This study focuses on disaster-affected areas in Pakistan where Sehat Kahani deployed telemedicine services through mobile units during flood emergencies, selecting locations significantly impacted by health and infrastructure disruption. Data collection involves semi-structured interviews with key stakeholders, including

Sehat Kahani staff members engaged in setting up and operating telemedicine mobile units.

The source population consists of Sehat Kahani staff, healthcare providers, and emergency management authorities involved in providing flood relief, as well as flood-affected individuals who benefited from telemedicine services and the funders who supported the flood relief efforts. The inclusion criteria for participants require that they be individuals impacted by the flood in Pakistan and assisted by Sehat Kahani, with participants being vetted by Sehat Kahani staff before selection for interviews.

Additionally, observations of the telemedicine mobile units' operations during flood emergencies were conducted to understand operational challenges and healthcare delivery processes. Relevant documents, reports, and data pertaining to the deployment of telemedicine mobile units were reviewed, including disaster response plans, project reports, and health outcome data. This mixed-methods approach ensures a comprehensive understanding of the impact of telemedicine on health outcomes, mortality rates, and healthcare system resilience in disaster-affected areas.

Data analysis involved two primary methods: thematic analysis and data triangulation. Thematic analysis was conducted by transcribing and analyzing interview data and observations to identify recurring themes and patterns related to the impact of telemedicine mobile units on health outcomes, mortality rates, and healthcare system resilience in disaster-affected areas. To enhance the credibility and reliability of the study's conclusions, data triangulation was employed to compare and cross-validate findings from different data sources, including interviews, observations, and documentation. This comprehensive approach ensured a robust understanding of the study's outcomes.

Ethical considerations for this study prioritize the rights and well-being of participants. Informed consent was obtained from all participants before conducting interviews or utilizing their personal information. To protect participants' privacy, confidentiality and anonymity was ensured by using pseudonyms in the final report. Additionally, measures implemented to safeguard the security and privacy of all data collected during the study, ensuring compliance with ethical standards and protecting participant information throughout the research process.

The study has limitations that need to be acknowledged. The study's sample size is a potential constraint. The specific nature of disaster events and the availability of key stakeholders might limit the ability to gather a sufficiently large and diverse sample. As a result, the findings may not represent the broader population affected by disasters. This limitation raises concerns about the representativeness of the findings and the ability to draw robust conclusions.

The case selection process and the availability of participants could introduce selection bias. The paper acknowledges that telehealth services might have been more accessible to certain groups, such as those with internet access and technological literacy. This bias may skew the results, potentially overestimating the positive impact of telehealth services during disasters and limiting the applicability of the findings to broader populations.

The study's findings may lack generalizability to other disaster scenarios, regions, or populations with different healthcare infrastructure and socio-economic conditions. Since the study focuses on specific events, the transferability of insights to dissimilar contexts may be limited. This restricts the broader applicability of the research in informing policies and practices for diverse disaster situations.

The research emphasizes the positive impact of telehealth services during disasters, which could introduce reporting bias. By primarily highlighting the benefits, the study may not fully capture the extent of health issues or challenges faced during the disaster. This bias may create an overly optimistic view of telehealth services' effectiveness, overlooking potential drawbacks or limitations that could be crucial for a comprehensive understanding of the subject. A more comprehensive understanding of telehealth services' negative aspects and limitations in disaster situations is crucial for a balanced and nuanced interpretation of the findings.

The limitations related to sample size, selection bias, generalizability, and reporting bias should be considered when interpreting the results of the paper. Addressing these limitations in future research would contribute to a more robust and comprehensive understanding of the role of telehealth services in disaster scenarios.

