'Won't betray Hippocratic oath': In the face of deficient PPE kits, spike in cases, Punjab doctors put up tough fight against coronavirus
Doctors in Punjab say that apart from testing their endurance, PPE kits, if faulty, pose a grave danger of exposure. Returning home amid a lack of accommodation facility at GMCH Amritsar also causes worries about their families' safety
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 eighth part of the series.
Every time Dr Jagdeep Dhillon (name changed) doffs his PPE kit after finishing a COVID-19 duty at Government Medical College, Amritsar, he takes back two concerns -- the exposure in case PPE kits were substandard and the likely effects on his elderly parents back home.
His concerns assume significance with 3,500 pilgrims returning to the state from Maharashtra’s Nanded, 173 of them testing positive for coronavirus , taking the state’s total cases to 585 on Friday. Seventy-six of these pilgrims are in Amritsar, a city where 75 new cases were reported on Sunday.
Dhillon says some PPE kits being provided were substandard and did not comply with the guidelines prescribed by the Ministry of Health and Family Welfare. “Some doctors complained that the kits were not impermeable and others found that the equipment did not fully cover their bodies,” he said. A local level fund used to procure equipment as and when needed does not quell the worry over the quality. “It’s like sending doctors on a suicide mission.”
Dr Surinder Bakshi (name changed), a resident doctor at Amritsar’s Guru Nanak Dev Hospital, echoes Dhillon’s concern. “There is no shortage of PPE kits and other equipment, but there have been instances of a quality deficit. During a week’s dealing with those admitted with symptoms of COVID-19 , he said he received kits on some days through which air blown on it was passing through.
Wearing a PPE kit, Dhillon says, tests the limits of the medical worker’s endurance. For the eight hours of duty, the kit cannot be removed, despite profuse sweating and dehydration. “The protective equipment cannot be touched from outside or removed under any circumstance. “On the day of my first COVID duty, I felt headache, dizziness and with the heat, it became a challenge to not reach out to a water bottle and drink from it,” he adds.
Moreover, doctors don and doff the PPE kit in the doctor’s room within the ward, in the absence of a demarcated area to do the same, increasing the time of exposure while having no equipment on for protection. “Imagine wearing a plastic bag all over your body,” Bakshi says, adding that staff can feel nausea and wearing a PPE kit for such long periods may not even be possible for those suffering from claustrophobia.
Bakshi lamented the risks that a haphazard roster posed, under which doctors are posted in COVID-19 wards and their respective departments. He cited a case at GMCH-32 Chandigarh in which an operation theatre attendant tested positive and so did three women resident doctors from the anaesthesia department.
“Our college posted doctors from all departments on COVID duty, be it medicine, surgery, orthopaedic, etc. And after serving there, doctors serve in other departments and are not given PPE kits or N95 masks. Aren’t doctors in non-COVID wards also at risk?” Bakshi too said that often doctors outside the coronavirus wards are only given FFPS-1 or FFPs-2 masks, meant to be used in case of high air pollution and dust.
This assumes significance even as a Supreme Court ruling asked the government on Thursday to update guidelines on the rational use of PPE to ensure that all healthcare staff involved in working in “non-COVID areas” also be provided full PPE kits.
Dhillon added that a new roster requires doctors from various departments to serve for seven days each in the green zone, emergency and flu corner and blue areas. Another combined period of seven days in the yellow, orange and red zones came into effect on 28 April.
“Earlier, we had to serve in the isolation ward at least once a week and then go to the emergency or OPD the next day,” he said. “A roster demarcating zones and duties was being followed in GMCH Faridkot and GMC Patiala from the time that they had only one patient each. We are implementing it now after we put up a fight and approached health authorities,” the resident doctor says.
The new rules that came into effect on Thursday also required that those serving in COVID wards should undergo a 14-day quarantine. Before this, there was no isolation facility for the medical staff. Dhillon, who lives with elderly parents suffering from diabetes and hypertension, feels like he is living alone even when he goes back home.
