Alumni Voice


 “Adoption of digital consultation can be great help in primary care”

Hnin Thida Nwe

Medical intern
in Yangon, Myanmar

2020 has been a year of unexpected changes and situations as COVID-19 pandemic strikes global health, economy, education and lives. The pandemic has brought changes to the way people live, work and interact since we have to follow the guidelines regarding social distancing, wearing masks and hand washing. As a doctor, the pandemic causes a lot of challenges in the workplace and daily life. I used to live with my parents before and I really like being with my family that can give me so much warmth and comfort. Since the pandemic occurs, I become a high risk person as I have to go to the hospital and work 24 hour shifts. I could not put my family members at risk because of me. Therefore, I have to separate from my family and stay at a hostel. This is my first challenge of being a doctor in the pandemic. 

Another challenge is working at the hospital with limited resources. We know that COVID-19 is new to everyone ranging from the most developed country to the least developed one. That’s why, there have been chaos when we encounter new virus of which we have little knowledge and experience. It is harder for a developing country like Myanmar. We have struggles to contain the infected patients in isolation wards which we do not possess enough. So we have to expand these wards and recruit doctors from other wards to them. Our workstyle has also altered as we need to wear personal protective equipments in the wards where there are no air conditioners and work 24 hours a day. It makes us exhausted both physically and mentally. 

While I am protecting myself as much as I can from contracting this virus, unfortunately on an evening when I return from my day shift, I had fever, stuffy nose, sore throat and anosmia (loss of smell). Therefore, the next morning, the nasal swab was taken and I am tested positive for COVID-19. Then, I am admitted to the isolation ward of my own hospital and then shifted to facility quarantine center. Luckily, I am recovering well from the infection and taking good rest to boost my immune system. However, it is sorrowful that one of my colleagues is hit hard by the virus and she is transferred to the ICU where she is receiving multiple drips to maintain her blood pressure. The pandemic shakes strongly to our weak healthcare system as the infection and mortality rate is increasing day by day. The healthcare workers and volunteers are experiencing burn out but we are trying to the best of our ability to fight against this mysterious virus. 

Due to constraints of the pandemic, doctors cannot see all of the patients in outpatient departments. There comes the role of teleconsultation and telehealth. Teleconsultation is a safe and effective way to assess, diagnose and treat the patient in the midst of the pandemic to reduce transmission of COVID-19. Although there are limitations of telehealth due to physical absence of the doctor to examine the patient, it decreases the burden of unnecessary visits to the emergency departments. However, it requires digital literacy to use applications like Skype or Zoom and good internet connection when patients need face to face consultation. In Myanmar, we mostly use telephone services for the consultation. 

Together with telehealth, electronic record system needs to be developed to compile patients’ condition, investigation results, imaging scans and treatment. In Myanmar, we still have to do these on paper which consume time and energy of precious human resources. Therefore, there have been obstacles for the digital consultation to fully develop in a developing country like Myanmar. 

In COVID era, the adoption of digital consultation can be of great help in primary care in developed world. The general practitioner will collect patient information including history, physical findings, vital signs and investigations in the record and monitor non-critical patients remotely. It will make in-person consultation as the final resort in treatment. It can also link the patients who require specialist’s help to see the respective specialists. The digital health will be convenient for people in remote areas, people in lockdown areas and areas where there are transport problems as well as patients who require regular follow ups. The technology nowadays can help fulfill the demand of digital health services.

In the future, the digital consultation is expected to combine with artificial intelligence to identify simple medical problems and provide public health services. The drawback of digital health is not being able to carry out procedures that require in-person attendance. However, the digital tools lessen the burden on doctors and deliver health services to the patients in a efficient way during this pandemic. The digital solution to overcome the healthcare challenges in response to the pandemic can be continued to develop even after the pandemic.    

In the age of the fastest growing technology, the healthcare services need to be integrated with technology in order to improve diagnostic accuracy and treatment plans. To sum up, COVID-19 has taught us plenty of lessons and raise awareness for pandemic preparedness. A holistic approach in combination with technology is necessary to cope with the challenges of the pandemic in multiple settings including healthcare.









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