Between what he saw on the news and heard from friends and family in India, Dr. Abhijeet Nakave learned the situation back home was heartbreaking.
A doctor on the frontlines told him, “it was a war zone” trying to battle COVID-19, especially in rural areas where hospital beds, oxygen cylinders and medicine were practically nonexistent.
Almost 30 million people have been infected and more than 355,000 have died in the populous country, many since the second wave of infection began May 1. At times, the virus has claimed more than 4,000 lives each day.
From his post half a world away, Nakave—hospitalist at Mary Washington Hospital in Fredericksburg and resident of Stafford County—wondered how he could help.
One person probably couldn’t make much of a difference, he thought. But if Nakave called on others like him—doctors born and raised in India—along with medical providers in America and beyond who wanted to help during the crisis, perhaps they could have some impact.
The best way Nakave, 41, could reach the masses was through a telemedicine platform he created in 2014—an app called MDtok that connected residents of India with specialists around the world. When people had questions about their diabetes or heart disease, cancer or thyroid problems, they could go to the app, find someone who spoke their language and make a virtual appointment. No one in India had to travel anywhere or pay anything.
Last month during the worst peaks of the pandemic in India, Nakave put out a virtual “code blue” call for help and more than 400 doctors from the United States, Canada, the United Kingdom, Singapore and Australia responded. Since then, the MDtok.com website has had almost 4 million hits and more than 30,000 virtual visits between doctors who live in other parts of the world but speak the “mother tongue” of their patients in India, said Dr. Poornema Ramasamy, an internal medicine specialist in Columbia, S.C.
She’s worked with Nakave through the American Association of Physicians of Indian Origin, which has broadcast news of Nakave’s efforts. Bringing change to someone’s life, “however small it may be,” is a passion Ramasamy shares with the Mary Washington doctor whom she described as patient, smiling and always responsive, no matter when he’s contacted.
“He has a good heart and his solutions are targeted towards making a positive change in the country where he hails from rather than making big bucks,” she said.
Nakave acknowledged he can do more from Virginia than if he tried to work in the sprawling country of more than 1.3 billion people. He said it makes him “feel human” to provide a helping hand to others.
“I couldn’t give my shoulder to console,” Nakave said, meaning he literally couldn’t provide a shoulder to cry on. “I could not be there physically, but at least from here I was able to gather a few doctors and give some support to the families.”
‘PAIN AND SUFFERING’
Because of the sudden surge of patients in India starting in May, COVID centers were opened to house them, but there weren’t enough doctors trained in the disease—much less in the skills required with intensive care. As doctors in America listened to their counterparts in India, they realized the medical officials needed education, counseling and mental health services as much as their patients did.
“We had a meeting yesterday where they were saying counselors and psychologists were giving all this care to the general population, and they need some counseling as well because they’re all around these dead bodies and patients dying,” Nakave said.
During one virtual meeting, a doctor in India shared a story of a father and son, both admitted to the hospital for COVID symptoms. Only one oxygen cylinder was available, so the older man gave it to the younger one. The father died the next morning, then the son “couldn’t be revived and he passed away as well. It was really heartbreaking,” Nakave said.
Dr. Dharmesh Mehta, a hospital medical director and president of the Association of Indian Physicians of Northern Ohio, said Nakave has reached out to various physicians, encouraging them to help with his mission.
“It is a sad situation in India and we feel the pain and suffering of our families and friends over there,” Mehta said. “This is a great initiative to help those in need in India. It gives us an opportunity to help those while being abroad.”
As a hospitalist, Nakave cares for patients throughout their hospital stay. He communicates with family members, near and far, and the primary care doctors and other specialiststreating the patients.
He typically works seven days, then is off seven days and devotes time during his days off to telemedicine appointments with people in India.
Nakave graduated from medical school in India in 2002 and practiced for three years before he came to America as a master student. At the time, he was interested in research and spent a year studying diabetes. He eventually became certified as a diabetes educator and started offering second opinions for friends and family members back in India who had been diagnosed with the disease.
He wanted to go beyond the medicine prescribed and look at changes a patient could make in lifestyle, diet and exercise. In the early days of his MDtok app, he focused on answering questions about diabetes.
Other experiences in the United States, after he did his residency at Eastern Virginia Medical School in Norfolk, opened his eyes to the need to have specialists involved with his app as well.
His first assignment was in Yakima, Wash., and as he treated patients, he would sometimes refer them to specialists in Seattle. Many were hesitant to cross the Cascade Mountains in winter.
He saw similar situations in other rural areas of Wisconsin, Michigan, Indiana, Pennsylvania, Oregon and even Danville, Va., where he spent two years. It wasn’t always feasible for patients to make the long trek to urban offices.
“That always intrigued me, how can I do something different for these patients?” Nakave wondered, and “then the technology kind of evolved.”
He began answering questions from family and friends in India, reviewing their lab reports and offering his opinion. Word quickly spread, and his “practice” grew from three patients to 300 to 30,000 consultations, all done virtually.
Because of his immigration status, Nakave is able to offer the app only in India. He arrived in the United States as a master student and has been upgraded to a skilled worker, but his visa restricts his work to one employer in the United States. He legally cannot open a business or become involved in an American-based venture, so MDtok has remained an India-based solution. Sponsors—many from India like Nakave—have offered financial support to get the app going, but no doctors are paid for consultations.
Nakave has applied to become a permanent resident, but says there’s a long line of Indian-born people ahead of him. He was told it might take 100 years to get his permanent resident status, or green card.
‘BETTER FOR THE FUTURE’
Until his immigration status changes, Nakave will continue his work, both as a hospitalist when he’s on the clock and as a virtual consultant when off it. Instead of holding the hands of patients—as he did when he lost three COVID-19 sufferers during the early days of the pandemic—he provides a virtual listening ear.
When he needs to master other skills, whether in diabetes education or creating apps, he takes courses to increase his knowledge.
“Dr. Nakave is not just a caring and capable physician, he is also very talented technologist,” said Glenn Morten, a technology adviser in Seattle. “He designed and created the MDtok demo on his own.”
Like others working with Nakave, who have only met him over Zoom, Morten is impressed by the “passion and self-sacrifice” shown by the doctor and others who’ve been recruited.
So is Dr. Daniel Woodford, medical director of the Mary Washington Medical Group. He said Nakave’s work to help those in India is an extension of the heart he has for his patients.
“Dr. Nakave has always demonstrated a passion for connecting sometimes distinct segments of health care—such as primary care and hospital medicine—through technology in order to provide the most comprehensive and successful care plan for his patients,” he said.
While MDtok’s current focus is COVID-19, the doctors involved eventually will go back to the app’s original mission of connecting rural residents of India with specialists around the world, Nakave said.
In the meantime, the Stafford doctor juggles his work between two continents with his family life. He and his wife, Archana, have a seven-month-old son, Parth.
“Sometimes I look at him, and say I don’t know where this world is going but I have to support this little guy,” Nakave said. “He’s kind of my inspiration, too. You have to make the world better for the future.”
Cathy Dyson: 540/374-5425