Dhananjay Vaidyanathan Rohini, Partner at Alstonia Impact, a development advisory firm in New Delhi, was having breakfast on 14th of June chomping on an omelette. He suddenly stopped. Something did not seem right. He had no sense of taste. As he had read that it was one of the symptoms of COVID-19, he googled it to make sure. He immediately went to get tested. His worst fears came true. The test was positive.
He was apprehensive when his family went to get tested. Fortunately, all of them tested negative. Leaving behind his wife and 18 month-old son, he moved into his study to quarantine himself. All kinds of fears and anxiety enveloped him.
A day later, his phone rang. It was a lady doctor calling from Bengaluru. She said that she was calling on the behalf of the Delhi government who had informed her about his condition. She first listened to his fears and then patiently explained how he would recover fast as he was young and healthy. She underlined all the precautions he should take which included things like sanitising his room and washing his plates.
"In a span of 20 minutes, she gently took me through the whole journey of what all to do and what not to do in graphic detail. She ran through the drill I have to follow in the coming 14 days in terms of what to look out for and whom to call if there was an emergency like difficulty in breathing. It was a personalised empathic call that did the magic. I finally calmed down," said Dhananjay.
The Bengaluru doctor was a volunteer who was part of the biggest ever tele-medicine initiative undertaken in India involving over 6,500 doctors to fight COVID-19 that was ravaging both urban and rural India. It is called Project StepOne.
Project StepOne actually started on a WhatsApp group when some eager and worried youngsters started talking of what could be done in terms of building a solution to tackle the pandemic in India. In their initial discussions, they figured out that the gameplay should be to Identify, Isolate, Test and Treat. But, this had to be done without the people having to step out of their homes as it would expose them to the infection.
Currently, StepOne handles 40,000 calls a day. As many as 3.5 million calls were answered in the last 100 days. More than 1.25 lakh consultations were completed. Over 27,000 high risk cases were dealt with weekly and 25,000 mental health counseling sessions have been completed by the doctors and volunteers involved. Massive effort. Shows what we can do with technology.
All this was possible as a group of start-ups got together in Bengaluru to come up with a system to reach out to victims of the virus, help them with advice, counseling and even handling mental health issues of those who did not contract the disease. On the very day they formed the volunteer group, they had over 250 members at the end of the day. It kept swelling everyday.
When cloud telephony partners like Kaleyra, Ozonetel and Exotel with software partners like Lucep & Freshworks and others to handle the calls like Sheros, Genpact, and Abhinava Med Tech, joined the movement, the tele-medicine initiative started to take shape. They created a system where anyone could speak to doctors on StepOne from home without even having an internet connection or a smartphone.
The idea was pitched to the Karnataka government which saw the potential in it and gave their helpline to StepOne. As it worked so well, other states also wanted the same system. In just four months, Project StepOne has emerged as one of the largest tele-medicine efforts in India serving people free of cost.
The start-ups involved were from different segments like tele-medicine, technology, cloud telephony and funding. Interestingly, these startups were directly or indirectly competitors, but to battle the virus, they bandied together to create a system to tele-screen symptomatic Covid-19 patients using cloud telephony.
This was just a week before the lockdown on March 23. It was imminent that India would go in for a lockdown and these young entrepreneurs, doctors, health care workers and volunteers thought it the right moment to set up something like this.
The timing was perfect. Patients desperately needed to reach out to doctors and were terrified as they saw the official healthcare machinery under a lot of stress and pressure as the cases were rising. State healthcare helplines were also ill-prepared for the pandemic and did not have the physical infrastructure to even answer calls that were trying to reach it.
Concerned citizens who feared that they were infected with the novel coronavirus just had to pick up their phone and call a helpline. As it was a virtual number, it would never be engaged even if multiple callers were calling at the same time. An automated interactive voice response which is basically just a computerised phone system that enabled a caller to make a selection from a voice menu would help the doctor to verify if the person was infected. In case they had COVID-19 symptoms, they would soon be called by a doctor who would advice them on the way forward, the precautions to take, whether hospitalisation was required and so on.
The Karnataka government saw that StepOne was efficiently handling the emergency with speed and commitment and so got them to handle the state helpline. Soon after, eight other states roped in StepOne to also handle their helplines.
Initially, StepOne got some crazy queries that was completely unrelated to the pandemic and so the techies tweaked their software to screen the patient’s query to determine whether it was related to COVID-19. Also, to determine how serious the case was and what was the kind of intervention was needed.
