Tag Archives: telemedicine

Doctors Open Doors To Sick Punjabi Truckers

The doctor leaned over Jitamber Singh Bedi and inserted the needle of the injection into his eyeball. Jitamber had a blockage in his vein that was causing his eyesight to cloud up. Vision problems are a side effect of diabetes. Like eighty-eight percent of truck drivers, Jitamber Singh Bedi too had Type 2 diabetes. 

In order to operate a commercial vehicle on the road, a driver must be able to prove they are maintaining stable blood sugars. Jitamber medical exam report is part of his driving record. It is filed electronically by the Medical Examiner (ME) with the US Department of Transportation (DOT) bi-annually. Any drop in health indices would mean he loses his license or at best, gets recertified every year. 

Over half of all long haul truck drivers suffer from hypertension and/or diabetes. These comorbidities put them at a higher risk for COVID.

“Sedentary lifestyle and erratic sleep gets you, if bad food on the road doesn’t,” says Jitamber Singh Bedi. “Sitting for ten hours a day for ten days at a stretch, the truck driver is a sitting duck for diseases like diabetes. And when they do take a break it is easy to pull out a cigarette.”

“At every rest stop I ended up smoking,” says Jitamber. 

Irregular eating habits and dehydration further strain the system. Jitamber is always worried about taking restroom breaks and therefore restricts the intake of fluids and food which can lead to the taxi cab syndrome. The inability of drivers to relieve themselves regularly throughout the workday leads to voiding dysfunction, infertility, urolithiasis, bladder cancer, and urinary infections as compared with nonprofessional drivers wrote Alon Y Mass, MD, David S Goldfarb, MD, and Ojas Shah, MD. from the Department of Urology, NYU Langone Medical Center. Paid by the mile, every restroom stop costs precious time.

“Sssssslow suicide behind the wheel,” says Jitamber, “with the pandemic that could take a quick turn for the worst.”

Jitamber graduated from Mayo College, where he went to school with the sons of India’s upper classes, princes, and nobles. After immigrating to the US, he worked for ten years as the Assistant Manager, Special Reporter and Editor for India Post, a California publication. Jitamber started driving a truck in the US in 2012.  

Jitamber & his wife Lisa

He still maintains his A1 license to drive a truck and is married to Lisa, a librarian at the county library. Jitamber is on his wife’s medical plan. Kaiser is their health insurer. Kaiser, a California company, has agreements with other providers to provide coverage all over the US thinks Jitamber. He does not really know how his health insurance will play out if he falls sick on the road.

Raman Dhillon of the North American Punjabi Trucking Association (NAPTA) has negotiated a health plan that truckers can buy into. Portability of insurance plans from one state to the other has been a bottleneck to seamless healthcare access. NAPTA wants to ensure that the trucker has access to pharmacy anywhere and medication can be prescribed to and picked up by the driver from the pharmacy closest to him. 

President Trump’s Emergency Order in the face of the COVID pandemic opened up anywhere anytime access to healthcare.

Anywhere Anytime Access 

Of the 1.5 million truck drivers on US highways, says the Punjab Truck Association, about 150,000 Punjabis are working in the trucking industry. The South Asian gene makes the Punjabi drivers more vulnerable to acute myocardial infarction (MI). Studies by UCSF, Stanford and El Camino hospital’s South Asia Heart Center, show that heart disease strikes South Asians at a younger age and more malignantly than the general population. “South Asians represent approximately 17 percent of the world’s population – yet they account for 60 percent of the world’s heart disease patients,” says Anita Sathe of the South Asian Heart Center which runs a program to help South Asians manage their heart risk.

The ability to access and monitor healthcare on the road is crucial to the health of Punjabi truckers.

COVID-19 opened the door for truckers to access technology-based ubiquitous healthcare. Under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act, the incorporation of telemedicine into routine medical care on a temporary and emergency basis, has lightened the burden on truckers. The waiver has loosened former requirements that the patient and provider be in the same state or that the patient must be in physician shortage areas to access telemedicine; so a doctor in New York now can be reimbursed for consulting with a patient out of California. 

