used to getting medical advice without a face-to-face interaction,” explains Razzak. “Then there’s the cost of the call, though Aman doesn’t charge anything for the service, and the fact that cell phone distribution is not universal and women in many communities might not have access to cell phones. Hence, they wouldn’t get the chance to use the service.”

Dispelling fears of any misdiagnosis, Razzak argues that the service doesn’t replace a doctor’s visit; rather, it augments and improves patient decision-making about the need for immediate care versus delayed care.

“Our focus is not to make a diagnosis on the phone unless it is simple symptom-based diagnosis such as fever or sore throat without any concerning symptoms such as difficulty in breathing or inability to swallow etc. “The service aims at giving patients required health information and explain to them what their symptoms may entail and provide symptomatic treatment.

There is no email involved and the entire process is based on a telephonic conversation which makes it easier for people to understand the service better,” he said. —Faiza Ilyas