But it was not as easy as it sounds. StepOne had to cater to different states with different languages. In some states, the dialects would change from district to district and to find doctors who would fit the bill as committed volunteers called for some work.
Rohan Havaldar, one of the volunteers of StepOne told India Together: "Our group of doctors and volunteers grew organically encouraged by the need of citizens to speak to doctors when there was so much of uncertainty. The callers found talking to the doctors so reassuring and also got immediate counseling. The role of doctors is central to this exercise."
IVRS Helpline – Citizens of the state can call the helpline number and share their symptom basis which if required, a doctor would call back and guide the citizen on next steps
IVRS Covid Patient out call counseling – If a citizen has taken a Covid detection test and been tested positive, the state govt shares this information with StepOne, for Doctors to call the patient, counsel them and share next steps on medical intervention basis their severity.
Web based tele-screening bot – An online chat bot that interacts with citizens who wish to share their symptoms and passes the information to a doctor basis the symptoms.
Mental Health Counseling – In this difficult time, many citizens are struggling to manage their mental health challenges and do not have access to professional help. The mental Health helpline provides counseling to citizens for expressing their issues for appropriate resolutions.
Plasma bank – Citizens of Delhi can now call up on a helpline 1031 / 1800111747 to donate or make a request for plasma with the entire logistics being taken care of at ILBS a Non-Covid hospital
Quarantine Monitoring – Service for states to monitor health of citizens under home quarantine and make sure right treatment is prescribed.
Spread and support
Other than Karnataka, the tele-medicine effort has now expanded to Odisha, Maharashtra, Chhattisgarh, Madhya Pradesh, Uttarakhand, Punjab, Delhi, Nagaland and Meghalaya. StepOne has doctors who among themselves speak 31 languages.
Arun Patre, who heads Incubation at the Mazumdar Shaw Medical Foundation, told India Together: "StepOne intends to continue in this current avatar till deaths due to Covid in India come down to zero. It hopes to create a structure similar to the National Cadet Corps and the National Service Scheme where the tech community would develop sandboxes for Sustainable Development Goals of the United Nations as a training ground for a new age IT task-force for management of national disasters."
He continued, "Corporates should dedicate some of their resource pools as part of their CSR initiatives to contribute such an effort. Hackathons where a large number of people congregate to engage in collaborative computer programming can be organised that can become a conduit to manage the ideas that merit these resources. The government can build a platform which could be deployed in emergencies and build infrastructure leveraging technology to combat challenges."
StepOne received a grant of Rs. 25 lakhs from the ACTFund that was set up by various venture capital firms and entrepreneurs to support initiatives battling COVID-19. It also got Rs.25 lakhs from Omidyar Network India and another Rs.25 lakhs from Wadhwani Foundation. The money came handy to set up telecom and server infrastructure to reach various corners of India.
Dr. Krishna Prasad Kudlu, Secretary of the Karnataka Ophthalmic Society, said: "Sometimes there comes a time when you feel that you are blinded and can no longer see the path ahead. The current pandemic is one such instance that makes the future looked blurred. Project StepOne showed us the vision ahead to fight the virus."
A National Health Digital Core
What India now desperately needs is a National Health Digital Core that will set up a robust technological platform to deal with health emergencies like the current pandemic. In fact, the pandemic should be seen as a great opportunity for the central government to set it up just as it set up the National Disaster Management Plan after the devastating Gujarat earthquake that killed over two thousand people and razed areas like Kutch to the ground.
Ideally, the digital core would through an intelligent automation system churn out data for machine learning systems, neural networks, text to speech, decision-making and construct algorithms for handling health related issues all over the country with the kind of speed and efficiency that we cannot imagine today with a broken infrastructure that got exposed during the COVID-19 crisis.
Once it is set up, the National Health Digital Core will be able to ensure that data is culled from internal and external sources to arrive at recommendations, design appropriate services, and arrive at decisions more accurately due to the deep learning process. It will help stakeholders to figure out the kind of services to roll out, transact, communicate and trace communication. We saw how this was so crucial in fighting this epidemic.
As the pandemic evolves, Project StepOne is working at leveraging their strategy and infrastructure to meet new challenges. They have started working on coordinating with plasma banks by making calls to those who recovered and cajoling them to help the sick. It is also trying to work out a system where critical patients who suffer from other ailments do not get left out as the pressure on the health infrastructure and health workers increase. "We want to see the day when no one dies of COVID-19 in India," says a Bengaluru-based volunteer as he multitasks at StepOne.
For him and thousands of doctors, it is a step towards saving numerous lives.