After a successful show, artists often extensively credit the backstage workers. After a super hungry person’s supper arrives, heartfelt thanks to the delivery boy – who rode through virus-ridden streets – happens naturally. Similarly, amid rising COVID-19 cases in Karnataka, there is an invisible workforce that listens to the sad and difficult stories of people affected by the pandemic to console and guide them. They are the medical students and the integrated doctors who counsel thousands daily, via the toll-free Apthamitra helpline of Karnataka. They filter out people by talking to them over phone and send them to the ones working in the frontline – in case someone tests positive for the new virus, while many of the potentially mild COVID-19 cases get treated by the helpline. The Apthamitra mobile app is designed under the aegis of National Association of Software and Service Companies. Infosys BPM and Hinduja Global Solutions are among others who helped. It was launched on April 22, with an exclusive toll-free helpline number, 14410. The AYUSH department manages it, while being run by the Health and Family Welfare Department and Karnataka State Disaster Management Authority (KSDMA). Those who experience COVID-19 symptoms usually call this helpline. But as cases rose, those testing positive has been calling the helpline – hoping that they might get help – as they have nowhere else to go due to delayed ambulances, while hospitals reject them. Mild and asymptomatic COVID-19 patients below 50 are forced to stay home and receive treatments due to the sheer magnitude of cases in Bengaluru. As of July 23, the city had over 29,000 active cases. Exactly a month back, as of June 23, there were only 1512 cases. Karnataka's death toll surpassed 3000 as of August 8. The commissioner of AYUSH, Meenakshi Negi, who is also the nodal officer for the helpline said, “People call the helpline with all their anxiousness. In addition to prescribing them OTC [Over The Counter] medications, the helpline also calls the vulnerable people.” “We have called almost 25 lakh vulnerable people twice, using the data from the state’s door to door survey.” “A lady from a family of four from Bengaluru’s Srirampuram calls me and asks me to help them arrange for a bed in any hospital, all four were tested positive in the family,” describes Dr Hema BN, an Apthamitra counsellor based in the city. When asked why they needed only one bed if all of them tested positive. The lady replied, “No neighbours are here to help. We can manage somehow, but my elderly mother cannot without food, please arrange a bed.” One more person called Dr Hema. His wife had died of COVID-19 and his three children - all aged below 10 - tested positive for COVID-19. “He cries calling me” says Dr Hema. Such is the condition of families exposed to the deadly pathogen. These stories are heard by doctors across Karnataka, and they have much more stories in count than what media shows us daily. Dr Sudesh Shetty, another Apthamitra counsellor, practising at a clinic in the city’s Nagappa Street said, “Some stories we hear are so devastating that we end up wiping tears from our eyes.” The number of people calling the helpline has also spiked in par with the rise in cases. In other words, as caseload increase, more sad stories are heard to be consoled and guided. Dr Shetty describes a case where a lady had called the helpline, “Her husband died due to COVID-19 and in less than 12 hours she and her two small children tested positive for the virus with all the symptoms. They did not get an ambulance and also the bed. Somehow, we managed to solve this problem.” The main reason for this is the lack of health infrastructure. The number of discharges per day is not more than or equal to the new cases seen on that day, leading to running out of beds. Dr Shetty said that in some cases, “We feel very helpless.” When receiving calls from remote parts of Karnataka, doctors based in other regions feel helpless as difficult situations arise in helping someone. Who are these integrated doctors? An integrated medicine course that covered both Ayurvedic and Allopathic studies - 5.5 years of BAMS and 2 years of Allopathic studies - was started in 1977. This course ended in the mid-1990s. Those who graduated the course are known as integrated doctors and can be licensed for practising both Ayurveda and Allopathy, according to Karnataka Registered Integrated Medical Practitioners Association (KRIMPA), formed by professionals to mark their identity as integrated doctors, said Dr Shetty, who is also the association’s joint secretary. There are about 2500 integrated doctors in KRIMPA. It is more than 25 years since the integrated course ended, while all those who graduated the course are now aged at least more than 50 years, with a lot of experience in hand. These doctors are the ones who attend to the Aptamithra helpline. They get calls from all over Karnataka. The process The helpline follows a two-tier system. In the first tier, UG and PG medical students from Ayush, Nursing and Pharma courses will pick the call to record the symptoms and travel history of the patients, which is forwarded to the second tier consisting of integrated doctors where they counsel callers by issuing telemedicine or refer them for testing and treatment via the Apthamitra app, based on the case. The callers will also get a prescription by an SMS to get the OTC medicines. These doctors also identify potential carriers of coronavirus to send them to fever clinics or request an ambulance based on the severity of symptoms. Contact tracing will also take place here. Once someone tests positive for the novel coronavirus, then their connection with the telemedicine doctors seize and is taken over by the ones who treat them, in person – the frontline health workers. Speaking about telemedicine, Dr Shetty said that they are allowed to prescribe medications listed in the Apthamitra app for symptomatic treatment. Paracetamol, cetirizine, chlorpheniramine maleate, oral rehydration salt sachets, magnesium trisilicate, domperidone, vitamin-C and B-complex are prescribed as per the necessity of the case. “We also follow up on all the cases until they get fully cured of their problems, and to confirm if they are quarantined well” he added. Some who might have had mild COVID-19, but not tested for it also get assistance with the helpline’s support, he added. Trend shift About 70 to 120 doctors actively work with the helpline, connected to each other via WhatsApp group. Each attend up to 80 calls per day as of now, says Meenakshi, while the helpline works from 8 am to 9 pm with two shifts. The doctors get paid per shift. In other words, these doctors attend to more than 7000 people per day. “During the lockdowns, we received from ten to 12 thousand calls per day,” said Meenakshi. It has been more than a fortnight over three months since the helpline started and it has catered to not less than 7.5 lakh people until now, she said. The Government is planning to recruit more such doctors owing to the case load. However, it is doubtful if their returns are in accordance with their efforts, according to sources. There is a shift in trend after the lockdown eased up, as observed by Dr Shetty. Among all the callers in a day, hardly one person would test positive for the coronavirus until May end, even though more of them were suspected by doctors. But after the lockdown was lifted, every suspected person was tested positive, eventually. “As more people started calling helpline due to the lack of ambulances and beds, the problems of our health infrastructure were also reflected in the quality of calls we were receiving,” said Dr Hema. However, Meenakshi said that the load on hospitals decreases as potential mild cases also get treated by the helpline. Spirited doctors When asked if they were able to emotionally cope up advising people after listening to their sad stories. “We feel disturbed at some stories, but it is our duty to console them, by giving them knowledge along with prescribing them medications,” Dr Hema said. Dr Shetty said he felt content when patients requested for the doctors’ personal numbers for the emotional support these troubled souls received. However, rules bar them from doing so. Most of these doctors have their own clinics, but as a higher necessity called, they have stopped going to their own clinics, he added. Dr NS Krisnamurthy, 58, another telemedicine doctor practicing at a clinic in Chamarajpet was not spared by the novel coronavirus. He and his wife contracted COVID-19 and underwent treatment. They have just recovered from the infection. He said, “After my home quarantine ends I will rejoin the helpline to serve those in need.” Medical Service Centre, an all India organisation, consisting of health personnel with the objective of service, dedication and mobility has appreciated the work of Apthamitra helpline's doctors. Its state secretary, Dr Vasudhendra, an ophthalmologist based in Davanagere said, “In the face of falling public health infrastructure and private sector profiteering, we should recognise the work of these integrated doctors and students helping them, in addition to the frontline health workers.”