In disaster relief, understanding the healthcare needs of the affected population forms the cornerstone of effective telehealth implementation. The interviews with Sehat Kahani staff-including Dr. Sara Saeed Khurram, the CEO, and Co-founder; Atif Ali, the Chief Growth Officer; and doctors emphasized the necessity of conducting a comprehensive assessment of the affected regions to identify communities that are challenging to access. Sehat Kahani conducted a comprehensive analysis of available resources, including budget and funds, to strategize the implementation of telehealth services. Collaborating with government agencies is crucial to gain insights into the affected areas. Conversely, collaborating with corporate partners and donors provides us with additional resources; Lifebuoy, a subsidiary of Unilever, equipped us with the necessary medications and care packages to run a mobile clinic. Additionally, Zong, a mobile data network operator in Pakistan provided necessary funding for implementation of a telehealth application which could handle a high volume of users.

Telehealth has the potential to play a crucial role in disaster relief efforts by bridging the gap between healthcare services and disaster-affected populations. Specifically, telehealth can bring about a range of benefits to these communities. Dr. Khurram shared that offering immediate access to medical consultations enables timely diagnosis and treatment of disaster-related injuries and illnesses. Telehealth also eliminates geographical barriers, ensuring that even remote or isolated areas can receive medical attention. Dr. Khurram recounts the case of an 11-year-old girl affected by the flood. She and her family walked through flood waters for days. Due to this, her feet had cuts that led to gangrene infection. Once reaching the mobile clinic, doctors treated the young girl by removing the dead tissue and providing antibiotics.

Telehealth facilitates communication between healthcare professionals, allowing specialists to guide on-ground medical teams, as illustrated in the case of a young boy affected by the flood waters who developed a skin rash all over his body. At the mobile clinics, the doctors connected with a dermatologist through telehealth. The dermatologist identified the rash and prescribed the boy with topical ointment.

This innovative technology minimizes the need for patients to travel to overcrowded medical facilities, reducing the risk of disease transmission and eliminating barriers to healthcare for many rural and economically disadvantaged patients, who must take time off work and travel a significant distance to receive care. Dr. Khurram shares that “Telehealth services can be adapted to address specific disaster-related health challenges, such as outbreaks of infectious diseases, ensuring a targeted response.” Ultimately, telehealth contributes to the overall effectiveness of disaster relief operations, promoting efficient and well-coordinated healthcare delivery to affected populations.

The interviews offered a better understanding of the implementation process, the challenges encountered, and the strategies employed to overcome them. The analysis also identified critical issues related to resource allocation, accessibility, security, scalability, personnel training, evaluation, inter-organizational collaboration, and the sustainability of telemedicine services. These findings were instrumental in understanding the factors that influenced the success of telehealth interventions in disaster relief efforts. By addressing these challenges and employing a combination of on-ground medical expertise and telehealth technology, the interventions were able to provide timely, effective, and sustainable care in disaster-affected regions.

Sehat Kahani's experience reveals a multi-tiered model that addresses accessibility concerns for vulnerable populations lacking technology or internet connectivity. Sehat Kahani first implemented the physical camps and then a two-tier telehealth model: The physical camps provided medical camps in the areas and offered one-on-one medical assistance, while the mobile unit consisted of a van that traveled across the affected areas, providing awareness and understanding of telehealth, and enhancing patient access, outcomes and experiences, and a telehealth app, a “One Window” application allowed current and new patients to connect with doctors and specialists in minutes. The combined efforts ensure that those without internet access can still receive medical attention.

Patients could download the "One Window" application to establish a direct link with healthcare providers. This innovative approach streamlined access to medical assistance and ensured that services were tailored precisely to the identified needs. Furthermore, the interviewees stressed the importance of collaborative efforts involving healthcare providers, telehealth specialists, and on-site relief teams. Such collaboration fosters a cohesive environment, ensuring the seamless integration of telehealth solutions and alignment with the healthcare requirements of disaster-affected communities.

In disaster scenarios where internet connectivity might be disrupted, physical forms can be employed to maintain medical care continuity. Partnering with tele companies like Zong facilitated internet connectivity in remote areas during disaster relief efforts. Addressing accessibility requires blending physical presence and online options and leveraging local community networks.

