COVID halted my volunteering abroad, so I reached out virtually
By Dr Kerry Greenan for Doctors.net.uk
During lockdown, we’ve become used to virtual parties, quiz nights, escape rooms, exercise classes… so why not volunteer virtually too?
This time last year, I was working in Zambia as a volunteer doctor with a charity called On Call Africa. We were running outreach clinics from rural health centres (RHCs) in the Southern Province, as well as training community healthcare workers and running health education sessions.
In Zambia, the population is very geographically dispersed and there is a relative shortage of doctors. For most people, their nearest point to access healthcare are the RHCs, which in themselves often require a long journey (usually on foot) from home. RHCs are usually staffed by clinical officers, who have undertaken a 3-year diploma in common medical problems; they then tend to work in these remote areas and will assess and manage any patients who present to them – overwhelming to say the least! Testing capabilities in RHCs are limited, and onward travel to district hospitals is expensive, time-consuming and may be impossible for many.
A rural health centre in Zambia. Image: The Virtual Doctors
Sadly, within a few weeks of arriving in Zambia the COVID-19 pandemic had broken out and with rising cases, travel restrictions and border closures we had to make the difficult decision to return home earlier than expected. Having experienced healthcare in Zambia first hand – seeing the distances that patients have to travel to access healthcare, the level of poverty and the scarcity of the doctors – leaving on the brink of the pandemic was not a decision taken lightly. I wanted to know how we could continue to support the communities we had recently been working with.
“During lockdown, we’ve become used to virtual parties, quiz nights, escape rooms, exercise classes…so why not volunteer virtually too? This is where The Virtual Doctors came in: a way to continue supporting healthcare in Zambia when being there in person isn’t possible.”
As a GP trainee, the way I consult in the UK has rapidly changed in response to the pandemic: in my practice, we are receiving many more e-consults and responding to patients by phone in the first instance, sometimes even responding by text. Telemedicine is a lot like this, except that we are receiving cases from trained clinical officers and acting in an advisory capacity. Working in healthcare, we are always learning and developing our skills, and every case received by Virtual Doctors is also a learning opportunity, both for me and for the clinical officer. I have the time to read up on conditions I might not be as familiar with (rashes caused by tropical diseases, for example) and by explaining my thinking and decision-making with the advice, the clinical officers can develop their confidence in managing similar problems in the future.
A clinical officer uses the VDr app to send a case. Image: The Virtual Doctors
Having some experience working in Zambia is really helpful in terms of being familiar with some of the common tropical conditions, as well as with the resources available to the clinical officers. But there are many conditions common to both countries, so it is by no means essential. The cases are allocated by specialty, so the cases I receive tend to reflect this: rashes, musculoskeletal problems, chronic conditions and maternal and child health.
I receive around two or three cases per month, and each case usually only takes me around 30 minutes to respond to, so I don’t find it to be too time-consuming to manage around my usual job. Unlike the clinical officers working in signal-poor areas, I have the advantage of being able to look up and check things online (in fact, I have much longer to think about the case and my advice than I do in an average GP appointment!) and second opinions or referral to a different specialty can also be sought if needed.
A breakdown of the cases The Virtual Doctors receives by speciality. Image: The Virtual Doctors
Dr Kerry Greenan is a Virtual Doctors Volunteer and a GPST3 working in the Tower Hamlets, London
It has been a really interesting experience to volunteer with the Virtual Doctors: I’ve had a whole range of cases which have required me to think in a different way, considering diagnoses that may not be common among my patients, and making management plans when you can’t rely on easy access to investigations. We get a monthly email listing feedback from clinical officers for each case, including whether the advice was educational and whether it prevented a hospital referral. This is always useful to see the impact of the advice you’re giving, and I hope that where advice has been educational it can provide a lasting impact for the clinical officers. Ultimately, volunteering with the Virtual Doctors doesn’t take a lot of time, but improving access to healthcare for some of the most rural populations is certainly a good use of that time.