By Nazish Hussain, TwoCircles.net
“No one gave much thought about the health workers that we too are at a great risk,” said a female doctor from Gandhi Medical College in Secunderabad, on condition of anonymity. Intern at the Casualty Ward, the medic said she was forced to halt her internship midway on March 23 due to poor availability of Personal Protective Equipment (PPE) exposing health workers to heightened chances of the risk of infection. Such is the case in Gandhi Medical College, the nodal COVID19 center in the state of Telangana.
COVID-19 was declared a pandemic by the World Health Organization (WHO) in mid March when India recorded a major spike in Corona positive cases, leading the Indian government to suspend all visas to India. As the government made urgent calls for social distancing to prevent community spread, people went on a panic buying spree triggering scarcity of sanitizers, masks, and essentials in the markets. Private companies were asked to shutdown and interstate transport services were also ordered to stop. While so much was done for preventive measures, little was highlighted about the medical services to battle the deadly pandemic. Lack of hazmat dresses, masks, ventilator, and isolation wards received less or no attention despite Indian health workers on the frontline continuously complaining of severe unavailability of adequate protective gears to keep them safe against the infection.
“There was a great influx of patients, in such situation whether you will look after yourself or the patients,” the female doctor recalled, outlining that the interns who joined early in March were provided with no prior training while they dealt with 200-300 patients having cold, cough and fever daily. The number of patients for screening was many and it was hectic for the doctors, she said, so they managed with normal masks meant for general public, due to the unavailability N95 masks.
According to WHO, health workers at the front line of COVID-19 outbreak response are exposed to various hazards including pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence. As the total number of Corona positive cases in India has reached 2301 with death toll at 56, according to the information updated by Health Ministry on April 4, health workers face a dangerous time ahead.
Duty and Risk to Health Workers
“We thought of it as normal Flu,” said the doctor from Gandhi Medical College, explaining that initially when her batch joined the medical workforce on March 13, they were not even fully aware of the situation. There were only three interns to manage the patients, who were not even used to wearing gloves and gowns due to lack of equipments at the government hospital.
WHO mandates guidelines for health workers, their employers and managers, citing health workers rights in these words: “assume overall responsibility to ensure that all necessary preventive and protective measures are taken to minimize occupational safety and health risks and provide information, instruction and training on occupational safety and health, including training on infection prevention and control.”
“It is a war, and as a responsible citizen it is our duty to fight against it,” said Dr. Madhan Pranesh from Coimbatore. Currently a backup, Pranesh has volunteered with Tamil Nadu health services in the fight against Corona. He explained that many doctors in India are above the age of 50 years, among whom are those with co-morbid conditions like hypertension, diabetes and more and all of this just makes them more prone to infections. He added that the disease can become contagious for health workers in close contact with COVID19 patient, and those getting exposed to COVID19 patients in absence of protective gear also become susceptible for its spread. He said that in many cases, internationally, this has led to deaths.
The Health Ministry in its latest update has stressed that community spread of virus is not there, and India is still in “local transmission and limited community transmission phase” but facts state that if the pandemic grows, India’s health workforce will be more at strain with the doctor patient ratio being less than the WHO prescribed 1:1000.
When Dr Pranesh was asked about the unavailability of PPE and scarce number of doctors in Coimbatore, he said he had no idea about the situation as he hadn’t been in contact with anyone but had spoken to colleagues from other medical colleges who affirmed the lack of PPE. According to Ministry of Textiles, the Health Ministry would require more than 700000 protective coveralls, 6 million N95 masks and 10 million 3-ply masks until the end of May. Despite Central government’s announcement on March 24 for allocating 15,000 crore to strengthen the health infrastructure, it remains a dream to see more isolation wards, testing kits and even training of professionals to combat the disease.
However in Kerala, where Nipah outbreak was successfully contained within a month by the state government in May 2018, things are different.
