When a woman was brought to Kolti District Hospital of Bajura nine years ago, it did not take long for Dr Gunraja Awasthi, who was then serving as a medical officer, and his team to figure out her condition was critical. Family members had taken the woman, who was in her teens, first to shamans and then to the nearby health post and primary health centre before bringing her to the district hospital, a two-and-a-half-day walk from her village.

“The baby had already died in the womb. The case was complicated. Her condition was deteriorating by the minute,” Dr Awasthi, who is currently the chief of the Sudurpaschim Regional Health Directorate, recounted. “Our immediate concern was saving the mother.”

At a hospital in a remote region like Bajura, where there was a lack of specialists, the only resort for Dr Awashi was telemedicine.

“Our team got in touch with a team of gynecologists at Patan Hospital, who instructed us through video conferencing on how we could detach the fetus from the womb,” Dr Awasthi told the Post last week. “We saved the woman.”

When the Health Ministry started telemedicine service from 25 districts—and later added another five districts—it had announced that it would be expanded throughout the country. Around 25 hospitals of remote districts of Nepal used to consult the Lalitpur-based Patan Hospital for telemedicine services.

Today, none of the hospitals or health facilities in the nine districts of Sudurpaschim is using telemedicine service, said Dr Awasthi.

In a country like Nepal where ensuring affordable and accessible community health care is a major challenge, telemedicine can be a game changer, say officials and health workers. But as countries across the globe are embracing this model of health care, Nepal is losing the service.

“The long-distance medicine service was popular and quite effective,” said Dr Bishnu Sharma, director at Patan Hospital. “But video conferencing service has been halted for years. It is not because of us. Government health facilities are not using it anymore.”

Telemedicine centre at Patan Hospital used to be in operation round the clock with seven doctors dedicated to service.

Doctors deployed at the telemedicine centre used to collect cases, and specialists at the hospital used to advise doctors serving in remote districts on medication and treatment.

Ashok Kumar Singh, a senior auxiliary health worker who is also the acting chief of District Public Health Office, Bajura, said poor patients of remote districts have been hit hard by the halt to telemedicine services.

“Doctors and auxiliary health workers have to refer patients to an advanced hospital for consultant service,” said Singh. “We cannot even fix the drug amount needed for pediatric cases and mental health issues. Had the service been there, patients from remote areas would have benefited a lot.”

While government officials admitted that telemedicine was quite effective, they stopped short of giving particular reasons for halting the service.

Dr Sushilnath Pyakurel, director general of the Department of Health Services, said telemedicine service had been stopped due to financial constraints. “The programme should have been expanded to the health-post level,” said Dr Sushilnath Pyakurel, director general of the Department of Health Services. “But we have not been able to continue the service even in the hospitals where it was earlier available.”

But Mahendra Prasad Shrestha, spokesperson for the Ministry of Health, blamed ineffective leadership at the department.

“Until a few years ago, telemedicine was quite effective,” said Shrestha. “Patients and doctors from remote regions benefited a lot. But for such services to sustain, the Department of Health Services needs to take the lead. It has neither allocated budget nor has come up with any programme.”

Amid this blame game between government agencies, patients from remote regions like Bajura are left with no option than to travel to Dhangadhi, Nepalgunj or Kathmandu.

In Kolti, where Dr Awasthi had saved the life of a woman nine years ago, doctors now wonder why the government shut such a life-saving means of providing health care services to the rural population.

“I have been here for the last three years. Telemedicine service has not been in operation since I came here,” said Dr Rupchandra BK, acting medical superintendent at Kolti hospital. “Doctors like us, who have been serving in remote districts, need such services the most to save lives.”

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