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 living with spinal cord injuries.
Ahead of International Spinal Cord Injury (SCI) Day, which takes place on 5 September 2021, healthcare providers the world over are reflecting on the theme “COVID-19 and SCI: Staying healthy with the help of telecommunication and telehealth” and 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 spinal cord injury (SCI) patients for whom travel can be a very real challenge.
However, says Dr Wilson, 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.
Affordable telecommunications important for SCI patients
“Over and above trying to avoid the risk of COVID-19, people with spinal cord injuries can often struggle with transport. 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 where the person will use a catheter to drain urine at regular intervals throughout the day. 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,” explains Dr Wilson.
“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. The same may apply to pressure sores, which are also common in people with spinal cord injuries 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.”
The doctor notes that according to the most recent statistics available from the QuadPara Association of South Africa, there are an estimated 50 000 people in the country living with SCI. A 2019 Cape-based study indicated that 60% of spinal cord injuries are as a result of assault, 26% from accidents during transport and a further 12% 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,” she 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 spinal cord injury 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. 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,” she says.
“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.
“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. 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 living 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.
As part of International Spinal Cord Injury Day, the Prevention Committee of the International Spinal Cord Society (ISCoS), of which the Southern African Spinal Cord Association is an affiliate, is organising a video competition. All members of ISCoS and its affiliated societies are eligible to participate. The three best videos will be selected and each will be awarded a free registration to the forthcoming ISCoS virtual meeting in Vancouver, taking place from 29 September to 2 October 2021. The announcement of the winners will be made on 5 September 2021 and will be advertised on the SCI Day website. The five best videos will also be hosted on the ISCoS scientific meeting platform. For more information, please visit http://www.worldsciday.org/index.html.
Patients who have data access and who prefer to make use of a virtual care platform can avail themselves of Netcare VirtualCare. This innovative and secure platform for virtual doctor consultations is being introduced across the Netcare Group’s operations with the strategic aim of providing patients with the best and safest health and care, digitally enabled and data driven. Virtual doctor consultations can take the form of either video consultations via mobile devices or computers, or telephone consultations via a mobile phone or landline, both from the comfort and convenience of the patient’s home.
Netcare VirtualCare is enabling patients and doctors practising at our facilities to maintain contact during the pandemic without physical interaction. At a time when there is heightened public concern about the potential risk of physical interaction, the option of virtual video or phone consultations is providing much-needed medical support and reassurance to individuals, especially to those who may be neglecting and thus compromising their health as a result of being anxious about visiting healthcare facilities at this time.
Notes to editor
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