The devastating effect of COVID-19 spares no one, not even hospitals. Ghana has recorded more than 8,000 cases with almost 40 deaths but other countries have seen worse, especially the United States of America (USA) which has recorded more than 100,000 deaths and still counting.
The Business and Financial Times (B&FT) sat down with Dr. Julianna Oye Ameh (JOA), Chief Executive Officer (CEO) of the Trust Hospital to discuss the impact of the virus on the health sector and in particular on the hospital she manages.
She talked about the rising cost and unavailability of Personal Protective Equipment (PPE), even when one has the money; COVID-19-induced changes to how the hospital is governed; reduced footprints in the hospital; how the Trust Hospital is making sure it remains a safe space for patients; and above all the introduction of technology to reach out to its clients via a service called The Trust Hospital Telemedicine Service. Have a great read.
B&FT: As a hospital, how has COVID-19 impacted your business?
Dr. Julianna Oye Ameh (JOA): I must say that COVID-19 has impacted us both negatively and positively. Negatively it has lowered our attendance level mainly because of the all preventive measures put in place including the three-weeks lockdown. We were hardest hit in late March and April but in May attendance is picking up with people coming back to the hospitals and clinics.
There was so much fear initially, due to the huge numbers of death being recorded in Europe and America, which affected hospitals because people felt hospitals were hotbeds for contracting the disease. Gradually with a lot more positive information and efforts by all stakeholders to reduce the stigma, people are coming to hospitals.
Our operations are hinged on attendance and so our finances have taken a hit and with our corporate clients asked to stay at home, many are not patronising our services and even struggling to pay us.
Also, our supplies are cash-strapped and unable to keep up with timelines and the delivery of Personal Protective Equipment (PPE), which include face masks, surgical gowns, hazmat gowns, goggles, N95s, gloves and others. At a point, even PPE were not available with the money one had due to the closure of borders.
The reopening of the economy is easing up the situation but PPE are still expensive. Prices have gone up by as much as 300 percent but we have to purchase these items to protect the staff and clients coming in.
Positively, COVID-19 has forced us to think outside the box. Is there something we can do differently to improve patient care to working condition of staff and improve the bottomline. This forced us to think very hard.
We are seeing changes to how we run the organisation, governance-wise. Meetings are no longer held in person which has actually improved efficiency. In the past we have to wait for everyone to be seated before a meeting starts but with a Zoom, Skype or Microsoft Teams meeting, everyone is on time because you can join wherever you are. This has given us greater efficiency and flexibility. A lot of the managers prefer it because it reduces travel time, the stress of moving from one point to another and people are more creative.
Also, this has made us look at options such as telemedicine as opposed to the patient coming in. Now we are looking at ways to do virtual consultations, here the problems and if there is the need for a video call, that is immediately done and examinations are done. We have discovered that not so many actually need to come to the hospital and queue up. We are now engaging clients and patients from home and if there is the need for a lab test, we either go the home or office or ask them to visit a nearest branch and medication is packaged and delivered at a small fee.
COVID-19 has allowed us to also strengthen our appointment systems. In the past patients or clients come and queue but now you can call and schedule an appointment with your General Practitioner and then you have the time to come in person or request for a virtual consultation.
We are rolling out a lot of services on the telemedicine option. In the area od diet, we have dieticians who can give consultations, physiotherapists who offer virtual consultations. Our ante-natal classes are being done virtually with a gym instructor giving directions. The array of options are many and our staff are more alert with everyone primed towards decongestion which has led to more efficiency and effectiveness in operation. Everyone is now more innovative and I am happy to be the leader of such a team.
The virus has truly forced hospitals to innovate to stay afloat. Without these innovations hospitals would definitely struggle.
B&FT: For how long has The Trust Hospital being deploying the telemedicine service. Does is it have a special name?
JOA: We introduced this service two month ago, but it has been in the works since 2019, COVID-19 sped up its introduction and rollout. Since its introduction, it is getting better and better. COVID-19 caused a 50% drop in our attendance but with the easing of restrictions and telemedicine we are working our way back to normal levels.
To us telemedicine holds the key to a sustainable future but right now we are working to strengthen it and allow the clients to build confidence in the service because we are so used to the traditional model of accessing care which involves going to the hospital, join a queue, and talk to a doctor. Currently a lot of education is being rolled out to build the confidence of the public.
