Region, COVID-19

“We can now offer consultations in ways we deemed impossible before”: how telemedicine is working in Guanacaste

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At Enrique Baltodano Hospital in Liberia, a medical specialist calls a patient who recently had surgery on the Zoom virtual platform. From his home, the patient shows the doctor his wound’s development by video or photo.

This method is known as telemedicine or teleconsultation. In Guanacaste, due to the positive cases of COVID-19 infections, hospitals opted to increase this technique and avoid a high flow of patients in medical centers.

The director of La Anexión Hospital in Nicoya, Anner Angulo, said that people fearful of being exposed to the pandemic have viewed teleconsultations positively and are accepting it very well.

Angulo did not specify the number of appointments that the hospital has performed under the category of telemedicine during the pandemic, but he did specify the areas in which it is available: dermatology, psychiatry, family medicine, internal medicine, geriatrics, pediatrics, mental health, and psychology.

“Now it is possible to provide consultations that we thought were impossible before, such as psychology for example, or a consultation with a postoperative patient who we want to follow up with to see how the surgical wound is doing. All this can be done thanks to telemedicine,” the director affirmed.

The hospital treats patients from Hojancha, Jicaral and Nandayure. Starting in 2021, it will also serve the canton of Santa Cruz.

How Does It Work?

The Telemedicine coordinator for the Liberia hospital, Luis Cerdas, explained that the technique has several methods.

The first is the medical session, in which they use the Zoom tool to follow up on the health of a patient.

Another way to apply it is teleconsultation. In this case, the patient has to go to a health center to be seen by a general practitioner who will contact a medical specialist through a video call to do the consultation.

“The doctor is there to introduce the patient, perform physical examinations and take vital signs; on the other side of the screen, the medical specialist accompanies the patient in real-time,” explained Cerdas.

For a service to be given remotely, each of the health centers has the following technical equipment to do so: a computer, a camera and audio speakers.

In addition, medical personnel has access to the digital file of each patient, and appointments are scheduled in advance by email or by a phone call.

The medical director of the Liberia hospital, Marvin Palma, added that each appointment can last from 20 to 30 minutes. The patient is the one who makes the decision whether to do the consultation by video call or in person.

Patients have seen it positively because they don’t have to spend so much money on transportation to get to the hospital,” Cerdas said.

The Liberia hospital offers teleconsultation in the areas of cardiology, neurosurgery, nephrology, dermatology, geriatrics, internal medicine and peripheral vascular issues. They offer zoom workshops to people who have recently been operated on and the nurses explain to them how to take care of themselves.

Telemedicine also includes administrative meetings, conferences with experts, work sessions, project monitoring, reporting, and legal advice to health services.

Great Progress, Many Challenges

The exact number of patients who have been provided telemedicine services during the time of this pandemic is still unknown. However, in Liberia, they have between 50 and 55 teleconsultations per week. That adds up to more than 1,000 consultations in five months.

During all of 2019, video calls were used to attend to 2,000 patients.

According to the president of the Costa Rican Social Security Fund (CCSS), Roman Macaya, 30% of all medical appointments throughout the country are carried out with the use of telemedicine.

“In four pandemic months, it is as if we had gotten into a time machine and gone forward in time to the challenges of 2050,” he told Semanario Universidad.

Cerdas sees the numbers as something positive. He believes that in the months of the pandemic, a substantial leap forward was achieved in terms of experience in the area of telemedicine in Liberia and throughout Guanacaste.

Now we have a cover letter; now we can present the numbers achieved during the crisis and decide based on that after the pandemic,” explained Cerdas.

Cerdas is also convinced that the experience provided by the pandemic in the use of telemedicine will benefit students in the future. As he explained, medical students will be able to complete their practice hours working with the digital tool in the same way that nurses and graduate doctors do now.

In addition, Palma thinks that the use of telemedicine will also have an impact on reducing waiting lines for medical appointments after the pandemic. According to him, it could lead to a 2% or 3% decrease of the total of appointments.

However, telemedicine results depend on how the province manages to overcome problems such as Internet access.

A study carried out in 2016 by the Superintendency of Telecommunications (Sutel) revealed that Guanacaste was the province with the least internet coverage in the country. Only 12.5% of the population had access to service.

I have already tested it. I recharged ₡3,000 (about $5.25) of credit for a person so that they could connect but it wasn’t enough. It is impossible for someone to spend so much money for a video call. We have to find a solution to that,” commented the Telemedicine coordinator for Liberia.