Every Second Counts: My Journey as a Virtual Doctor

Having recently reached the landmark of responding to my 400^th “Urgent: New Case Assigned”, I thought I should finally respond to the request I received to write a blog about my experiences as a “Virtual Doctor”.

I first came across “the Virtual Doctors” at the “Volunteer EXPO” show at the NEC in May 2022. This was of immediate interest to me. As a result of numerous visits to Uganda with Partnerships Overseas Networking Trust (PONT) and the Welsh Ambulance Service, where we are training Village Health Teams, I was already very aware of the medical problems that arise in rural African communities. So, I signed up.

After 31 years as a Consultant Obstetrician & Gynaecologist, I retired from my NHS post in 2006 but have remained fully registered and licenced to practice, subjecting myself to the annual appraisals and revalidation.

Since May 2022, I have never turned off my availability to respond for Virtual Doctors. It is not that I have not got a life to live! I simply enjoy being on call for problems arising in a speciality that I love, and it does provide that frisson of an adrenaline buzz. Even on a Caribbean holiday last year I was able (and permitted!) to respond to sixteen referrals in a 6-week period.

I always respond as soon as I see that an urgent referral has occurred. It is understood and always accepted at home as a priority. I have given myself this rule because if the referral is a request for advice concerning a woman in labour, a response is required now, not tomorrow morning.

There have been so many close calls: hypovolaemic shock, septic shock, eclampsia, massive antepartum and postpartum haemorrhages, and ectopic pregnancies near the point of rupture. There was also the tragic case of the 16-year-old girl, who finding herself pregnant drank a glass of paraquat. I advised urgent transfer to the University Teaching Hospital in Lusaka. It is remarkable that she lived for a further 9 days before she passed away from multi-organ failure.

As responders, I feel it is important that we give praise to the Clinical Officers when praise is due, some of them are remarkably efficient in the histories they provide and the actions they take.

It is also our role to make suggestions to prevent the likelihood of a particular problem from recurring. Lack of emergency transport is a perennial problem throughout Africa; I remember the situation where the Clinical Officer urgently requested an ambulance to transport a woman in labour to the nearest hospital with the facility to perform an emergency Caesarean section. There was evidence of both maternal and foetal distress.

After waiting for 11 hours, with the foetal heart rate falling, the Clinical Officer was finally able to source an alternative means of transport. He accompanied the patient and 12km into the very bumpy journey delivered a very asphyxiated baby himself in the vehicle. Fortunately, the hospital was nearby where both mother and baby were stabilised.

I suggested to the Clinical Officer that he should call a meeting of the community that his Health Centre served. He should discuss with them the potential disaster which could happen to themselves or any member of their family if an ambulance were not available. There would undoubtedly be people in the community who had means of transport who would be willing to be on a rota to drive the Clinical Officer and a patient the 12km to hospital. It might just save a life.

The most useful aids that I have found are the lists of Level 1 to Level 3 hospitals in Zambia and a clear simple map. It is helpful to know the facilities the different levels of hospitals provide.

Level 1 hospital is the District Hospital and supposed to cater to the needs of the local population.
Level 2 hospital is a provincial General Hospital providing specialised services including referrals from Level1 hospitals.
Level 3 hospitals are Central Hospitals and include referrals from level 2 hospitals.
On receiving a new referral, by clicking on the name of the clinic (underlined and in red), the District and Province of the clinic is shown.

The hospital list can then be helpful in locating the level of hospital required. I have found that a number of referrals are now coming from Level1 hospitals.

The internet is also very helpful in informing us of the distances from a clinic to the Level 1 hospital but sometimes that can be considerable. For major medical problems, if there is the option of recommending to the Clinical Officer to refer to a nearby Level 2 hospital (and providing him or her with distance), that can make the difference in saving a life.

To date I have only had two referrals from Malawi, both as it happens, for gynaecological cancers. After screening the referral centres, I found by chance that Malawi’s first ever National Cancer Centre at Kamuzu Central Hospital in Lilongwe had opened for patients this year. Thank you, Google!

It will be particularly interesting to see the referrals that may come from the Mercy Ships Partnership. As a Rotarian, this is of particular interest to me as this is a medical charity that has been supported by Rotary International.

The Virtual Doctors is a fascinating organisation. It provides an invaluable service, and it is a privilege to pay a small part. Long may it flourish and grow.

Roger Neuberg

Consultant Obstetrician & Gynaecologist, FRCOG, LLM