Telemedicine based on mobile devices for cleft care during COVID-19 pandemic: An Indian experience

ABSTRACT

Background/Purpose: The global COVID-19 pandemic has severely affected the management of patients with cleft lip/palate. Our center is providing comprehensive cleft care to the remote hilly region of Uttarakhand, India, for the past 3 years. Before the pandemic, about 15 to 20 patients of cleft lip+/palate were operated per month. At the wake of the pandemic, there was uncertainty about how to alleviate anxiety and provide follow up care to these patients. Telemedicine has been effectively used for providing global cleft care. However, in the absence of dedicated telemedicine hubs in the remote localities we adopted a cost-effective, mobile device-based teleconsultation service to provide timely and regular expert advice to the caregivers of these patients. The present study describes our experience. Methods/Description We dedicated a single mobile device with 3G connection for the teleconsultation services. Initially, a whatsapp group was created which included our cleft care team members, postoperative patients, and Community Health Workers (ASHA workers) from different villages who provided information directly about any newborn or new patient with cleft deformity. Then their phone numbers were included in the group. Patients were divided into 2 groups group 1 Newborn/New patient;group 2 Postoperative patients which included patients operated for lip only, patients where lip and palate surgery has been done and follow up of other surgeries. Algorithms were developed for each group. In group 1, feeding advice was given, taping was shown on amodel and weight gainwasmonitored. In group 2, speech evaluation was done. Speech therapy sessions were conducted through video calls. Feedback was obtained in the common phone number. Results: Over a period of 5 and a half months, we were able to provide cleft care support to 78 patients. Twenty newborns and 7 new patients were registered. Among the 51 patients who has already been operated at our center 9 were of cleft lip waiting for palate surgery. We found an average weight gain of 2.2 kg in boys and 1.56 kg in girls over a period of 3 months. Of 36 patients who had both lip and palate operated 21 were less than 5 years of age and 15 were more than 5 years. These 15 children had one online speech training session every month and at the end of 3 sessions were asked to send an audio clip of sentences provided by our speech therapist. We found the cost advantage of teleconsultation to be Rs 2658 by comparing the mobile data plans needed to the cost of public transport to travel from the patients residence pin code to our institute. Conclusions: Teleconsultation is an effective stop gap method in bringing patients under the ambit of comprehensive cleft care during COVID-19 pandemic. This low-cost mobile-based telemedicine service and algorithms developed for diagnosis and follow-up can be used effectively during normal times to reduce the financial burden to the caregivers.