Coronavirus: Medical professionals are not breathing easy

Doctors, nurses and other health workers are facing testing times

As the COVID-19 pandemic paralyses the world, doctors, nurses and other health workers in the country are not breathing easy, even those who are not on the frontline.
Ravita Bajwa, a staff nurse in an Emergency Department, is one of them.

She is not sure whether the next patient who comes in is infected. These are tough times for everyone but tougher for health workers.
“The present situation is frustrating and frightening,” said Ravita. “We are grossly unprepared. If we can't have things implemented properly in hospitals, it will be dangerous for us and the patients.”

She is only reflecting the fears of health professionals across the world who are suddenly staring at the enormity of the situation -- indeed, like the rest of the world.
They are anxious about the choices they may have to make, the risks posed to them and their families.

“In the Emergency Department, we don’t know what kind of patients come in. But now, we are looking at their travel history as well,” Ravita said.
Health workers are at an increased risk of contracting the virus being right in the middle of the ‘war zone’. They feel their needs should be paid attention to and they be protected. All for the greater common good.

“Saving lives requires strength and that will only come from a good healthy medical team,’’ said Ravita.

But she has her shares of worries too. “A lot of nurses will be calling in sick soon -- working long shifts and duty hours and without enough time to consume even one meal properly. People too are anxious and it is a very chaotic situation,” she added.

This chaos is only the tip of the iceberg though. The voices of healthcare professionals and the huge challenges they face are getting louder by the day.“There are a number of issues being faced by health professionals,” said Dr S Venkatesh, lead interventional cardiologist, Aster RV Hospital.

“Firstly, we get a lot of enquiries. Many people who have contracted or who think they are affected are worried about their symptoms. They call to find out what they are supposed to do,” he said.

“Though there is a Covid helpline, the common complaint is that the helpline is very busy and not active all the time and the fact that there are not many designated centres where people can walk in and get tested,” informed Dr Venkatesh.

“A clear policy about what has to be done has not been instructed to us. The Karnataka Medical Council has a database of all the doctors, so the doctors could be periodically advised as to what would help,” he said.
The surge in the number of cases has brought the medical professionals face to face with unprecedented challenges, something that cannot be wished away anytime soon.

Elaborating on the bigger challenges, Dr Venkatesh said, “Even though some of us may not be dealing with Covid patients right now, the patients who come in may have symptoms which they don’t tell us about. There are patients who have hidden their history of travel or contact. That is irresponsible behaviour.”

“Sometimes, there are patients who do not know that they have been exposed to the virus. During that period of time, some of the patients who come in, inadvertently, expose themselves to others and us. Even though we are now wearing masks etc, the fear is always there,” he explained.

These are circumstances many health workers have not experienced before. “We need to be medically fit and look after ourselves so that we can look after the patients. People have become very cautious about everything. The situation can get very chaotic if it is mismanaged,” she said.

These are, by all accounts, testing times for the mental well-being of health workers.“There is psychological pressure even on the doctors who are not on the frontline,” Dr Venkatesh said.

“All hospitals have few intensivists, few doctors who man the emergency and the ICUs, and few pulmonologists. But as the number of cases are expected to go up or even if patients keep coming every day, the same set of doctors cannot keep on getting exposed. Therefore most hospitals will have to share other colleagues’ burden of screening patients at the entry,” he said

He added that the same set of five doctors cannot go on screening because they will fall ill over a period of time.
“Doctors will take rotas to sit in the clinic to screen patients. We will have to perform duties in the wards where these patients are there. There is the constant fear that we will be directly exposed to such patients,” added Dr Venkatesh.

With lack of resources, including Personal Protective Equipment (PPE), being a grave matter of concern, the outbreak has understandably heightened the anxiety levels of health workers.

“I feel sad for my colleagues who are working in the frontline and are facing the risk of infection. They will be in quarantine for a long time and away from their family,” Ravita said.
“Psychologically, doctors are aware of the hardships patients are going through, shortage of medical supplies, the type of difficult decisions doctors have to take, like giving up on patients because of lack of resources like ventilators. Those fears are much more,” pointed out Dr Venkatesh.

“Many of us are already stressed thinking of what could be the magnitude of the problem. We also have families. We have to constantly think about procuring masks and sanitisers and supplies. The usual problems that we go through as citizens also exists,” added Dr Venkatesh.

Dr Murtuza Ghiya, an Assistant Professor in Emergency Medicine, points out that the overwhelming emotional responses of patients, the large number of patients and the chaos are challenges facing the medical community.

“Healthcare workers are unable to adequately take care of themselves and are put up with the herculean task of treating others. This is creating panic and fear amongst health workers, who are trained to manage medically but not administratively, more so in chaotic and crowded areas like OPDs, Emergency Departments and ICUs,” he said

“The challenge is not in making protocols but having administrators help doctors and nurses execute them. Most of the execution involves non-medical administrators (HR, information, crowd control, paper work-checklists, stocks, co-ordination and logistics),’’ he said.

On whether enough PPF is being made available for health workers, he says it is. “But that’s the easy part,’’ he added.

“When it comes to planning, there is good effort but at the central and institutional levels, there should be reasonable plans. The tough part, though, is training and execution. The attempt is there, but in a situation where hospitals are so under staffed at the junior level already, taking leave even otherwise is such a challenge, forget about during a pandemic,” he informed.

“Absence from patient care even for a couple of hours for training is not possible. Doing it in batches is not feasible. Who will make sure that the PPE training is executed when junior staff is struggling to get water, meals and rest while working long hours on a regular basis? So, the truth remains, our basic needs are our priority,” he said.

“We are also tax payers. So the nursing staff and other healthcare workers should be provided free health check up and concession,” said Ritika.

Ask Dr Murtuza whether the mental wellbeing of health workers are taken care of in these times and he said, “Compassion comes out of someone only if you first have compassion for yourself. By and large, the burden of ‘being a brave selfless-saviour’ has led to a new generation of completely disillusioned young doctors and nurses struggling to cope with the emotional and physical burden,” he said.
“This is the result of an understaffed, rapidly corporatising healthcare ‘business’ that India is evolving into,” Dr Murtuza added.

The government, meanwhile, has a bigger role to play in helping them, points out health professionals. What is being done is not enough.
“At the micro level, Covid or no Covid, adequate staffing (medical and administrative on the treatment floor) is the key. There should be back-up staff in case of disasters and pandemics,” he said.

“After all, since it is healthcare business we are talking about, quoting Richard Branson, I would say “clients do not come first, employees come first. If you take care of your employees, they will automatically take of the clients,” he said.

Things are not hunky dory and people are slowly getting used to the new normal amidst the rule-breakers.
“In India, we had about a month of heads-up situation compared to other countries,’’ said Dr Venkatesh.

He added that for some time, it looked like the government was not taking adequate steps though there was some kind of a screening.

“We have seen fallacies in that type of screening. Contact racing should have been more stringent.”

“Understanding that cases have come inside and that they have spread it to a number of people, you can’t start contact tracing. It’s then social distancing becomes important,” he said.

“The government has to make sure that the infrastructure is adequate. It’s going to be a long haul. We have to carry forward social isolation and if we don’t do that, we will go the Italy or Iran way,” added Dr Venkatesh.