The Covid-19 pandemic has put undue pressure on the healthcare system across the globe. The way the crisis is being handled has put the spotlight on the pitfalls of the medical systems in place.
Metrolife spoke to some healthcare experts in the city to know more about the struggles the medical community is facing during these tough times.
Lack of protective gear
Given the nature of the virus, and how contagious it is, medical professionals on the frontline are putting their lives at risk every single day. “The virus survives on surfaces for many hours, which means that we have to be careful not only with patients, but also with any equipment we handle. This is why protective gear is so important,” says Dr Murali Chakravarthy, MD chairman, Central Infection Prevention And Control Committee, Fortis Hospitals.
Since doctors cannot maintain social distancing while treating patients, Personal Protective Equipment (PPE) ensures that they remain protected. PPE varies situationally; the gear needed to treat patients with the flu varies from what is required when dealing with those infected with Ebola or H1N1.
In the context of Covid-19, which is spread primarily through close contact and droplets, PPE includes a bodysuit that covers the entire body, shoe cover, gloves, face shield, and an N95 mask. Dr Murali explains, “We have to follow certain protocols even when donning and doffing the suit. Between the point of wearing it and removing it, about 8 to 12 hours can pass. Once you wear this, we can’t eat, drink or even relieve ourselves. So we tell our personnel to keep a full stomach and empty bladder before getting into the suit.” Many professionals have taken to relying on adult diapers to ease this experience.
Many hospitals are running out of required equipment. They have started rationing the gear and working in limiting the usage as much as possible. Every part of the gear, except for the N95 masks is now being made in-house at many of these hospitals.
Fear of infection
Doctors have to constantly work with the fear of getting infected themselves. “It is not just the fact that our lives are put at risk. What about the possibility of us infecting others. Besides, even if one doctor has to practice isolation or undergo treatment, we are losing one soldier in this war,” Dr Murali shares.
Reports suggest that more than 50 health professionals in the country have tested positive.
Understaffed and under-equipped
India has less than one allopathic doctor per 1,000 people, which is the minimum recommended by the World Health Organisation, and only 1.7 nurses per thousand people, as opposed to the WHO-recommended three-per-thousand. In 2016, the Indian Medical Association registered a shortage of tens of thousands of critical-care specialists.
The government needs to make healthcare a priority, says Srikant Subudhi, healthcare administrator, Fortis La Femme Hospital. “Italy has one of the best healthcare facilities in the world and yet their system broke down. We spend only 1 to 1.5 per cent of our GDP on healthcare, which is abysmal.”
The country does not have the public healthcare system it deserves, says Dr B Joseph, who works with the Department of Community Health at St John’s Hospital. “We are not spending enough money on healthcare, which is such an integral part of our lives. There is also the fact that 70 to 80 per cent of the expenditure in the country is out-of-the-pocket,” he says.
While testing for the virus is the way forward, from an infrastructure point of view, the number of ventilators we have in tertiary care centres is far fewer than what we need. There are many infrastructural pitfalls that need to be addressed, he adds.
The dominant share of India’s doctors and beds are in the private healthcare sector. “We talk about getting more ventilators, but where are the doctors and experts that can handle them? We need to improvise on the healthcare education system, rely on private PPE models and stop relying solely on government hospitals,” adds Dr Murali.
Physical and verbal abuse
There has been an increase in instances of medical professionals being attacked. On April 6, a video of a doctor who works at the Surat Civil Hospital, Gujarat being harassed by her neighbour went viral.
Just ahead of the nationwide lockdown, the Resident Doctors’ Association (RDA) of the All India Institute of Medical Sciences (AIIMS) in Delhi wrote to Union home minister Amit Shah about forceful eviction by landlords fearful of infection.
There have been many reports of relatives attacking when a patient’s situation deteriorates. A doctor on duty at a government hospital in Hyderabad was reportedly attacked by the relatives of a 49-year-old who died of Covid-19. “It is already a stressful situation, and such incidents hurt us. People need to grow up and the government needs to step up in such cases,” says Dr Murali.
Psychological impact of working on the frontlines
The lack of clarity on the future in itself makes the situation very stressful. For those working on the frontlines, the work does not end at the hospital, their work affects their personal lives. “Since we want to limit contact, the number of doctors, nurses and housekeeping staff in medical wards and the ICU have been limited. However, this means that we are overburdened. After one shift, we take a leave for two weeks so we can quarantine ourselves,” says Dr Murali.
Doctors can’t hold their babies or play with their children. Those with older or immunocompromised family members have to isolate themselves. “Working in the ICU is not the issue. The number of deaths, the helplessness and having to make the decision of who gets to live, as it happened in Italy — all of these would definitely have an adverse effect on our mental health,” he adds.
Dr B Joseph’s department has been tasked with the responsibility of community survey of areas where people have been tested positive. “It is very stressful when you are working in the hospital and are exposed to people who have been tested positive, because of how easily the virus can be transmitted. One of my colleagues developed a cough and fever. She is diabetic, but until the test results come, it is very worrying,” he says.
Plea to public
Stay at home and help flatten the curve, say experts. “Even if someone needs to be taken to the hospital, they only need to be accompanied by one person,” says Dr Murali.
Avoid using N95 masks, as it is short on supply and is of utmost importance to healthcare professionals. Instead, use homemade masks if you have to step out. “There is only so much that the medical community and the government can do. A lot of how this plays out depends on every single individual,” adds Dr Murali.
Dr Swathi Rajagopal, a consultant for Infectious Disease & Travel Medicine, Aster CMI Hospital, says that people need to be honest about their medical and travel history with doctors. “While there is a fear of being stigmatised, being honest will help them help you and those around fight this situation successfully,” she says.
How to help
- Srikant Subudhi, healthcare administrator at Fortis La Femme Hospital started an online petition asking that the government recognises the outbreak as a national emergency. The petition calls for making PPE available, as well as working towards reducing the attacks on medical staffers. Sign the petition on www.change.org
- Shishu Care Foundation is raising funds to purchase PPE kits and supply them to doctors who need them at different hospitals across the city. The average cost of a kit is Rs 3,000. You can contribute on www.milaap.org
- St Johns Hospital is looking for funds to ensure that no patient is turned away for a lack of finances. They have set up a screening clinic, a dedicated isolation facility and a dedicated 15-bed Covid ICU. For details on how to contribute, visit www.milaap.org
- The Nawayath Club has collaborated with the Bengaluru Bilal Bagh to raise funds to purchase PPE for the medical staff in the city. To know more, visit @nawayathclub on Instagram