The rule that a new patient could not use telehealth and must have an established relationship with the doctor has been relaxed as have some of the HIPAA requirements like data transfer and storage. The new criteria allow the use of tablets or smartphones, so a driver can call a nearby doctor from his smartphone. However, all calls must be video calls;  audio-only calls may not be made. 

“From March 6, 2020, a range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, offered telehealth to all patients,” says Apexon Healthcare executive Siva Sundar. “Meeting the doctor through zoom or Facetime has become the norm for everyone during the quarantine.” 

Telemedicine and walk-in medical clinics located at truck stops and Pilot and Flying J Travel Centers proliferated with the advent of COVID. For the sake of the truckers, these new rules must outlast the pandemic and become the new normal. 

Checking For Sugar On The Road

Jitamber Singh Bedi would find it useful to wear body sensors that alert him, his family, and his doctor to potentially serious changes in his health status. 

Continuous glucose monitoring devices to monitor the driver’s blood sugar – motivates healthy behaviors says Rajeev Sehgal, Jitamber’s classmate from Mayo College, who has been wearing the Dexcom 6 device for over 6 months. “In the same way that wearing a Fitbit can be motivational for meeting daily fitness goals, real-time monitoring of blood sugar levels might reinforce good behaviors around eating and exercise,” he says. 

The tiny sensor he wears on his stomach sends real-time reading of his blood sugar levels to his phone every 5 minutes.  “It is extremely comfortable to wear. I can swim with it. I change the device every ten days,” says Sehgal who highly advocates its use by drivers. The device allows quick remedial actions for timely diabetes management and the information can be kept private or shared with family members when the driver is on the road.

If the sensor indicates high sugar and blood pressure levels, the trucker can consult with a doctor by teleconference over Facetime. If they’ve embarked on a trip without getting a refill or forgetting to pack their meds Telemedicine can get them their meds at a pharmacy close to where they are. 

“At present, the sensor is prescribed and covered by insurance for people who have uncontrolled type 2 diabetes but it should be authorized for truck drivers who are managing their diabetes,” says Sehgal. 

Monitoring blood sugar levels on the go will allow the trucker to take immediate remedial action. A brisk walk could fix a spike in blood sugar levels following a sugary lunch or in case of a drop in sugar levels, a quick pop of sugar will prevent deterioration in vision like the one Jitamber had to face. A year ago he noticed he couldn’t read street signs. Retinal vein occlusion and macular edema caused big brown blobs to float in front of his eyes. After a series of shots at regular intervals, Dr. An Ngoc Huynh, MD at Kaiser Irwindale California declared his vision to be 20:25.

“The main thing I want to better understand is, how different things I do affect my glucose levels,” says Jitamber. “I will track my blood sugar levels to see how it responds to food, sleep, and exercise. Fasting, exercise, stress, or sleep can be tweaked to get the marker to the right place. Precision in targeting our health issues can prevent shots in eyeballs,” said Jitamber.

Read other articles in this series:

Road Warrior

Punjabi Truckers Find A Warm Welcome At US Highway Dhabas


Ritu Marwah wrote this series while participating in the USC Center for Health Journalism‘s California Fellowship.

 

Snapshots of Life In COVID Times

Ruma Sikka, a realtor in Washington D.C., is using Zoom and Facetime to show her homes virtually on Open House days, ever since COVID-19 shuttered her city in March.

“Surprisingly,” she says, “I’m busier than I’ve been before. Since real estate has been declared an essential business, we are open – we just can’t show houses the traditional way.”

Doing things the traditional way is fast becoming a thing of the past as the coronavirus changes how society goes about the daily business of life.

Past pandemics left the societies they visited transformed forever. As we cope with Covid-19, the invisible microscopic monster circling our cities and homes in real-time like its 13th and 20th-century cousins, major social changes are already being seeded.

