5,000 miles stretch from the UK to our colleagues and patients in Zambia. But we bridge the gap with our Telemedicine. We cannot do everything from where we are. But we can do something.

Over the last 15 months, as well as providing Wash Stations, The Virtual Doctors has dealt with referrals about many aspects of COVID management. Early on, most of the case queries were around practicalities of testing, isolation and community care. It gave the Clinical Officers a chance to discuss and understand principles of management, as we learnt together and shared our knowledge. Signposting them to local guidance and protocols was really important. As well as answering individual case queries, we tried to point them to useful and relevant resources for their setting.

During wave two in Zambia the number of case referrals to us about COVID positive patients increased; previously it seemed our rural populations had been relatively spared and now many of our Zambian clinicians were encountering the disease for the first time. We could sense the anxiety across our WhatsApp Support Group.

Patients requiring hospital treatment for COVID in Zambia are referred to designated facilities, so not all our team members are involved in the ongoing care of such patients. But we were certainly receiving referrals from some of these isolation units. To share learning quickly across the group, we put together a COVID case scenario, with the help of one of our fantastic Zambian Physicians, outlining the typical symptoms and signs of a patient with severe COVID and describing the standard management available in a District Hospital. Whilst following up-to-date National guidance, we tried to keep it simple and to reflect what was possible on the ground, reminding them that we can always ‘do something’ even with limited resources. It was shared with the whole team via the Support Group (it can be read on our forum here).

At the moment, as a terrible third wave tears through Zambia, our clinicians are seeing increasing numbers of sick COVID patients. We have advised on both young and elderly patients, on patients with co-existent disease such as diabetes and HIV and also on sick pregnant patients. We have been consulted about management of symptoms and complications, about treatment options and need for escalation of therapy and about end-of-life care.

As we learn, so we hope to share our knowledge with our colleagues. Hearing back that a patient has improved and been discharged is invaluable. Sometimes we know that none of us can change the inevitable outcome, but we can still share valuable experience through the consultation, whilst at the same time bridging the distance, reducing the isolation of these Front-Line Health Care Workers. Isolate. Quarantine. Distance. Separation in the pandemic. But through this also a sense of togetherness, with shared challenges, shared goals and shared fears.

We have reflected above on our involvement in COVID care over the last 15 months. But importantly during this time our core service has continued as usual. One of the major threats from the pandemic is the disruption to Essential health care services and the long-term problems this will bring worldwide. The WHO Pulse Survey looking at the impact of COVID on Health Care describes the ‘substantial disruption to essential health services across the globe’. It notes that access to Telehealth technologies was limited in 70% of countries that they surveyed(1). The Virtual Doctors model has allowed us to continue giving expert advice to Primary Health Care Workers throughout. Whether it is by advising on stroke care, or management of malnutrition, treatment for hypertension, or assessment of a patient with halitosis, interventions following a snakebite, or review of a patient with intractable hiccoughs, expert opinion on complications of HIV, or management of a patient following an overdose, we believe we can do something.

(1) https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS-continuity-survey-2021.1 Accessed June 2021