Affordable access to telemedicine important for people with mobility issues

With so much of daily life over the past 18 months having changed to virtual interactions, opportunity abounds for faster and more convenient contact between patients and healthcare providers as well. This may be particularly true for those with mobility challenges, such as people with spinal cord injuries.

For World Spinal Cord Injury (SCI) Day, which was commemorated on September 5, healthcare providers the world over reflected on the theme “COVID-19 and SCI: Staying healthy with the help of telecommunication and telehealth”. They considered how remote connectivity has been of assistance to patients in recent times.

According to Dr Virginia Wilson, who practises at Netcare Rehabilitation Hospital and is chairperson of the Southern African Spinal Cord Association, telemedicine has the potential to be especially beneficial to SCI patients for whom travel can be a very real challenge.

However, she adds that there is a barrier of access for the majority of South Africans seeking virtual care, due to the high cost of telecommunications in the country.

“Right now, telemedicine is mostly beneficial to a very small group, yet there is a real opportunity here for data and call service providers to make a difference in the lives of those who are challenged when it comes to mobility, and to help improve connectivity with healthcare providers,” Dr Wilson says.

Affordable telecommunications important for SCI patients

“Over and above trying to avoid the risk of COVID-19, people with SCIs can often struggle with transport,” Dr Wilson explains. “It is also often the case that these individuals may not have the financial resources to get to their treating doctor, particularly when they live in more remote areas.

“In such cases, telemedicine can make a significant difference, most notably when it comes to the more common ailments from which SCI patients tend to suffer. For example, urinary tract infections can occur quite often due to the need for assistance with passing urine, for example by means of intermittent catheterisation – a process where the person will use a catheter to drain urine at regular intervals throughout the day,” she says.

Dr Wilson continues: “In quadriplegic patients, a suprapubic catheter can be required, where the catheter is surgically inserted via the abdomen directly into the bladder to ensure the regular drainage of urine. Urinary tract infections can be treated quite simply telephonically by listening to the patient’s symptoms, sending them for a pathology test and then prescribing medicine accordingly, without them needing to physically come in for a consultation.”

She further uses the example of pressure sores: “The same may apply to pressure sores, which are also common in people with SCIs who spend long periods of time seated in a wheelchair, resulting in sores on the skin and underlying tissue. Our practice, for example, has a designated smart phone for patient interactions where they can confidentially send images of their pressure sores and we can then give them instructions for home treatment or, if necessary, ask them to come in if they require more specialised wound care.

“In fact, we were recently able to get a patient admitted to hospital with the use of telemedicine, contacting the surgeon directly with the patient’s permission and expediting what would otherwise have been a more painful and more costly experience for the patient,” she says. “However, many more persons could benefit from more affordable access to mobile communication.”

Dr Wilson notes that, according to the most recent statistics available from the QuadPara Association of South Africa (QASA), there are an estimated 50 000 people in the country with a SCI. A 2019 Cape Town-based study indicated that 60 percent of SCIs are as a result of assault, 26 percent from accidents during transport, and a further 12 percent from falls.

“The causes of injury may vary from province to province. For example, in Gauteng, where there is a great deal of mining and industrial work, we see a high number of occupation related injuries,” Dr Wilson says.

Specialised care for SCI patients

Elma Burger, spinal rehabilitation programme manager of the spinal unit at Netcare Rehabilitation Hospital, says that people who have just experienced a SCI require highly specialised care and various levels of medical support, as well as a dedicated team of professionals overseeing the rehabilitation process.

“Therapy intervention starts on the day of admission to our rehabilitation hospital and is based on the patient’s needs,” she says. “We provide holistic, person-centred therapy that includes occupational therapy, physiotherapy and speech therapy. Furthermore, the patient will have access to a multi-disciplinary team of doctors, specialist nurses, psychologists, social workers as well as dieticians and orthotists when required. We also have close working relationships with external specialists such as plastic surgeons and urologists.

“The role of the nurse forms an integral part of therapy. New skills that patients have acquired in the gym are carried over into the ward where they are accommodated, and where they continue to receive support in developing these skills. All the while, a customised patient programme is followed to meet each patient’s unique needs, with the ultimate aim of integrating the patient back into society,” Burger adds.

“To achieve this, the discharge circumstances, such as home accessibility, return to work and other life roles are paramount in steering the programme. Families and/or other appropriate next-of-kin therefore need to be included – that is an important part of the process. Prescription of the appropriate equipment is done as early as possible and care is taken to ensure that the patients are discharged with a customised wheelchair in an optimal position,” she explains.

She continues: “While our society and infrastructure have a long way to go when it comes to being inclusive of people with spinal cord injuries, they can most certainly live full and active lives and make valuable contributions to our communities and the economy as a whole.”

Burger comments that the team at Netcare Rehabilitation Hospital have found telemedicine to be of considerable help over the past 18 months, with family meetings being moved to virtual platforms and carer videos being produced and emailed to families. “These videos have proven to be a valuable resource for patients and their loved ones, as they can be referred to whenever needed after a patient has been discharged,” she says.

Gugulethu Setati, general manager of Netcare Rehabilitation Hospital says that the team at the facility have been encouraged by the progress that patients have made, despite the difficult circumstances around COVID-19.

“The pandemic has affected the healthcare community in a profound way, however human resilience and resourcefulness have shone through with both healthcare professionals and patients making significant adjustments to overcome challenges,” Setati notes. “We hope that telemedicine and virtual consultations can continue to be of help to patients across South Africa, and that access to this important tool will increase, as its value has been clearly demonstrated.”

A clear message for accessible connectivity

Dr Wilson notes that during this time of great change, an important message for SCI patients has emerged: “Pick up the phone. That is what I would encourage all people with SCI to do if they are struggling with their condition or a related ailment. By calling your doctor early on, rather than waiting for the next check-up, you may well be able to avoid unnecessary pain and cost.

“If telecommunications service providers can come to the table with more affordable call and data rates, ease of healthcare access can be a reality for so many in need,” she concludes.

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