The Black Death that raged through 13th century Europe and Asia took a human toll but also sparked enormous social unrest. Historians trace a direct trajectory between the impact of the plague and the destruction of feudalism in Europe, leading to the Age of Enlightenment and the Renaissance. The Spanish Flu of the early 20tht century crippled economic activity, leading historians to speculate that the economic misery in its wake paved the way for fascism and authoritarian dictators like Hitler and Mussolini.

Today, in the first quarter of the 21st century, a global pandemic is visiting mankind again. It’s been identified and sourced and we even have a DNA profile and snapshot of the perpetrator. The world is at its mercy, practicing social distancing and shelter-in-place while fending off infection with masks, gloves, and ventilators.

In this new dystopian reality that has become our lives, Ruma represents the resourcefulness with which many professions are adapting to the needs of the moment.

As the COVID quarantine encircles daily lives and workplaces, regular folk are adopting new norms – many of which could become permanent social transformations as we battle the beast together.

For Deepa Chakrapani at the World Bank in Washington D.C., teleworking is proving to be a phenomenon that is a lot more productive and viable than expected.

“There are no scheduling conflicts. Everyone is in quarantine so no excuses! We are a lot more focused and…. we are beginning to realize how much we can get done without meeting in person.

She predicts that telework which has been undervalued for years (being reserved for illness or pregnancy), will be reassessed as an alternative to costly travel. It’s a view echoed by strategy consultant Natasha Marwaha, who finds working from her home office more efficient, collaborative, and productive. “I think, going forward, telework will not be scorned as working-lite!”

A real boon is the hours saved on her commute adds Deepa. “Apart from more time at home with my teenagers (who are captive audiences now), it’s given me an opportunity to volunteer as block captain in my neighborhood. I check up on neighbors, especially elderly ones, and make sure they are doing alright.”

“I feel we are living through a social experiment,” says Deepa, “and its product will be a greater sense of community—I think there will be more awareness of the contribution of everyone, in whatever profession or situation, to society’s well being.”

Perhaps this awareness is nature’s antidote to the ‘social pollution’ affecting society. Consultant Rahul Prakash coined the term to describe “…the rise in competitiveness and a constant outward focus towards more” that has accompanied the rise in prosperity in the last decade. The explosion of social media”, he says, “has created a FOMO mode for our lives – more wealth, more travel, more friends, more visibility.”

Rahul, who has worked in Private Equity for 25 years and advises companies in the Mergers and Acquisitions space, says his particular business has stalled due to the economic uncertainty. But the pandemic has pushed a pause button. “We are being forced to disengage from all that extra noise and activity that comes with social excess, and concentrate on essentials, on the essence of life and family.” There is a benefit to the isolation and down time everyone is experiencing.

“It’s hard to predict the economic fallout from this pandemic,” he muses. “Though, I doubt it’ll be a V- shaped recovery.” But one of the more significant economic effects of this pandemic will be how recovery money is distributed, he feels. “The social and economic are all very intertwined in our current economic shutdown.”

Recovery from the pandemic however, will take more than contributions from the federal stimulus package or government handouts. Ordinary citizens are stepping up to help and make a difference, volunteering with food deliveries, sewing masks and donating supplies.

Jason, a medical resident on the front line of the crisis treating COVID patients every day, is Natasha Marwaha ‘s son. His mother worries about him all the time.

“I haven’t seen him in weeks. He’s staying away because he doesn’t want to expose us,” says Natasha. “Everyone is working diligently in his hospital.”

Along with her family, Natasha has started a D.C. based charity to collect personal protective equipment like masks, for essential workers. “Early on in the pandemic, the shortage of PPE worried us, and we wanted to contribute, especially since my son is in the frontline.”

To date, they’ve raised more than their goal amount.

The pandemic is demanding the most of medical professionals like Jason, while changing how they manage their regular patient load.

