HAVING an excruciating pain involving his eardrum, seven-year-old Habibullah was brought to northern Kabul’s Shefajo Hosp­ital, where paramedics immediately sought medical help from eDoctor, only to be connected with Dr Sadia Khalid, a resident of Karachi’s PECHS neighbourhood.

Her diagnosis of earwax buildup in Habib’s ear canal, followed by a 10-minute brief procedure carried out in Kabul under her online supervision, brings an end to the schoolboy’s week-long misery. Another consultation comes to a fruitful end, as the young patient starts feeling better to the extent that his mother spontaneously exclaims, “It’s a miracle.”

This “miracle” is made possible every day for more than two months through a technology-driven initiative by a local startup for the crisis-engulfed Afgha­nistan’s women and children that first successfully brought more than 1,000 Pakistani female doctors — who had quit the profession due to family or social issues — back to practice over the past more than four years.

It all began in the last quarter of 2021 when eDoctor was spotted by the Afghanistan Council for Obstetrics and Gynecology which sought the former’s support for fast shrinking healthcare for a vulnerable segment of society amid falling donor support for essential services in the landlocked country where women had lack of access to essential healthcare. With a history of serving in the conflict and war-hit areas, it came as another feather in eDoctor’s cap.

“Afghanistan is not the first conflict-hit part of the world where we are offering such telehealth services,” says Abdullah Butt, the founder and CEO of Educast, a parent organisation of eDoctor. “We were frontline workers in serving pregnant women and their newborns using technological skills and telehealth in war-torn areas of Yemen, in collaboration with local organisations. And then we took the challenge to support Palestinian women in Ramala and West Bank.”

In these areas, the telehealth project offered maternal and child tele-consulting, mental hea­lth online sessions, mobile clinic, teaching nutrition and Covid-19 care. “So such experiences hel­p­ed us bring more value to Afgha­n­istan,” says Mr Butt.

But how this eDoctor came into being is another interesting and inspiring story.

It was in early 2018 when, Mr Butt says, he had met his school days doctor friend who was then looking after one of the largest public sector hospitals in Karachi as its administrator. It was a kind of reunion, he recalls, when his doctor friend shares recent back-to-back deaths of pregnant women at her hospital who had lost lives due to heavy blood loss only because their transportation to the health facility was delayed.

“And both women who had died were actually coming to the hospital to deliver a child from a goth on the outskirts of Karachi only because their families were not able to get hold of any female doctor in their respective areas,” he says. “During the same sitting I came to know that there is a serious shortage of female doctors in the profession. That fact further fuelled my curiosity and facts started unfolding. Then I decided to work on this and started gathering facts. I gathered data, met the experts and interviewed dozens of out-of-practice female doctors. This how the idea was conceived and it all began.”

In 2018, Mr Butt and his team came to know that there were some 35,000 Pakistani female doctors who had completed their medical education at the expense of the state or privately but were no more associated with the profession. Majority of them quit the profession after getting married while a large number migrated to other countries with their families, leaving behind their professional career.

The initiative reached out to a large number of those female doctors in Pakistan and around the world through social media platforms, their family contacts and data from medical universities. As a result, a large number of them from different parts of the world showed willingness to get back to the profession without disturbing their family and social lives. They went through a six-month online certification programme enabling them to get updated knowledge in various fields to earn “Family Medicine Certificate” that enabled them to provide basic healthcare advisory from their home.

With more than 1,000 Pakistani female doctors serving from their homes in Pakistan to the Middle East and the United States to Europe, the telehealth project has now started coming into global limelight. Despite being more challenging, its new venture in Afghanistan is making an impact.

“Our maternal mortality has touched 638 per 100,000 live births. It is a shocking number,” says Dr Najmusama, president of the Afghanistan Council of Obste­trics and Gynecology and senior doctor at Kabul’s Shefajo Hospital.

“With eDoctor we are at ease to a large extent. We have a team of our own Afghan female doctors and paramedics who are working with eDoctors from six different countries offering best possible healthcare to women and children. In case of any complication, we refer cases to eDcotor in Lahore and Oman or any other destination. So far we have met 100 per cent success.”

This success is coming with a “hectic effort”. Dr Sadia Khalid, one of several members of eDoctor team offering her services to Afghanistan’s patients from her Karachi home, believes that the neighbouring country is in dire need of medical help.

“It’s a wonderful experience, but we have found that they [Afghanistan] badly need well-equipped hospitals and more female doctors,” she says.

“I don’t know whether there’s a cultural constraint or social issues, but female patients there don’t want to be seen by male doctors and they don’t have many female doctors available. So there’s a pressure on us. At times we witness dozens of [female] patients turning up within an hour. Secondly, years of war and violence have badly damaged its health system. They don’t have the capacity to handle medical emergencies. They badly need well-equipped hospitals and healthcare professionals.”

Dr Seemi Jamali, former executive director of Jinnah Postgra­duate Medical Centre, sees the growing telehealth a good sign of innovation but believes that the tech-driven initiative cannot bec­o­me a parallel healthcare system.

“It’s good if such things are offering services in conflict-hit areas or those parts of the world where you don’t have any help,” she says. “But the health science is quite a big thing which you can’t permanently practice over any video platform. For most things and diseases, you need to examine people. So I must say that it can be helpful only if the regular healthcare system isn’t available. Otherwise, it cannot replace the regular healthcare system. Every patient cannot avail of this facility. Medicine is more about personal compassion. For that you need to be personal more often.”

Published in Dawn, March 7th, 2022