Few months ago, Sri Lanka’s health system was exhausted beyond capacity due to the COVID-19 pandemic.
Many severely ill COVID-19 patients could not get treated in hospitals as there were no beds. To prevent the situation from going bad to worse, the Doc 247 integrated call service, resurfaced. Doc 247 is free trilingual 24/7 call service where the general public can talk to doctors regarding any health query. Even though many had not been aware of this service, it had been around for quite some time. Speaking to the Daily Mirror, Dr. Sajith Edirisinghe, Lecturer and Clinical Geneticist at the Department of Anatomy, Faculty of Medical Sciences at University of Sri Jayawardenapura and member of the Coordinating Committee of Doc 247, revealed that the Doc 247 service was initiated by the Sri Lanka Medical Association (SLMA) a few years ago. “This phone service will be activated when a national disaster arises. Once the disaster is over, then the phone service will become dormant,” shared Dr. Edirisinghe.
Prof. Indika Karunathilake, former President of the SLMA and member of the Coordinating Committee of Doc 247, stated that through this service they were able to identify patients who needed immediate care and were able to direct them towards the hospitals. He shared that the aims of the Doc 247 call service were to reduce the number of non-urgent admissions to the hospitals, to provide correct information to patients who are receiving home-based care and to transfer patients who are in need of urgent care, to hospitals. “Through this service we were able to reduce admissions of patients who did not need urgent care, thereby allowing patients who are in need to urgent care to access the services. This also reduced the burden on the health system,” he remarked.
Doc 247 is an integrated system which is integrated with other helplines. “This service is also integrated with helplines such as the 1904 helpline for the National Operations Centre for Prevention of COVID-19 Outbreak (NOCPCO) and 1990 helpline for Suwaseriya Ambulance Services,” explained Prof. Karunathilake. Patients could also send a SMS to 1904 instead of calling 247.
“Junior doctors and medical students supervised by the senior doctors will receive these messages and call the patients to assess them. Afterwards, those who have to be immediately transferred to the hospitals will be transferred via the Suwaseriya Ambulance services; the ones who have to be transferred within 24 hours will be informed to the Ministry of Health and will be admitted to a hospital within 24 hours. Those who are to stay at home will be given health advice and their queries will be answered,” he revealed.
How does Doc 247 work?
When queried as to how the assessment procedure takes place, Dr. Edirisinghe shared that there were a set of questions which utilized the COVID-19 red flags that the volunteers (doctors and medical students) would ask to assess the patient. Based on the assessment, it would be decided whether the patient is in need of urgent hospitalization or not. “Before any volunteer is recruited into the system, Prof. Karunathilake, Prof. Manuj Weerasinghe, Dr. Ruvaiz Haniffa and I train them on how to assess a patient and get all the important information within 10 minutes. The patients only get 10 minutes to talk to a volunteer at Doc 247. We have WhatsApp groups where all volunteers including specialists, senior doctors, junior doctors, interns and medical students are in. The volunteers can send in information about their assessment and patient’s health status and the specialists and senior doctors can give further advice which is then relayed to the patient. Our volunteers will call the patient back and relay further advice and information,” he shared.
Doc 247 consists entirely of volunteers ranging from specialists to medical students. They can tune into the system as per their convenience. When doctors are busy, they can opt out of the system and when they are not busy, they can join in and answer calls. He stated there was a roster system in place as well to ensure that a particular number of doctors are available at a particular time.
He also noted that the waiting time was 1.5 - 2 minutes as per their observation. In the event that the waiting time exceeds two minutes, the members of the Coordinating Committee would inform the volunteers in the WhatsApp group to join the system. “We also have another group, SOS groups where there are volunteers willing to join in any time especially when we have a high number of callers or when the waiting time exceeds two minutes,” he said.
A: Patients with breathing issues (patients who are in urgent need of hospital-based care)
B: Patients with fever
C: Asymptomatic
SMS in the following order to 1904:
A or B or C (SPACE) AGE (SPACE) NIC (SPACE) ADDRESS
Is it only for COVID-19 related queries?
“While the service is primarily used for COVID-19 inquiries and assessment, we have had calls from people who have other chronic diseases and even mental health issues. In patients with chronic diseases, we have noticed that many have not gone to their usual clinics such as the Diabetes clinic due to the lockdown and the pandemic. For such people we give them advice regarding the tests they should do and urge them to at least meet their family doctors to check their current health conditions and update their medication,” stated Dr. Edirisinghe adding that many people called the hotline because they needed assurance and the volunteers would reassure them. In cases where further psychological help is needed, these patients are directed to 1926, the helpline of National Institute of Mental Health (NIMH).
Prof. Karunathilake shared that through the Sri Lanka Army and the NOCPCO, the Doc 247 service is also able to lend high-quality oximeters to needy patients in home-based quarantine. The oximeters would be given for 10 days, and then it would be collected, sterilized and kept for 72 hours and be given to another patient. “If patients need social services, they are directed to Sarvodaya,” he informed.
Unanswered calls?
According to the Coordinating Committee, there was a 70% response rate for this service. Dr Edirisinghe shared that a list of missed calls is taken daily and then put to the 1904 system where a separate set of doctors would call these numbers back and assess the patients whose calls were missed. He also mentioned there was also another system in place, where these missed calls would fall into a doctor’s personal number and the doctor could call back, but the doctor’s number would not be visible to the patient and instead the patient would see it as 247 calling them.
“Only about 2% needed urgent care.”
“We have an average of 2000 patients calling us daily. So far, Doc 247 has attended to over 50,000 patients and over 40,000 SMS via 1904. Out of the 50,000 calls on 247, only around 1,000 patients needed urgent care and needed to be hospitalized. We realized that most COVID-19 patients did not need to be hospitalized and were able to undergo treatment in a home-based care setting. Only around 2% needed urgent hospitalization,” revealed Prof. Karunathilake.
“Through the Doc 247 service along with other measures such as the vaccination programme, the congestion in the health system has been reduced. Now, we observe that there is a gradual reduction of serious cases,” shared Dr Edirisinghe.
The public can access this service by dialling 247 using any mobile network in Sri Lanka or by dialling 1247 using the landline
