Although the COVID-19 Pandemic, starting in early 2020 brought in unforeseen chaos and challenges to healthcare systems, telehealth gained popularity as its importance heightened during this time. Telehealth consists of using digital information and communication technologies like mobiles, smartphones, computers and tablets, and the internet, to access health care services remotely and manage health care. The importance of this technology can be hardly over-emphasized in a country like Nepal where people live in remote and often, inaccessible places. The role of Artificial Intelligence in the delivery of health care remotely, including the use of tele-assessment, tele-diagnosis, tele-interactions, and tele-monitoring needs further exploration. Telehealth makes health care easily accessible for people living in remote communities, those with limited mobility, time, or transportation amongst others.
i) Teleophthalmology (Diabetic Retinopathy and Glaucoma) Eye Care in Rural Areas
Artificial Intelligence models in eye care and tele ophthalmology was initiated by CHEERS at two community outreach services at Bode and Siddhi Memorial Hospital in Bhaktapur in 2020 and at its Community Eye, ENT and Rehabilitation service (CEERS) in Adarshakotwali, Bara District in 2021.Adarshakotwali is one of the least developed villages in Bara and is deprived of health and specialist care. Local community medical auxiliaries were trained by BPEF in Eye, ENT and rehabilitative care and placed at the different Centers. These personnel trained in Tele ophthalmology have a link to specialists stationed at the base Hospital. Through these Centers, people deprived of Specialist care from Kathmandu were able to avail required services. Periodically, the Specialist team visited these Centers to care for patients who needed further investigations, management and surgical care.
This helps people living in remote villages to some extent, to somehow stop worrying about traveling to the nearest eye hospital to get their eyes tested. With Teleophthalmology gaining momentum, people can now think of virtual consultations with an eye specialist. This program covers all the necessary parameter checks concerning the eyes, including sugar levels and retinal photographs. The ophthalmic assistant at the field forms a link between the senior ophthalmologist at the base Hospital and the patient during tele-eye health. The validity of the screening capacity of this AI is fairly accepted. Using AI at CHEERS has two folds benefits. Firstly, diabetic retinopathy and glaucoma, which are common causes of vision loss, are likely to be missed in communities and outreach clinics. Secondly, ophthalmic assistants are learning to screen for these diseases by comparing their predictions with AI. Moreover, this has become an
32 opportunity for ophthalmic assistants working in rural outreach clinics to upgrade their skills via tele-eye health, confirming their interpretations by an ophthalmologist and AI.
A successful case study using AI is described below:
Case study: Doctors save woman’s eyesight using Artificial Intelligence
Fifty-two-year-old Sita Prajapati from Lele Village in Lalitpur District, came for free consultation to one of Daily Screening and Treatment Service (DSTS) camps organized by CHEERS. Although diabetic, she was not taking medication regularly, not having any adverse health issues yet. She thought a pair of glasses would correct her slight diminution in vision in her right eye. A fundus photography with the help of Artificial Intelligence at the DSTS, revealed that she had proliferative diabetic retinopathy.
Sita received additional virtual consultation from an ophthalmologist at the CHEERS base Hospital. Diabetic retinopathy had already affected her vision and would have been missed if no retinal photography had been taken instantly at the outreach camp. Had it not been for technology, Sita could have lost her vision eventually. She was grateful that her condition was diagnosed on time and is now under regular follow-up with a retina specialist from CHEERS. She already had two sessions of retinal lasers to protect her vision.
CHEERS started Tele Otology services through its two community outreach services at Bode and Siddhi Memorial Hospital and, at Community Eye ENT and Rehabilitation Services (CEERS) in Adarshakotwali,
Bara District in 2021.
The organization trains Community Ear Health Workers (CEHWs) in tele-otology techniques. They use an
otoscope to examine the existence of any ear diseases especially mid ear diseases in patients at the Primary ear treatment centers and are in touch with a group of ENT specialists at the Base Hospital. With the help of a fiber optic internet connection and mobile data, live virtual synchronous tele consultations are undertaken in real time with the use of Zoom app or Medapp software. Images are shared whenever needed.
Having tele-otology at their nearest primary health treatment centers-especially a community hospital allows people to get treatment for ear conditions, which they would otherwise never have availed of. It also saves them time and transport cost spent on visiting the nearest specialty service providers. Patients who would never have made hospital visits were encouraged to do so as a result of taking a liking to technology and trusting it. In developing countries like Nepal, with scarce specialized health care facilitators, tele-otology can cover a wider population with the help of minimally trained human resources and limited mobility. Moreover, tele-otology may have a significant role in the early identification and diagnosis of middle ear disease and prevention or timely management of deafness and life-threatening pathologies in developing countries.