SLMA/Mobitel: DocCall Medical advice at your fingertips

A big vacuum that exists in the health services in Sri Lanka is the non-availability of a telephone call centre service from where the public can obtain reliable initial advice (not treatment) for medical conditions.

In 2012, when I was the President of the Sri Lanka Medical Association, I took steps to remedy this situation. The solution was the SLMA/Mobitel:DocCall Service. Sri Lanka Telecom Mobitel (Pvt) Ltd was invited to provide the telecommunication platform for the DocCall medical advice service. The SLMA recommended a set of doctors who were members of the SLMA to provide the medical advice.

The DocCall service is accessible for all active Mobitel subscribers via the easy to remember short code 247 (standing for 24 hours a day 7 days per week) regardless of their connection type (i.e. Prepaid / Postpaid). DocCall connects people from all corners of the country with a qualified doctor 24 hours a day 7 days a week in their preferred language for initial medical advice and guidance. In order to ensure the anonymity of the client and the doctor, a conference-bridging platform is utilised to link two parties. By dialing 247, a person can access the DocCall platform, which creates a conference bridge between the doctor and the patient without revealing the patient's mobile phone number and demographic information, while the DocCall platform operator has no access to the information shared between the doctor and the patient.

A grateful father

Here is a narrative of a typical consultation: A lone soldier stationed in a camp in Delft Island off Jaffna is worried about the poor weight gain of his 18-month old baby girl living with her mother in Madulla, a remote village in Badulla district, and decides to get advice from a doctor at around 11.00 pm simply because that was the only time available for him to do so. A doctor living in Colombo explains the reasons for poor weight gain and suggests a few feeding options and directs the baby to the General Hospital Badulla for clinical evaluation and investigation.

A few days later, the grateful father calls back to say that the investigations had shown that the baby had a urinary tract infection and was being treated at the Badulla General Hospital.

Going beyond the familiar

Sounds familiar? Yes, to a certain extent inquiring and receiving information on medical conditions over the phone is not a new thing.However, in Sri Lanka, it was limited to doctors and their close circle of relatives, friends and a few selected patients. The real revolution begins when the two communicating parties, although strangers, trust one another to discuss sensitive details of a medical condition. Their trust is built on the prestige of the institutions they are associated with. The doctor providing medical advice is a member of the Sri Lanka Medical Association and the client, seeking services, knows that he is speaking to a qualified doctor and the doctor knows the call he receives is genuine, not a hoax, because that call is directed to him through Mobitel's DocCall platform.

A survey of 1,346 customers who have used the service showed that 95 per cent of them were highly satisfied with the service provided. Furthermore, it was noted that the service is accessed by a diverse segment of customers all around the country ranging from teenagers to senior citizens, students to PhD holders, and housewives to professionals. An analysis of calls received from clients since the commencement of the service revealed the stark reality of the unmet needs of traditional health care provision.

Stigma

Majority of calls received from male clients were on sexual problems ranging from erectile dysfunction, premature ejaculation and sexually transmitted diseases. Most of the callers had never talked to their doctors about the condition they suffered mainly due to ignorance, perceived 'stigma' and embarrassment associated with having oneto-one discussions on sexuality.

Hence, they resorted to receiving advice and obtaining care from quacks. One young client with premature ejaculation living in Tangalle had travelled several times to Colombo to see a so- called traditional healer, bypassing many government hospitals and specialists, merely because he was unaware of services and facilities available at local hospitals, and was too shy to ask anybody.

A considerable number of women called in to tell their problems to a doctor with the hope of finding a solution or to get guidance on finding the correct doctor for a consultation. The main problem in one such woman, who wept through the entire 10 minute phone call, was that there was no one at home to listen to her problem, the doctor was successful in consoling her and directing her to seek appropriate medical care at the end of the conversation. People with socalled socially unacceptable illnesses and unable to find proper solutions to their problems, due to stigma, or ignorance, become desperate and turn to quacks for help and end up losing health as well as wealth.

At your fingertips

With the help of the DocCall service, people have the choice of receiving qualified medical advice without ever revealing their identity, thus improving the chances of getting proper medical attention. Senior citizens, mostly with chronic illnesses, who are concerned about their diseases, and the treatment they are receiving, use the DocCall service to ask many questions from a doctor to clarify their doubts; a need, they claimed, was not being adequately fulfilled in their consultations with doctors. The SLMA/Mobitel DocCall service has truly brought medical advice to the fingertips of patients, highlighting the fact that simple telemedicine services still have a place in the modern world of apps and wearables. (The writer is

the President, Health Informatics Society of Sri Lanka; the Past President, Sri Lanka Medical Association; the

President-Elect, Commonwealth Medical Association; and a Fellow of the National Academy of

Sciences of Sri Lanka. He can be contacted via vajirahwd@hotmail.com).