[«Le Devoir» en Inde] Telemedicine, a small miracle for rural India

Muttanahalli, in southern India. It took more than three hours to cover the 120 kilometers leading to this village from downtown Bangalore, the country’s Silicon Valley. This small community of 600 inhabitants has the charm of another era. As soon as you arrive, you quickly run into herds of sheep blocking the narrow dirt roads.

Here, residents have to travel about 50 kilometers on these country lanes to get to the hospital in Mysore, the nearest town, a two-hour journey. In even more remote villages, twice that distance may be needed to reach a hospital.

Access to health services is particularly problematic in rural areas of India. About 70% of health infrastructure is concentrated in urban areas, where only 30% of India’s population resides. In recent months, in this remote village, the MedLumos telemedicine clinic has become a tool to try to bridge this gap.

At first glance, the premises seem rudimentary: a small warehouse with sliding garage doors, a single room with faded pink walls, a wooden desk and a few plastic chairs to accommodate patients.

Ratnamma, a tiny 70-year-old woman dressed in a sari – traditional dress – with red and gold hues, and her husband, Mahadevappa, came to the clinic located less than four kilometers from their residence on a motorcycle . On the scene, the couple is patient alongside three other elderly people.

Ratnamma feels increasingly fragile: suffering from heart disease, she has no choice but to have regular medical check-ups to control her diabetes and monitor her blood pressure. Getting around to her many medical appointments had become a concern in itself for the woman worried about her state of health.

Shortly after arriving, Ratnamma is cared for by Kavitha Siddarju, a 39-year-old nurse in a white lab coat. The latter takes her vital signs using intelligent instruments. The results are entered into a PDF document on a mobile phone and then sent to a doctor at a hospital in Bangalore.

Ten minutes later, Ratnamma and the nurse chat with him via video conference on WhatsApp, a widely used messaging app in India. In a brief conversation, the doctor explains to her that her sugar level is high and reminds her of the indications for her new medication. After a few minutes, she is free to return home in peace. “It’s fast and convenient. It will save us several visits to the hospital, ”says her husband, who almost always answers questions for his wife.

Trust and familiarity

Next patient: Shivamma, a 92-year-old woman with polar white hair and small oval glasses. As soon as she is seated, without embarrassment, she bares her chest to reveal a nasty wound that has been worrying her for three weeks.

“My grandson is a doctor, but he practices in town. He heard about this clinic and suggested that I come for a general examination,” she explains in Kannada, the mother tongue of the majority of the inhabitants of this southern state of the country.

Like all the patients present that day, Shivamma was using the services of MedLumos for the first time. The clinic had opened its doors two months earlier, in August 2022.

After serving in the military for 25 years, D^D Aradhana Sood, founder of the clinic, wanted to contribute to society in a different way. “With my years in the army, I witnessed the disparity of health infrastructure between villages and big cities. I’ve always wanted to do something about it,” she told the To have to.

This trained dermatologist could not just offer a simple mobile application, as in big cities. For her, it was clear that these small communities needed a hybrid solution to be receptive to telemedicine.

Local staff were also needed who were trusted by the population and who could speak Kannada. Hindi and English are the official languages ​​of the country, but they are eclipsed in favor of local languages ​​outside the urban centers.

Nurses Kavitha and Sowmya come from the community — they had previously practiced in schools. With the help of Pankaja, the medical assistant, they were trained to act as a bridge between patients and doctors in hospitals in urban centres.

“Telemedicine is a new experience for patients, but also for us. We are very proud to have learned to use the technology and put it to good use in the community,” says Sowmya with a smile on her face.

All doctors offering remote consultations at MedLumos Clinic practice in Bangalore and also speak Kannada. Knowledge of the local language and culture is an obstacle that explains why the mobile application model of many young companies does not find takers here.

“All of these applications are primarily aimed at urban communities. Their penetration into the villages is almost nil. Most people in the community have never heard of it,” says Dr.^D Sood.

A smart stethoscope

Also present that day, the D^r Satish Jeevannavar traveled from Bangalore to see his latest innovation: the AiSteth, a stethoscope that uses artificial intelligence to analyze heart and lung sounds. The sounds picked up are converted into a visual pattern which can then be interpreted by a remote doctor.

With this tool, the D^r Satish not only seeks to facilitate the triage of patients requiring a consultation with a cardiologist, but also to bring cardiology services to remote areas.

“India has only 5,000 cardiologists for 1.3 billion people. It would take decades for there to be a cardiologist for every village. Thanks to technology, we can at least replicate some of their expertise and bring it to these remote regions,” he explains.

He was the one who used the stethoscope when taking Ratnamma’s vital signs. In a few minutes, it was possible to consult the data analyzed by the device, which required three years of development.

Although the stethoscope is not 100% accurate, the D^r Satish aspires to make life easier for rural health care workers and to promote heart disease screening in underserved villages.

A social mission

Like the others start-up who have embarked on digital health care since the pandemic, the MedLumos clinic falls under the private sector. However, its services are more affordable than elsewhere, assures the founder: patients have to pay 125 rupees for a consultation, or about CA$2.

“The next step is to discuss with microinsurance companies to see how we can make the services even more accessible. For our patients, 125 rupees can be a lot of money,” admits Dr.^D Sood.

Another cost is added for the inhabitants of these communities: agricultural workers for the vast majority of them, they lose their means of subsistence for the day if they have to be absent to go to the hospital in town. This fear of losing income and the long distances to travel lead to a reluctance to seek care, says Dr.^D Sood.

Two MedLumos clinics are currently operational and three more are expected to open in the coming months to serve even more villages.

However, telemedicine will not cure all ills: distrust of technology, service costs and long journeys to hospital for emergencies remain important realities in these disadvantaged villages. But for the residents of Muttanahalli, the MedLumos clinic, as rudimentary as it may seem to Westerners, is a small revolution in itself – a step towards more equal access to health care.

This report was financed thanks to the support of the Transat International Journalism Fund.The duty.

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