Dr Suvendu Maji, MBBS, MS, DNB, Clinical Tutor, Department of Surgical Oncology, Medical College, Kolkata, India.

All of us are in the midst of an unprecedented war, something we have never fought before and never thought of. It all started with the detection of first case in China, in December 2019 and by the end of March 2020 the disease had already effected over 160 countries worldwide prompting the W.H.O¹ to call it a global pandemic. Thousands of people have lost their lives since its inception and the toll continues to rise.

The first case in India was reported on 30th January 2020 in Kerala. Three weeks later on 22 March the ‘Janata curfew’ was imposed which was later converted to a nationwide 3 week lockdown starting on 24th March, bringing the entire country of 1.3 billion people to instant standstill. During this time period more than 4000 people have been infected and over 100 deaths have been reported in every nook and corner of the country. This daunting situation has led to radical changes in our healthcare system and the way we treat patients.

While many are directly involved in taking care of COVID patients, the effect of the pandemic is also being felt strongly by those who are indirectly taking care of patients with non COVID illness as well. Among them are a large section of patients who suffer from chronic diseases like diabetes, hypertension, rheumatoid  arthritis and cancer. Being a surgical oncologist I will focus on the last type of patient, many of whom I feel are really unfortunate, in the wake of the disease.

Since the lock down began I had been getting numerous calls from a variety of cancer patients in different stages of illness regarding their treatment. A significant number of them are those in whom cancer has been detected and awaiting diagnosis like biopsy or are waiting for admissions for surgery. Another group of patients are those whose chemotherapy dates are prescheduled, but are unable to travel to the hospital. The next group of patients are those who would otherwise require emergency surgeries like colostomy but are stuck in their home due to no availability of transport and lack of family support due to fear and panic.

The last group of patients are those who are in dire need of follow up, medical consultations and opinion and those who are undergoing palliative care or best supportive care at home and need monitoring of treatment. Also cancer patients from our neighbouring countries who depend on India for their treatment are at much discomfort due to loss of all connectivity.

Doctors are faced with dual challenge. On one hand they had to continue treating infected COVID patients and on the other hand they need to prevent getting infected themselves by following necessary precautionary measures like wearing of masks, gloves, personal protective equipment and practicing social distancing religiously. However due to inadequate infrastructure, lack of protective equipment, huge crowds in government hospitals, and redirection of almost all health facilities towards treatment of COVID patients, a vicious cycle of infection and reinfection and further shortage of manpower is bound to occur. For example recently doctors in Delhi state cancer hospital treating patients contracted infection and the hospital was quarantined.

In this hour of need effective use of social media, especially Facebook, can be helpful to deal with the crisis. With the wide availability of internet and ever increasing numbers of Facebook users I found it really useful to connect to a variety of needy cancer patients through my Facebook page. With around 3500 followers, it has enabled me to connect patients far and wide at when convenient, while maintaining social distancing.

Last week I made a post for a free cancer consultation and shared it in some of the well-known pages and groups with many followers. Since then more than 30 patients (some of them even from Bangladesh) had consulted me for second opinion about their cancer diagnosis, medications advice, follow up queries all free of cost. Additionally my page is connected to my Whatsapp group through which many of my anxious cancer patients had been in touch with me, in a time where travelling is restricted.  Moreover through my own Facebook page, I have been posting useful content on COVID illness, its impact on cancer treatment, and the precautions and guidelines that care givers of cancer patients need to follow. This has helped me create targeted awareness among the general public at a time when it is much needed².

Facebook has a share option and allows the users to connect directly to doctor without any third party regulations. Its free service, widely available and unlike other digital platforms, does not require one to sign in or pay for subscriptions. Unlike telemedicine and video conferencing, which requires a laptop/computer with fast connectivity, the same can be achieved through a cell phone without hefty investment. Let me illustrate through some examples.

An anxious patient relative called me up for help. Their daughter has metastatic carcinoma breast with bone metastasis. She started complaining of excruciating back pain a few days back. She has already stopped responding to oral pain killers. Meanwhile due to the travel ban, she could not get any access to opioid drugs. I posted her situation in my WhatsApp group and was lucky to find one of my colleagues (who works in a private hospital close to her residence) who agreed to help her. She was referred to her and after receiving palliative radiotherapy she is better.

Another helpless father contacted me through my Facebook page. His elderly son was suffering from advance carcinoma gallbladder. He had received a major part of his treatment in another state and was undergoing second line palliative therapy here in Bengal. However, soon after the lock down was announced, the patient’s condition deteriorated due to abdominal distension and swelling of the whole body. They tried to contact their doctor through email and calls, but to no avail. I had a video chat with them and advised them to get admitted under a general physician. I had a talk with the physician and guided through treatment. Tapping ascitic fluid twice gave sufficient relief to the patient and a lot of satisfaction to me.

In another instance one patient from Bangladesh had recently undergone groin dissection in their country. However he ended up with wound infection and discharge. He could manage to consult some local physicians but was in desperate need for an expert second opinion. With an advice for daily dressing, bed rest and antibiotics I could soothe his nerves.

In this unforgiving and challenging times with mere resources at hand we, the doctor community, need to act smart and quick. Wise use of social media and Facebook pages can be a boon in this time of crisis. The great flexibility that comes with this digital technology and ability to reach far and wide is its greatest appeal. The use of such online platforms should not be restricted to apex institutes like Tata Memorial Hospital, Mumbai (they are appealing patients to use their e –tool, Navya), but in fact every doctor including oncologist can use it for their respective patients.

References

1. World Health Organization (WHO) (2020, March 18). WHO Director-General’s opening remarks at the media briefing on COVID-19. Retrieved from https://www.who.int/dg/ speeches/detail/who-director-general-s-opening-remarks-atthe-media-briefing-on-COVID-19---18-march-2020

2. Shankar, A., Saini, D., Roy, S., Mosavi Jarrahi, A., Chakraborty, A., Bharti, S., Taghizadeh-Hesary, F. Cancer Care Delivery Challenges Amidst Coronavirus Disease – 19 (COVID-19) Outbreak: Specific Precautions for Cancer Patients and Cancer Care Providers to Prevent Spread. Asian Pacific Journal of Cancer Prevention, 2020; 21(3): 569-573. doi: 10.31557/APJCP.2020.21.3.569