The service is referred to as The Trust Hospital Telemedicine Service. Also it is seen as a helpline because it was born out of the need to reach out to our clients. During the lockdown especially, it became worrying when clients were not coming for their review. When we reached out, it became apparent that they didn’t feel safe coming to the hospitals and clinics.
B&FT: As much as telemedicine is a great service, it definitely has limitations. What are some of the services telemedicine cannot offer currently?
JOA: Telemedicine cannot deal with emergencies. Once you have an emergency medical condition you have to be rushed to the hospital. Also, a first time serious medical condition, it is advisable to come to the hospital but then for your reviews, telemedicine can take of that. For our mums and dads with their diabetes, hypertensions, they do not need to come to the hospital unless they are unwell.
Sometimes, they need a refill of their prescriptions, doctor asking about symptoms, and they can always check their sugar levels and relay that to the doctor via telemedicine. Obviously surgery cannot be done over telemedicine but unless in serious emergencies, patients are prepared towards surgery and telemedicine has a role to play in preparing the patient. The doctor getting you to do labs before a surgery can be done using the telemedicine option.
B&FT: What are communication channels being deployed currently for telemedicine?
JOA: Telemedicine currently has two options: phone and video calls to reach out to patients or clients. As an evolving service, we are improving our means of communication. As technology improves we can use cameras and monitors to beam teleconsultation to clients and we are investing in this.
B&FT: As a Trust Hospital service, are all health professionals including doctors and nurses, enrolled to offer services to clients?
JOA: Every doctor, nurse or other health professional who works for and with the Trust Hospital is part of this initiative but it is currently being rolled out with doctors and nurses who work at the main facility on the Oxford Street, Osu but it is being rolled out to other hospitals and satellite clinics.
B&FT: How affordable is the use of telemedicine?
JOA: One of the best things about technology is that it usually cuts down cost and so it is with telemedicine. Using telemedicine to reach out to your doctor is more affordable than coming to the hospital to see the same doctor. Apart from affordability, it offers convenience like no other service can.
B&FT: The service is just two months old but catching up real fast. What are the plans and projections for the next two years?
JOA: The hope is to see this service become much bigger and better but we do appreciate the footprints in the hospitals and clinics. We are therefore looking at a win-win here because telemedicine is not the answer to every medical condition especially severe and emergency conditions. With time, you should call in but patients can be referred to the hospital.
At the end of the day we are driving efficiency, less congestion in the facilities, less delays because time is money. We want things to run smoothly and seamlessly to help clients access quality healthcare and still do their works.
As a paediatrician myself, sometimes I consult at Dome, Accra, which has one of our satellite clinics. Recently a mother came in with her child, who had a cough, which is one of the symptoms of COVID-19 and we respectfully asked the mother to stay outside but made her comfortable. When I approached her to apologise for asking her to stay outside, she said she was happy sitting outside because she didn’t want to be stigmatised.
That got me thinking that a lot of mothers out there want consultations for their children but they do not want to come to the hospital for fear of being stigmatised. Children cough, it is normal but in these times, people can be funny. Therefore, telemedicine is the surest way of giving these mothers the opportunity to be rest assured that their children and themselves are fine and if there is the need for medication, there is always the courier service.
B&FT: What are your last words?
JOA: The Trust Hospital is very passionate about patient and staff safety and so we have put in place so many measures to make the place safe for our clients. We have invested a lot in the best disinfectants with anti-viral properties and our cleaning team is doing over and above what we have asked them to do. We have put in extractors and doing a lot to ensure patient safety.
There is less congestion, less waiting time and the staff are highly motivated and following the necessary safety measures in place. it is a very safe place for people to access healthcare. There should be no fear at all.
Even if our clients show symptoms, we have our own isolation bay at the Specialist Hospital. We are working well with the Noguchi Memorial Institute for Medical Research and the Municipal Health Directorate. There really is no need to fear and stigmatise any COVID-19 patient or hospital.
All our staff are highly trained and professional. We do give the best of care and we have never compromised on the standard of care. I want to assure the general public that the standards of care have not been compromised, we have cut corners because of COVID-19, neither have we reduced it. Our medicines are top brands are we are value for money. Our clients should be rest assured and partner with us for better outcomes.