Health: In conversation with Kranthi Vysyaraju, Ashoojit Anand and Dr Ramakrishna Prasad of PCMH/Aveksha

PCMH Clinic and Aveksha Home Care are healthcare organisations with a national presence in India. PCMH attends to about 800 patients in their clinic. As of last December, their patient-retention rate was 96%. Most patients are elderly, who avail their services for palliative care and chronic conditions. PCMH and Aveksha have been helping vulnerable communities as part of the CovidActionCollab. The CAC Team spoke to the team of PCMH and Aveksha to learn more.

Dr. Ramakrishna Prasad, Founder, PCMH

What have been your key actions, initiatives and outcomes around the COVID-19 response?

Tele-medicine and Tele-Counselling: We ensured that our patients knew early on that we are available to provide telemedicine. We provided our frontline health workers (13 nurses and 4 doctors) with capacity building and emotional support to offer telemedicine services and undertake clinical management. We actively provide teleconsultations in 11 sites with underprivileged communities. We initially had about 150 unique patients, but now, with the help of the nurses, we can have an impact on about 15,000 community members. We also provide tele-counselling to tackle mental health issues in light of COVID-19.
Guidelines and Advisories: We put out documents on our website, detailing COVID-19 precautions, including social distancing, personal hygiene and safety measures. We also provided guidelines for people who are experiencing COVID-19 symptoms.
Awareness Programs: We created videos for COVID-19 awareness (see Resources below) and conducted awareness programs in residential areas.
Home-Visits: Despite lockdown, lack of transportation and PPE shortages, the team has continued to do home visits for treatment. 50 home visits to patients in Bangalore in one month.
Vulnerable Communities: We are also writing many proposals to expand patient-centred telecare and home-based services to vulnerable communities

Through our national and international teleconsultations, and our home visits, we have had over 500 patient encounters as part of our COVID-19 response.

What are your biggest learnings/challenges?

One of our biggest learnings was how to uphold empathetic patient care and put our patients at ease virtually.

Building up the confidence of our nurses and frontline workers and helping them fight their feelings of helplessness, anxiety and unpreparedness to provide effective care was a challenge we overcame. For this, since we could only use platforms like Google Meet, it was important for us to develop a relationship with caregivers and foster trust among nurses to provide appropriate care.

Helping the elderly access medication and groceries was another challenge. For this, we are promoting safe applications for the elderly and collaborating with partners distributing these resources.

Our final concern is that non-COVID related efforts might be slipping through the cracks. There is a lot of anxiety among patients who have other health concerns such as diabetes, hypertension, etc. We must continue to dedicate resources to these issues

Any stories/insights emerged from the field or your work?

When we started teleconsultations, we came across an elderly man in Mumbai who was suffering from fever, cough and breathlessness. Through a video call, we measured his breathlessness with the help of his daughter, contacted a lab in their area, and arranged for a COVID-19 test and X-ray at home. The father was diagnosed with pneumonia, shifted to a hospital and kept in isolation until the COVID-19 report came back negative. To be able to help from a distance was very rewarding.

An 11-year-old boy with impaired speech and hearing and a cochlear implant- typically categorized as high risk for COVID-19- was brought to us by his mother. She was worried that the boy, whose eyes watered excessively when he ate, had contracted COVID-19. When care providers found that these symptoms started long before COVID, they had to build trust with the mother without even seeing the patient and assuage her fears.

How did you leverage the COVID Action Collaborative? How do you plan on doing so in the future?

The CAC gave us access to nurses and counsellors for mental health consultations. We also helped train the nurses affiliated with CAC programs in telemedicine. Due to the collaborative, we were able to reach out to the most vulnerable communities which do not have access to the right information. Otherwise, our services would have been limited to upper-middle-class and upper-class patients.

Resources from PCMH & Aveksha