When Rancho, a character played by Aamir Khan in the movie 3 Idiots, helped deliver a child with telephonic help from Kareena Kapoor, who played a doctor, the viewers watched with shock and curiosity at the same time. Though the filmmakers took creative liberty to create a dramatic scene, a sane mind could think of a situation in real life where doctors, not equipped to handle emergency or complicated cases, get such expert help on the phone which eventually helps save a life or two.

The health advice call centre, set up at the Aundh chest hospital in Pune under the National Rural Health Mission (NRHM), promises to do just that for doctors and frontline health staff in rural parts of the state where quality health care is rare.

In one such instance, Premkala Raut, 24, was taken to a primary health centre in a village in Nanded district late in the night with intense labour pain. The baby’s head was not coming out, so the medical officer called up the health advice call centre.

The gynaecologist available on the other side asked the medical officer if the patient can be shifted to another hospital. When she was told that the nearest rural hospital was 13 kms away, the gynaecologist gathered all details of the woman’s health and suggested the medical officer to give contraction inducing drugs to the woman through saline. As she was about to hang up, the medical officer told her the baby had come out. But it was not crying. The doctor asked him to pat the baby and give suction. Suction began and the baby did cry, but not loud enough. At this point the paediatrician at the call centre took over. He suggested the medical officer to keep the baby warm, start oxygen, do suction and monitor heart rate. All went well and the mother and the baby are now fine.

A medical officer in a remote village could accomplish a complicated delivery and provide subsequent care to the baby with help from specialist doctors, situated miles away in a call centre in Pune.

The 20–odd health advice officers (HAO) and 11 specialist doctors attached to the call centre are helping state’s front–line staff in rural areas perform their duties better by providing medical advice round the clock. With an average 600 calls per day, the state’s first health advice call centre received over a lakh phone calls since it became fully functional seven months ago.

"We have a series of such success stories where round–the–clock, qualified and standardized medical information and advice have helped people across the state," said Niraja Banker, manager (operations) at the health advice call centre, which is run on behalf of the state government by the Health Management and Research Institute, Hyderabad, a non–profit social venture of Piramal group. The Institute runs similar ventures for governments of Andhra Pradesh, Assam and Rajasthan.

Banker said, "Most of the calls coming from state’s front–line health staff are about health issues of pregnant women and infants. Besides, there are calls for dog bites, snake bites, vector–borne and waterborne diseases."

The 20–odd HAOs who first attend the call are either doctors with BAMS degree or qualified pharmacists. They transfer the call to specialist doctors comprising gynaecologist, paedeatrician, physicians, surgeons, public health experts etc depending on the urgency and seriousness of the health issue. Most of them have either retired from government services and have experience of many years in the particular domain.

It is not just medical advice, the call centre also provides guidance on various government schemes and how to avail them.

In one such case, a 20–year–old woman in labour was admitted to a rural hospital in Malegaon in Wshim district. She was referred to Akola for further treatment and her husband was told to deposit Rs 800 as ambulance charges. Since they were poor, the man called 104 and asked for advice.

As the case fitted under the Janani Shishu Suraksha Karyakram scheme, the call centre experts spoke to the medical officer of Malegaon and told him that she can be provided the ambulance free of cost. She was transferred to Lady Harding hospital in Akola where she underwent a C–section.

Kanchan Salunkhe, an accredited social health activist (ASHA) from village Alvi in Sangli district, accompanied a seven–year–old boy who suffered dog bite to the civil hospital in Sangli. She was told to buy an injection from the market which would cost her about Rs 5000. Salunkhe called 104 for advice. She was told about an injection, Rabipur, which is available at all civil hospitals. Salunkhe approached the RMO and the boy was given anti–rabies vaccine. Salunkhe again called 104 and thanked the call centre officials for the timely advice. "The advice given by our experts is practical where the staff concerned is helped to perform duty using the expertise and resources available at the government health facilities," Banker said.

The 20–odd health advice officers and 11 specialist doctors at the call centre help the state’s front-line staff in rural areas perform their duties better

A few days ago a call was received in the middle of the night from an ASHA working in a village in Pune district. She had a child whose nose was blocked and he was unable to breathe. "Our pediatrician asked her if she had any medication with her to which the ASHA replied in the negative. So the paediatrician advised her to heat a little water, add half a tea spoon of salt, mix it thoroughly and put a drop in the child’s nostrils. We received a call the next morning from that ASHA that the advice worked," Banker said.

"The objective of the project is to primarily reduce death rate, infant mortality rate, and maternal mortality rate and disease morbidity," said Vilas Deshpande, deputy director, information, education and communication bureau.

The state government’s 24X7 health advice call centre (toll free number 104), meant primarily for frontline health staff in rural areas, is now open for all.

"Some three months back, we started providing free medical advice directly to people. Our call centre offers help round–the–clock on treatment for common ailments," said Niraja Banker, manager (operations), who looks after the functioning of the call centre. Of the 1.22 lakh calls the centre has received in the last seven months, 50% were directly from people.

"Callers primarily seek advice on common health issues like headache, fever, stomach and body ache. Besides, we get calls seeking advice or beauty tips to get rid of pimples and body scars," Banker said.

Telephonic or online care, however, has its limitations. Some patients cannot do without the physical presence of a doctor. "In such cases, our HAOs tell them to see a doctor," Banker said.

More importantly, the call centre’s health advice officers (HAO) are not allowed to prescribe drugs; they can advise, or at best, suggest over-thecounter drugs.

Twenty-three–year old Preeti Mane, an HAO with the call centre, is a pharmacist by profession. She said that most calls are about common health issues. And for that, the HAOs are given a set of common symptoms seen in adults, children, elderly and pregnant women and commonly given medications to treat them. "We call them algorithms. We are not allowed to suggest anything beyond the algorithms. If a caller requires more than regular medical advice, then the call is transferred to specialist doctors," Mane said.

The call centre aims to reduce the burden on the public health system. "Medically validated algorithms and disease summaries provide paramedics and doctors with the support to drive this high level of standardised care forward," Banker said.

Senior family physician Hillary Rodrigues, former president Indian Medical Association (IMA) said, "The person seeking advice needs to explain his medical history, allergies etc to get the correct advice. In common cold and fever, a patient may have contraindications from a drug if he is suffering from associated illnesses. The dose of a common drug could be different for different people depending upon his body weight, age and presence of underlying disease, if any."