Telemedicine Volunteering Experience as a Medical Student During the COVID-19 Pandemic in Brazil
Authors: Loyola Correa Tulio , Sandoval Terra Campos Guelli Mariana 
Published: January 2021

The COVID-19 pandemic has strongly affected Brazil in many different aspects, and the country is considered an epicenter of the new disease. With over 5.5 million confirmed cases and 160 thousand deaths by November 2020,1 the country’s healthcare system got oversaturated during the pandemic. Also, since SARS-Cov-2 is a highly transmissible virus, to avoid its spread to the society, many universities canceled in-person classes for indefinite period. For this reason, as a way to deal with both situations, many Brazilian medical students enrolled themselves as volunteers in telemedicine services across the country.
Recognized for acting in various sectors of society, volunteering has acquired entrepreneurial characteristics, as it is no longer restricted to assistance and solidarity, and it increasingly occupies spaces for training, education, culture promotion and professionalization.2 In this sense, medical students enrolled in telemedicine may enhance their clinical and communications skills in a period when in-person medical care is not possible to be carried out by many students.
Volunteerism is composed by people who perform a social work that reaches areas which the Public Sector is unable to effectively cover.3 The non-governmental organization Médecins Sans Frontières (MSF) announced that Brazil was testing in a very slow rhythm during the pandemic peak in the country, with 7,500 tests per million people, which is around 10 times less than the United States (74,927 per million).4 Thus, during a pandemic scenario in middle-income countries where the lack of available healthcare resources may pose risks to many lives, telemedicine plays an essential role in relieving the country’s overwhelmed health system. Still reported by MSF,4 nearly 100 nurses were dying from the disease per month during the pandemic peak in Brazil, being the fastest rate in the world. So, shown that in-person contact helps spreading the disease, telemedicine can be an interesting tool to avoid new infections, since the attention may be provided without exposing the health professional and the suspected case to one another. Many medical decisions-makings are purely cognitive, and telemedicine can deal with some less severe not life-threatening cases, following-up the patients and referring them to more specialized health facilities if necessary.
In a nation of continental dimensions like Brazil, the country’s different regions may face different pandemic phases during the same time. In this regard, since the medical students or volunteer doctors don’t have to leave their houses, telemedicine is also a great strategy that promotes better allocation of health professionals for more distant areas that are facing a worse pandemic phase and have less resources to cope with the health crisis. On this point, more than 15 thousand free telemedicine consultations have already been carried out in 135 different cities across Brazil by the project we are involved in.
Nevertheless, it is known that ill-prepared medical students added to the unfamiliarity with the latest guidelines might pose a risk to the country’s public health.5 Also, since telemedicine is a new device for the majority of the students, basal and continued training are essential to offer a high-quality health service. On this matter, during our volunteering experience, materials that guide how to access and deal with the virtual platforms were offered by the project’s staff. In addition, at the weekly meetings, those responsible for training explain in details everything that must be done so that patient care is satisfactory and effective. After a certain period working in the same role, volunteers receive new training in order to be prepared to assume new roles in the project. With this, the experience becomes broader, allowing a comprehensive knowledge of the project's functioning.
Despite COVID-19 cases, our telemedicine volunteering experience covers through video calls several medical fields, such as: pediatrics, gynecology and obstetrics, psychiatry, dermatology, oncology, ophthalmology, allergology, cardiology, sports medicine, geriatrics, otorhinolaryngology and other infectious diseases. However, we could notice a high prevalence of psychological assistance needing, specially between the older individuals. The reasons are diverse and often have a deep relation with the current pandemic reality, which consists of social isolation. Since the advent of COVID-19, there has been a significant increase in stress, anxiety and depression rates worldwide,6 and online mental health services were widely implemented in China during the outbreak to alleviate psychological distress,7 showing how important these aids are during pandemic times.
We believe that telemedicine volunteering is an extremely positive experience in medical training. As COVID-19 appears that it is still going to be part of our lives in the next year and it might change the way medicine is performed in many different manners, it is important to train medical students in this field so that the new generation of medical doctors is born capable of using technology as an ally to cope with adverse situations.