The internet connectivity offered by the telehealth model is significant, as shared by one interviewee, “I had a very bad cough and fever for two months and was getting concerned about it. I’m busy with work, so I didn’t get time to visit a doctor. I tried out the Sehat Kahani app after a friend recommended it. The doctor I got connected with, and she pointed out that I might have tuberculosis. She told me to complete some tests and asked me to visit the clinic with the results. I used the booking feature on the app to schedule an appointment and show her the results. Lo and behold, it was Tuberculosis.”

The interviewees highlighted a significant challenge posed by limited internet access in disaster-stricken areas. While technological solutions, such as the proposed application, play a vital role, the interviewees stressed that physical presence remains indispensable. The ability of 4G or 5G technology to extend connectivity is acknowledged, but boots-on-the-ground interventions were deemed essential to bridge connectivity gaps comprehensively. The strategy proposed included forging partnerships with internet providers and leveraging existing infrastructure to establish robust and reliable connectivity networks. This holistic approach guarantees that the benefits of telehealth are accessible to even those residing in areas with inconsistent internet connectivity, thereby leaving no one behind.

Strategic partnerships and collaborations underpin Sehat Kahani's success in disaster relief efforts. These collaborations extended beyond healthcare professionals to corporate partners, donors, and government agencies. Key partners like Unilever and Zong played crucial roles by providing funding, resources, and internet connectivity. Collaborating with government entities allowed for comprehensive assessments and prioritization of efforts. This approach diversified available resources and contributed to the overall success of implementing telehealth services in disaster-stricken areas.

The Sehat Kahani staff emphasized that safeguarding patient information in telehealth is non-negotiable. Security, privacy, and confidentiality were paramount concerns in handling healthcare data, particularly during disaster relief efforts. The interviewees underscored the necessity of adhering to stringent data protection regulations like HIPAA to ensure patient information is transmitted and stored securely. However, implementing patient care in mobile health clinics sometimes does not allow for privacy. To mitigate this situation, Sehat Kahani utilized spatial separation and partitioned areas by placing two doctors under a tent ten feet apart, with a curtain between them, allowing doctor-patient privacy. This approach ensured data security and respect for privacy for individuals seeking medical assistance through the medical clinics. By prioritizing these aspects, the integrity and trustworthiness of telehealth services in disaster relief efforts are upheld, paving the way for their effective implementation.

Sehat Kahani's approach to maintaining security and privacy during telehealth services is notable. While challenges arise in ensuring complete confidentiality in online consultations, the organization addressed this by maintaining physical separation and privacy in medical camps.

Sehat Kahani's strategic planning and scalability measures allowed them to effectively manage an increase in patient volume during disasters. Their telehealth platform was designed with the capacity to handle a surge in patient requests. This highlights the importance of anticipating and preparing for increased demand, ensuring the technology can handle the load and maintain seamless service delivery.

Sehat Kahani's approach to training healthcare professionals for telehealth services focuses on tailored training that addresses disaster scenarios. They provided online training programs for healthcare providers emphasizing empathy, rapport, and technical proficiency, contributing to effective patient care while preserving privacy. Dr. Khurrum explained that Sehat Kahani had a constant stream of doctors trained every 15 days. By continuously training and updating healthcare professionals, they ensured the readiness of their teams to utilize telehealth technologies effectively in disaster situations.

Sehat Kahani's approach to evaluating the success and impact of telehealth services during disaster relief operations was metrics driven. They utilized response time, patient consultations, medications provided and reach affected populations as indicators of effectiveness and efficiency. This data-driven evaluation allows for a comprehensive understanding of the impact of telehealth interventions in disaster scenarios.

Sehat Kahani's strategy of establishing communication groups with partners through platforms like WhatsApp and sharing standardized information and media allowed for effective collaboration and information sharing. This streamlined approach ensures that all stakeholders are informed and aligned, facilitating better coordination and a cohesive response.