“I rigorously sanitise myself on reaching home, wash my own clothes and use different utensils. I enter my house through a separate entrance and stay in my room, hardly interacting with my parents,” he says. In the self-imposed isolation, Dhillon continues to read books, work on his thesis and keep in touch with colleagues from other parts of the state to stay updated about the situation at other hospitals in Punjab.
Bakshi, however, was lucky to get a place in a friend’s room in the college hostel, where he stayed during the week-long duration of his duty. “I isolated myself in that room, did my chores and food was brought from the mess and kept at the entrance. I have my wife and toddler son back home and I could not go back and risk their safety,” he says.
At the Gian Sagar Hospital, doctors and other medical staff are sent to the hostel for mandatory quarantine after serving in the COVID ward. “It has been a month since I’ve gone home. At the hostel too, people don’t meet each other and only interact from a distance,” senior surgery resident at SAS Nagar’s Gian Sagar Hospital Dr Sameer Singla said, adding that he bides his time by reading books and watching television.
Doctors tend to get homesick and he often motivates them over video calls. He added that apart from his duty hours, he remains available for help during the rest of the day and even hands out his contact details to discharged patients.
Four staffers of GMC Amritsar were given showcause notices on 24 April for releasing statements on the shortage of PPE kits earlier this month, The Print reported. Later, Amritsar MP Gurjeet Singh Aujla asked the deputy commissioner to probe the allegations, while the Punjab Nursing Association also said that the 2,000 PPE kits procured from the fund provided by Aujla and Rajya Sabha MP Shawait Malik were “of sub-standard material and not safe for staff”.
Sources had told Times of India that the hospital had ordered 2,000 PPE kits and 2,500 N95 masks from a Delhi-based company and that 650 of these kits had already been used.
“I have lost faith in the system. Medical workers are not heard and then letters of complaint are lost in the system. If we talk to the media, we are given showcause notices. Our attention should be on treating patients and not writing letters or worrying about faulty equipment and schedules. Imagine if while dealing with the outbreak, our safety is compromised and doctors are lost,” Bakshi says.
In SAS Nagar, a shortage of equipment was not faced as of Thursday. However, four people posted from surgery and some medicine residents gave letters about faulty kits their respective department heads, Singla said. SAS Nagar was among the five industrial districts, apart from Jalandhar, Patiala, Ludhiana and Amritsar, that accounted for 73 percent of the total confirmed cases as on Wednesday.
Moreover, MBBS interns and resident doctors assisting the efforts to contain the coronavirus infection also faced the issue of a meagre stipend of Rs 9,000 a month, whereas states like Assam pay as much as Rs 21,000 monthly. Only on 24 April did the state government announce that the stipend was increased to Rs 15,000.
Even as the coronavirus outbreak continues to have dire consequences, doctors continue their attempts to keep the patients’ morale high.
“The first time I was posted, a 65-year-old diabetic patient came with breathing problems. He asked me if COVID-19 patients survived at GMC Amritsar and told me, ‘please save my life. I have only one son and I want to see him again’. The patient was later put on a ventilator, revived after a cardiac arrest, but he ultimately died. Our profession is such that we have been trained to cope with death, but this scenario is a different and a very stressful one,” Dhillon recounts. At the COVID ward at Gian Sagar, Singla recently distributed toys and chocolates sent by the government amid the 6-7 children admitted there.
Despite authorities’ action and no signs of abatement of the coronavirus , Dhillon and the 53 medicine department resident doctors at GMC, Amritsar continue to report to duty with enthusiasm.
“We work despite such demoralising notices and actions of authorities. There is no one to tell us that we’re doing a good job. But we have taken the Hippocratic oath and the thought to betray it even in such trying times does not cross my mind,” he adds.
According to Singla, who took the duty of the COVID-19 ward in-charge, the question of not attending to patients will never come to his mind irrespective of how long it takes for the outbreak to abate. “People have to help us and each other out by following the lockdown and social distancing guidelines. The disease is highly contagious, but not untreatable. So panic needs to be avoided,” he says.
So far, 1,102 confirmed cases have been reported from all the 22 districts in Punjab. As of Sunday, the districts which have the most number of cases include 218 from Amritsar, 124 from Jalandhar, 111 from Ludhiana and 95 from SAS Nagar.
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