“Let’s see if we survive this.”
The young resident doctor at one of Hyderabad’s top government maternity hospitals where several doctors have contracted the novel coronavirus in the last couple of weeks is very matter of fact . The simple question that evoked an instantaneous response was: “Isn’t it great to start a medical career in the middle of a global pandemic?”
Over the last few days, nearly 110 healthcare providers including resident doctors, nurses, technicians, and faculty members have tested positive for the SARS-CoV-2 while they performed their duties in non-COVID hospitals. The Telangana Junior Doctors Association says 63 doctors including postgraduates and MBBS interns have tested positive from Osmania Medical College alone. The rest are 22 doctors at the Nizam’s Institute of Medical Sciences, five in Gandhi hospital, and 20 paramedical and nursing staff who are also undergoing treatment. The overall number of positive cases among healthcare workers since mid-March, when the first positive case was detected in the state, has crossed 200.
According to the Chief Minister’s Office (CMO), last week, 153 health and medical staff including doctors have been tested positive for COVID19 in the last three months, and that this was a worldwide phenomenon. The CMO statement added that the health condition of none of the medical staff was serious.
It is after some of the members of Telangana Junior Doctors Association (TJUDA) met with health minister Eatala Rajender recently and apprised him of the fear in their minds that the Director of Medical Education (DME) Dr. K Ramesh Reddy restored the roaster system and divided the entire medical staff into batches.
Earlier, in a telephonic conversation with indianexpress.com, Dr. Reddy responded to these apprehensions of the junior doctors and stated that all those seeking medical care in all hospitals should be dealt with as they were potential cases of COVID. He maintained that an adequate amount of PPE kits, N95 masks, and sanitisers are supplied to hospitals with instructions to use them generously.
Indianexpress.com caught up with three such young resident doctors from three different departments in three different non-COVID government hospitals and what binds them all is the fear, for they know for sure their risk of exposure to the virus. As of June 15, the total number of positive cases in the state stood at 5193. Of them, 2240 are active and undergoing treatment. As many as 187 persons have succumbed to the infection in Telangana to date.
An obstetrician-gynecologist PG, who we spoke to, starts her 30-hours long shift at the government maternity hospital in Petlaburj by doing rounds of the wards in the morning. The crowded wards and humid weather does not allow the doctors to wear a PPE suit during the Out-Patient duties, forcing them to manage with only N-95 masks. They wear the protective suit during labour room duty in the afternoon. A 2-3 hour break in the night is all they get during the entire shift.
“It is very tough to stay inside the PPE suits. We get dehydrated, there is a possibility of urinary tract infections as we cannot even drink water or go to the restroom. The caseload at the hospital has risen so much that no other hospitals are taking delivery cases. All cases from districts are also referred to here. That is why there is a dangerous possibility of patients and doctors getting exposed to the virus,” she says.
The Modern Maternity Hospital at Petlaburj sees a footfall of at least 700 outpatients a day. On average, 70 deliveries are performed at the hospital every day. The doctor further adds: “Many of our cases are referrals from all across the state, and also private hospitals. The patient may present in the last stage. Our priority is to take care of the mother and baby’s health. And hence there is no screening for COVID before delivery.” Following the delivery, if the patient is symptomatic the samples are then sent for testing. Here again, only symptomatic cases are tested and doctors fear there could be several others who are asymptomatic carriers.
None of the doctors were prepared for a pandemic of this scale and nature as COVID, the doctor says. But it is the constant worry about the health of their parents back home that pinches them more. Admitting that the present times are as challenging as it could get, she says, “we might be doctors to society but on any day we are children to our parents. While we are worried about passing on the infection, they are also emotionally traumatised worrying for us.”
Another junior doctor working at the Department of Orthopaedics in Osmania General Hospital, who is in self-isolation after having himself exposed to an outpatient who later tested positive for COVID, says it is nothing but the negligence and nonchalant attitude of top bosses that has led to many healthcare providers turning into patients. According to him, as much as 80 per cent of the patients visiting hospitals for outpatient services could do well through teleconsultation.
Extensive testing in the community, he says, should have been done and no one knows why the hesitation till now. “When we get a patient in the Orthopaedic department, we are forced to take a CT scan as a precaution. If there is haziness around the lung area, there is a possibility of an infection. It is just for our own safety and we have had such people testing positive for COVID,” he added.
Now that the government has asked hospitals to ensure an adequate supply of N95 masks and PPE kits, the 29-year-old says this ought to have been done much earlier. “Since we are a non-COVID hospital, there was hardly any focus on us even as our caseload increased. We were given only one N95 mask from the hospital between March and June. It was the JUDA which arranged a regular supply of masks for the doctors,” he added.