“Dealing with COVID is like flying a plane while reading the manual,” says Dr. Narain Rajan, a cardiologist who practices in Washington D.C. “You simply don’t know when something you’re doing is going to be wrong, and disaster will hit.”

The crush is peaking at the hospital where he performs procedures in ICU’s filled with COVID patients. “I think we learnt from New York’s bitter lesson and created extra hospital capacity on time, so there’s no overwhelming of resources,” says Rajan, but he worries about going home every day and exposing his wife and children to COVID.

He shrugs off his frontline hero status. “I come home in my scrubs and then proceed to scrub myself thoroughly – we have to live with this risk, there’s no other option.”

It’s an option filled with “a sense of mission and urgency which makes every day rewarding, even while it’s heartbreaking,” says Vandna Kishore, a pharmacist at the FDA. “A couple of weeks ago I was on rotation for emergency authorizations for specific medicines which are needed to enroll patients in trials right away. I was struck by the influx of applications for teens, pregnant women, and young adults who need to be intubated and given these medicines. The applications for pregnant women are particularly hard, emotionally.”

“We are terribly busy at the Agency,” says Vandna. Response teams that include FDA employees have set up screening procedures and testing centers nationally, at critical locations, – some are even in parking lots. “We’ve also speeded up the process of the emergency authorization of the use of certain trial medicines for extremely sick patients, (medicines like hydroxychloroquine and remisdivir) and are fast tracking the process of reviewing how effective they are.”

Healthcare practitioners like her are juggling an enormous workload as they cope with the COVID crisis and its constantly changing landscape.

Vandna and her husband are teleworking as much as possible from home as does Dr. Rajan, who minimizes face-to-face contact with patients for non-emergencies, through online consultations via Zoom or WebX. “I’m shifting to a lot more telemedicine with my patients to limit physical contact. It’s working pretty well, so far, he says. “The new patient-centered approach requires patients to take some of their own vital signs which he monitors, and provides pre-emptive care to keep patients away from the hospital. “I used to have 15-20 patients in the office a day, and now we only see 1-2 of the serious cases.”

Dr. Rajan believes that telemedicine will begin to play a much bigger role in future patient care, since statistics will prove how effective it could be.

But unlike professionals in other fields who feel teleworking has opened new possibilities in the workplace, architect Madhur Khanna finds it cramps the creativity required in the architectural design world. “There’s something about face-to-face consultation when a design is being worked on, which is irreplaceable,” Khanna, who is part owner of her own consulting company still completing projects because construction is an ‘essential’ service.

There is a silver lining to her quarantined life, however. Khanna now takes a walk every afternoon, something which was unthinkable in the hectic schedule of her former life.

“I’ve started thinking a lot more about how we are ruining our planet and how we should go forward from this catastrophe to build sustainable environments in which viruses like COVID have no chance of entry. And I know many others are thinking along the same lines. That is the good I see, coming out of this nightmare.”

Building a sustainable practice is how Ruma Sikka views her future as a realtor, ever since the pandemic put an end to live showings.

At each viewing, she walks through the house with her phone and laptop, showing clients all the features on Zoom or Facetime. “We can even host walk-through groups on Twitch, with new interactive software.”

Ruma is brushing up on relevant technology and networking with other realtors.

The real estate community has rallied vigorously around this slump with webinars on virtual marketing and using technology to augment sales. “We are also trying to figure out guidelines for how we are eventually going to show homes, safely, to clients,” says Ruma.

“All our virtual marketing groundwork will bear fruit once the lockdown restrictions ease,” she declares. She remains extremely optimistic about the prospects of an early bounce back in the real estate market.

“There are many reasons to be hopeful,” she says. “We’ll get through this dark tunnel eventually, to the other side. But life will never be the same again.”

Jyoti Minocha is a DC-based educator and writer who holds a Masters in Creative Writing from Johns Hopkins and is working on a novel about the Partition.


Edited by Meera Kymal, contributing editor at India Currents.

Imagecredit:TheDarkNut, Pixabay

Photo by manny PANTOJA on Unsplash