“Everyone is worried because it is highly infectious disease but for health workers it is a different case,” said Muhammad Aslam, a nursing staff in Government Medical College and Hospital (MCH), Kozhikode, Kerala. Aslam says it is their duty and responsibility as health care workers to fight fearlessly.
Kerala reported its first positive case soon after three students arrived from Wuhan. But the state government immediately started gearing up to face possible cases of Corona and arranged services for care givers. The government is currently organizing a scheduled daily training class for employees, staff nurses, grade two employees and attendants other than medical interns. Aslam is one of the staff who has been attending the training programme, getting lessons on the aspects covering what is Corona virus, how it spread, how to use PPE kit, how to put on the kit how to put off the kit and much more, from live demonstrations by an expert.
Stigma around Health Workers
“People at masjids were scared of me, they thought I would contaminate them,” recalls Aslam, who was working at MCH during Nipah virus outbreak in 2018. He shared that it was Ramadan in May 2018 when he was working in the Nipah outbreak and some people even asked him not to come to masjid for prayers, fearing he would be dangerous to everyone.
Aslam has been a practicing nurse for 12 years now and remains a solid evidence of health workers facing social stigma. Asked about reactions during the Corona outbreak, Aslam says that although he himself has not faced any similar situation but this time it was one of his friends, who was standing at a queue in a bank when a person to his left moved away from the spot after learning about his profession.
According to several news reports, doctors across the country had to go through distressing experiences owing to their job during pandemic. Residents Doctor’s Association at AIIMS, New Delhi wrote a letter to the Union Home Minister Amit Shah, requesting to take appropriate actions against eviction of health care professionals from their homes and provision of transport facility during COVID-19. Similar other cases of eviction of health workers have been reported from Hyderabad and Kolkata. 200 house surgeons were evicted from a hostel on 24 March, fearing infection from them.
Fear of contaminating family
“Since I am working without enough protective gears, what if something happens to my six months daughter or aged mother because of me!” said the female doctor from Gandhi Medical College. She discussed that the reason she left her internship midway was because she feared being a potential carrier of the disease to her infant and mother, who are highly susceptible to infections.
Being a health worker in times of a pandemic is also emotionally straining. Other than job strain, health workers are constantly worried of being a potential carrier of disease to their families. Many of them have young infants or aged parents.
“My parents are very much anxious, they keep saying I must not work in Corona isolation ward,” says Aslam. He has an infant at home and is maintaining safe physical distance from him due to his profession. Although he does not touch his baby boy before a shower, changing dress and cleaning up well, he admits it is taxing to perform a duty while being a potential threat to one’s own family. Aslam informed he is about to begin isolation ward duty along with his wife from April 4.
“I expected this since I joined nursing field” says Aslam, expressing the constant struggle between his professional and personal life as a health care worker.
Message from Health workers
Dr. Pranesh who is awaiting his turn to join the health workforce in fight against Corona, believes in primordial prevention and community health care. To dispel the prevalent myths related to COVID-19, he is making informative videos targeted at general population.
Through his videos, Dr Pranesh wants to bring our attention not only to hygiene but also towards the lower socio-economic strata of our society who he feels need to be educated.
“If they get affected, it will reach us ultimately,” says Dr Pranesh adding that it is our responsibility to educate people about preventive measures and to provide them with protective gears as there is a looming threat of community spread.
At such a difficult hour, it is these doctors, nurses and care givers grappling both with the shortage of personal protective equipment and facing stigma and stress and it becomes imperative to listen to their experiences and suggestions as they are battling the deadly viral infection in closed doors, often away from their homes for weeks.
Aslam, who is on ground witnessing isolation ward patients, fears that if COVID-19 keeps multiplying it would become difficult to manage it with the existing health care infrastructure. As a responsible care giver, he explains, they are ready to work even without leave so that they can effectively treat patients but it would really help if the spreading rate is low.
“So help us reduce the cases by staying at home,” Aslam adds.