He recalled how a circular was issued earlier against the testing of anyone for COVID before a surgery. “That is unethical. Operation theatres get contaminated and the virus will stay for longer than usual. Now again we have resumed testing before surgeries. We should have done that long ago.”
The doctor says he, however, has no complaints and that he, like his fellow doctors, has sacrificed more than 15 years to just fulfil the dream of becoming a doctor to serve the people. But in the same breath, he says the government must safeguard the doctors.
“After intermediate education, we struggle for a year studying for 16-18 hours a day to just qualify for MBBS. It takes six years to finish the UG,” he says, adding that it is just a beginning. Again one has to study for 16-18 hours a day to secure a specialisation of choice.
“We struggle through three years of PG and do 60-68 hours of straight duty. We stayed away from all things fun, stayed away from family and friends, and we delayed our marriages. While other friends are living a family life and minting money, at 29 years of age, we live in a hostel room with two other roommates. That is how it is. Imagine,” explained the doctor.
Though there is no sign of flattening of the COVID curve, according to him, the overall experience of the crisis would help mould him into a better doctor. “Not just for doctors, it is a learning experience for the entire humankind. It will improve our lives, our understanding on how to approach a crisis, and how important is empathy towards others”
A junior doctor in the department of Community Medicine at the Osmania Medical College, who has stopped travelling home due to the risk factor involved in her job, feels the sudden spike in the number of positive cases among the community in Telangana is a result of confusion created by the unlock process. According to her, the community was not effectively informed of the reasons for lifting the lockdown. In urban slums especially, she says, the people who were already in loss of livelihood were not in a position to understand the situation.
The final year PG doctor, as part of her job profile, visits various containment zones, and tries to inform and educate the people regarding the do’s and don’ts to prevent the spread of the virus.
Starting at 9 in the morning, the door-to-door survey of symptomatic patients go on till 6 pm.
“We just wear our N95 masks and are at maximum risk while moving inside containment zones. It gets hectic because of the nature of the population and also the weather. Also, it is not possible to have lunch or keep sipping water while on this job,” she says. Recalling the example of more and more doctors and medical staff testing positive for the disease from non-COVID hospitals, she says the virus is in the community and most people are healthy carriers of it.
While screening for the coronavirus on the go is not possible, as RT-PCR tests are time taking procedures, she points out that effective communication with the community is crucial. “We were clearly unprepared for the pandemic. Communication is equally important as treatment. If higher officials, social influencers, or celebrities could have regularly communicated with the public, the situation would not go out of hand. When we talk to the community, as doctors, some respond positively and some don’t. We have faced even instances of getting beaten up,” she rues.
In any case, when doctors themselves get tested positive for the virus, the message conveyed is negative. “If we cannot protect ourselves, then people would start wondering how we could protect them from the disease. That’s why the government must safeguard doctors,” she concludes.
A senior government doctor, when contacted, said the signs are crystal clear with the medical community facing a COVID threat, and it is high time the state government starts testing more in the community. Telangana has been in news for its abysmally low testing numbers and the number of tests conducted so far is kept a secret that no one is willing to share.
“Testing should be seen as an early warning system. Early detection and monitoring of asymptomatic patients are as important as treating symptomatic patients in hospitals. The recent spike in the number of symptomatic cases is proof enough to suggest that a large number of asymptomatic patients are out there in the community,” he said.
Dr. K Mahesh Kumar, the President of Healthcare Reforms Doctors Association(HRDA), told indianexpress.com that the state government needs to ensure the availability of protective gear to all doctors in COVID as well as non-COVID hospitals to plug an existing mismatch in supply.
“The present working staff is under a lot of stress and the government should use the services of 1400 PG doctors who are awaiting final year exams from June 20, to address the need for workforce,” he said. The HRDA has approached the Telangana High Court seeking a stay on the exam and utilisation of final-year PG students as senior residents.
Similarly, he said, the government should recruit more manpower permanently through the Health and Medical Services Recruitment Board (HMRSB) which, according to him, has not seen any recruitment since its inception one-and-a-half years ago. “This will bring some relief to the present workforce and also help in the long run too. There is no point trying to recruit on a contract basis as no one will show any interest and delay the process further,” he added.
A glimmer of hope appeared on the late evening of June 14 when Telangana chief minister K Chandrasekhar Rao finally announced his decision to conduct 50,000 tests across 30 assembly constituencies in the districts of Hyderabad, Rangareddy, Vikarabad, Sangareddy, and Medchal-Malkajgiri. This will be done over a period of 10 days and among people living in containment zones, family members of positive patients, and frontline workers including doctors, paramedical, health, municipal, media, and police personnel, as a confidence building measure, according to the government.
In the three months between March and June, Telangana had conducted just a little over 40,000 RT-PCR tests. The CM has also allowed private hospitals and laboratories to join the fight against the pandemic. A cap on charges to be collected for testing and treatment has been announced now.
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