For Mumbai doctors at centre of fight against coronavirus, donning PPEs for long hours is an unprecedented ordeal
The high number of cases in Mumbai means that overstretched doctors have to wear extremely uncomfortable PPEs for long periods of time.
Editor's note: This series will focus on the difficulties faced by the medical fraternity at COVID-19 hospitals, their duty hours, access to protective gear, facilities they get during quarantine, how are their families coping with this new reality across different states in the country. This is the sixth part of the series.
Since the outbreak of the novel coronavirus in India, there has been much discussion on the availability of personal protective equipment (PPEs) for medical personnel. However, an aspect that statistics cannot bring to light is the extreme discomfort that doctors go through while wearing the PPEs.
Doctors in Mumbai are going through a particularly harrowing time, with the metropolis presently being the city that is worst-affected by the disease. Till 25 April, Mumbai has reported 4,870 COVID-19 cases. The high number of cases means that overstretched doctors have to wear PPEs for long periods of time.
Amit Ganvir, a doctor at the Jaslok Hospital at Mumbai’s Pedder Road, testifies to the difficulties of wearing the requisite protective equipment for long periods of time. For the first two days that he worked with coronavirus cases, his team worked on two shifts of six hours each per day. This meant that the doctors would get two PPE kits per day. Later, as more and more patients began to be admitted and the hospital started facing shortages of PPEs, doctors began working for 12 hours straight.
Ganvir said, “If one removes any part of the equipment for even a short period, then it will be considered as contaminated and cannot be used again. So, once we wear the PPEs, it is not possible to even drink a glass of water or empty the bladder for the next 12 hours.”
He added, “We also face difficulties when we wear hoods —which are plastic headgears that are necessary when we perform procedures to put patients on ventilators. Due to our breathing, the face shields get foggy within about three minutes, after which it becomes difficult to see properly. Because I know how to swim, I can hold my breath for about thirty seconds longer. But this is not possible for everyone. Also, if the face shield becomes foggy before the procedure is complete, we have no choice but to remove it. This increases the risk of infection for us, but there is no other way.”
The Union health ministry’s guidelines on the rational use of Personal Protective Equipment (PPEs) recommend using the full PPEs in intensive care units (ICUs) and emergency units, especially when aerosol-generating procedures are being conducted. Aerosol-generating procedures include various kinds of ventilation, nebuliser treatment, etc. Doctors who conduct these procedures are considered to be at high risk for the novel coronavirus .
According to the official guidelines, the components of PPEs are goggles, face-shield, mask, gloves, coverall/gowns (with or without aprons), headcover and shoe cover.
Doctors rue having to stay away from families
Many doctors in Mumbai have been staying away from their families for a long time due to concerns that they might end up infecting their loved ones, particularly those with weaker immune systems. However, this inevitably takes a psychological toll.
On this issue, Ganvir said, “I have not gone home since just after Holi (which was on 11 March) as I do not want to risk infecting my family members. It is certainly a difficult time for those have been away from their families since the coronavirus outbreak. No one is used to staying away from home for such long periods.”
He added, “A very small percentage of doctors — perhaps 5 percent — have been going home in the past few weeks. Some of them are newly married or have small children. The doctors who have been going home have been taking extra precautions. They avoid close physical proximity with their family members and wear masks even when they are at home. After all, medical professionals know the risks of transmitting the virus to those around them.”
Ganvir said, “The situation is even worse for people whose families stay outside Mumbai. While they do speak to their families over the phone, they have not met their family members for a very long time now.”
Among the doctors who do not go home, some doctors stay in the hospital’s quarters, while for some, hotel rooms have been booked. Presently, doctors deal with COVID-19 patients for seven days at a stretch, after which they have to remain in quarantine for the next seven days.
Further, hospital personnel who are suspected of having been exposed to the COVID-19 virus are quarantined for 14 days. One of them was Vijaykumar Narwade, who is presently working in the ICU section of the Gokuldas Tejpal (GT) Hospital.
Narwade, along with several other hospital personnel, was earlier quarantined for 14 days after he dealt with a patient who later tested positive for the virus. However, he later tested negative.
He recalled, “During the period when we were in quarantine, our families would be especially worried about us. They would call to check on our health multiple times in a day, and would sometimes video call as well. They would also be concerned since we were eating hospital food. But we had no choice — we had to eat that food, whether we liked it or not. It would not have been proper to complain.”
Narwade also expressed concern about doctors facing stigma and discrimination from people around them. He said, “I have read and seen news about doctors facing stigma from communities, being forced out of rental accommodation, etc. That is certainly a worry for us. I personally have not faced any disrespectful or impolite behaviour from anyone till now. However, I can see that people are apprehensive about being around me if I wear a doctor’s apron.”
Citing instances of people being fearful of being around doctors, he said, “Recently, when I went to a petrol pump near the GT Hospital to refuel my bike, an attendant asked me to stand away from the others, rather than join the line. At a medical store, too, a shopkeeper asked me to wait outside and tell him what I needed from there.”
Narwade also pointed out that PPEs for doctors are extremely uncomfortable, particularly in Mumbai’s rising heat. On the issue of availability of this equipment, he said, “Adequate PPEs are available as of now. But I don’t know what will happen if there is a major rise in cases.”
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