Background: Kaza is a remote location in the State of Himachal Pradesh, located at an altitude of 12,000 feet. Apollo Hospitals – Telehealth Services has been providing specialty, super specialty and 24/7 emergency stabilization care in Kaza, since 2015. Apollo has been playing a critical role in delivering quality, reliable and timely care to the communities and has saved many lives over the years. This note details one such latest instance showcasing the sheer dedication, commitment, humane approach, and capability of Apollo’s remote health care in making a direct impact in patient lives.
Post-Partum Hemorrhage & Preterm Infant: On 11th August 2021, a 27-year-old pregnant female patient admitted at Community Health Centre (CHC) Kaza was diagnosed with Abruptio Placentae. A caesarean section was performed on the same day for delivering the baby. Persistent post-surgical vaginal bleeding developed as a complication. To manage this complication, an opinion from a specialist was required for ensuring evidence-based care. Apollo Hospitals has been rendering telehealth services to the tribal communities in Kaza, since 2015. A teleconsultation with Urogynaecologist – Dr. Alpha Khakhar (MD, MBBS (OB/GYN) 20 years of experience, Apollo Hospitals Chennai) was organized by the telemedicine staff. The specialist obtained detailed patient history, performed thorough examination over telemedicine, and diagnosed the condition as post-partum hemorrhage. The specialist advised on the line of treatment for clinical management of the patient. On the other hand, the delivery was preterm, and the baby was born with low body weight. In addition, the baby had bluish discoloration at birth. Cardiopulmonary Resuscitation (CPR) was performed for 2 minutes followed by other emergency clinical management procedures. Following CPR and emergency care the baby was shifted to neonatal care unit. However, the baby continued to have intermittent low blood sugar levels. A teleconsultation with senior Pediatrician Dr. Latha Vishwanathan (MBBS, DCH, DNB (Pediatrics) 22 years of experience, Apollo Hospitals Chennai) was organized. The Pediatrician after performing detailed assessment of the baby, advised to administer IV fluid and NG (nasogastric) feeding; monitor oxygen saturation and Random Blood Sugar (RBS) levels regularly; and measure body weight on daily basis. Apollo staff worked with Government staff in monitoring the baby round the clock and ensured oxygen administration based on saturation levels. On 18th August at around 10:00 p.m. the blood sugar levels of the baby dipped drastically to 31 mg/dl. A teleconsultation with senior Pediatrician was organized immediately and advised clinical intervention was administered. The Govt. emergency duty doctor monitored the baby, under the guidance of senior Pediatrician from Apollo. Vitals and blood sugar were checked at hourly intervals and monitored by the specialist.
Transfer to Higher Medical Center: After providing required care and monitoring the mother and infant for 6 days round the clock, their health condition continued to deteriorate. The mother developed pedal oedema and the baby’s health condition was not satisfactory. Therefore, both the mother and the baby were shifted to Mission Hospital in Manali on the early morning of 18th August 2021, for further management. The Block Medical Officer (BMO) at Kaza requested Apollo’s telemedicine staff for accompanying the mother and the baby. One staff nurse and one telehealth coordinator accompanied the mother and the baby. Vitals, blood sugar level and oxygen saturation of the baby were monitored at regular intervals during travel. Fluids were administered as per the advice of senior Pediatrician. On the way to higher center, the baby developed breathing difficulty, this was efficiently handled by Apollo staff by using Ambu bag. The staff along with the mother and the baby reached Mission Hospital at Manali by 6:30 p.m. after carefully managing the baby for 12 hours, under the expert guidance of the Pediatrician. Apollo staff detailed the doctor at Mission Hospital about the provided treatment and admitted the mother and the baby.
Outcome: Apollo staff stayed for an additional day and followed up on the healthcare status of the mother and the baby on 19th August 2021. Both mother and child were stable and being monitored by the staff at Mission Hospital. The mother expressed her gratitude with tears of joy for saving her child by providing tender loving care, and thanked Apollo.
