Coronavirus outbreak: As West Bengal catches up on tests, the medical community gets the brunt of a sick health system

Editor’s Note: This series will focus on the difficulties faced by the medical fraternity in COVID-19 hospitals, their hours of service, access to protective equipment, the facilities they obtain during quarantine, how their families are coping with this new reality in different states of the country. This is the fourth part of the series.

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Locked inside a hotel room, Doctor A spends his hours outside the hospital counting minutes in silence, until it is time to return to one of Kolkata’s most important coronavirus war rooms: the MR Bangur Hospital, declared a COVID center -19 earlier this month. Speaking on condition of anonymity, the doctor, a first-year resident in the hospital, seems exhausted, almost quitting on the phone. “The situation is pretty grim, you know. How much can you fight against the system and the government? Dr. A asks.

Despite having a home in the city, the doctor has remained in the hospital-assigned accommodation after being placed in solitary confinement about a fortnight ago. However, food is not available on-site and must be ordered online. To escape thoughts of death and depression, Doctor A turns to Tiktok-ing with his colleagues. “What else do we have? It’s incredibly depressing. They didn’t even give us time to prepare for this crisis, and the news that the hospital is going to become a COVID-19 center was suddenly announced.”

After completing six and 12-hour shifts three times a week in coronavirus isolation rooms, the doctor returns to handling cases of emergency work, or “COVID pregnancies”, without ‘quarantine sheets’ as they have done some of the doctor’s peers at other hospitals in the city. has been awarded. “Although ideally we should have seven days off after working in the COVID rooms, we are asked to report to work. And so are we. MR Bangur, at the end of the day, is not a medical school, it is a district hospital without the necessary infrastructure to face a crisis of this scale, “Dr. A tells me.

As circumstances changed overnight, hospital staff were left in the lurch without adequate training on how to treat the disease, or even putting on and disposing of a PPE (Personal Protective Equipment) kit. “We understand that it was an emergency, but we don’t even have the basic training to deal with patients with COVID-19. We started working with doctors and trainees from other medical schools and finally figured things out. At least those working on the front line. they must be trained in general medicine, thoracic medicine and anesthesiology, “says Doctor A. They are not afraid to work, says the doctor, but they need to be better equipped to carry out their tasks, and not only should they be asked to issue death certificates in isolation rooms like “puppets.” “Patients are dying before our eyes, and we can hardly do anything about it.”

However, Dr. Monica Saha, another resident doctor at the same hospital, appears to be enjoying the challenge of the unprecedented medical crisis. For her, it is an opportunity to rise to the occasion and contribute significantly to society. “Honestly, I Dear to be published in the rooms of COVID-19 to save lives. PPE is all in place, so there is very little to fear for us right now, “he tells me as he is quarantined in a doctor’s room on the hospital campus. From the family of a doctor, with her father, Dr. Makhan Lal Saha as head of the IPGMER surgery department and SSKM Hospital, Kolkata (a coronavirus testing center), Saha chooses to be optimistic and shows faith in the government’s efforts.

“I think the situation will be handled even better once the quick test kits arrive, which should happen in a couple of days. That way, we will be able to detect patients from the start without risking exposing more healthcare workers and patients to the virus, “she says. On April 21, the day after Bengal received his first batch of such Kits made in China, the Indian Council of Medical Research (ICMR) advised states to stop using them after complaints of faulty equipment.

Saha’s father, along with friends and family, stepped forward and raised money to donate face shields to MR Bangur Hospital, which has now been distributed to 175 health workers at the facility. The gears are made of fiberglass used in helmet visors and cover the entire face from forehead to chin. “It is an additional layer of protection as the disease spreads through the drops,” says Monica Saha. However, the situation is far from similar just 23 kilometers away, at the Sagore Dutta Medical College and Hospital in the North 24 Parganas district.

Speaking to us on condition of anonymity, a medical staff working in a COVID-19 isolation room at Sagore Dutta Hospital, who will be referred to as Zion in this document, mentions how the protective equipment provided to the cleaners in their institute might not be enough. “They are wearing surgical uniforms under raincoats, with N95 masks, face shields and black rubber boots provided by the hospital,” says Zion. Led primarily by a group of 28 interns and a handful of home staff supervisors, the isolation rooms at the facility have a meager capacity of eight.

“A couple of days ago, we discovered that one of the patients who entered here as a suspect had tested positive. The problem in this installation is a serious lack of labor. We don’t even know if suspicious patients who are prescribed tests are actually being tested or not. If the doctors manage to take the contact details of the patients, they have to call them personally and find out what happened. Even if someone tests positive, test centers don’t alert us. Doctors here have to look up that information personally, ”says Zion.

This information is then used to track down by contact each health worker who had interacted with the suspect on the day of their visit, after which they are asked to remain under quarantine observation for seven days, and not for the recommended period 14 days. “In general, former hospital day academics who are now interns have to go home after doing their homework in isolation rooms every day. Only when any of them comes into direct contact with a confirmed positive case are they offered accommodation at Apex Lodge in front of the university building. They are asked to watch for seven days to see if they develop symptoms. If not, they are asked to resume duty from the eighth day, “Zion reports. However, this system depends purely on the doctors who care taking note of the patient’s contact details and, if not, do not inform about possible risks of infection.

According to the guidelines on the ‘rational use of personal protective equipment’ published by the Ministry of Health and Family Welfare, personnel with thermal pistols parked at the entrances of various facilities falls within the ‘low risk’ exposure category. and it is advised that you only wear triple layer medical gloves and masks. But Zion has doubts about its effectiveness, citing the growing number of cases of healthcare workers testing positive for the coronavirus despite following official protocol. “Our group D personnel do not have enough protection. Isn’t this a complete exploitation of the underprivileged classes who are literally risking their lives for a meager salary simply because they are not privileged to sit at home? Zion asks, echoing the thoughts of a nurse, who wished to remain anonymous, and will be named Nurse W, who works in a COVID-19 isolation room at MR Bangur Hospital.

Being the only child of parents living in the city’s suburbs, the nurse wonders what the family must be going through, as the pandemic continues to hold the world hostage in their homes, especially endangering the lives of the front-line workers like your son. “They have no choice but to accept it as a destination,” Nurse W’s voice trails off. They were initially afraid; now they are simply numb. “It is what it is, you know? I can’t stop working, even though I’m not quite sure how protected I am using the PPE they’ve given us, ”says Nurse W, adding that the protective gear they gave them at MR Bangur doesn’t seem to be done. of the same material as those recommended on the internet.

“It appears to be made of some woven material, very thick on the skin. I don’t know what they are doing in Beliaghata ID, but at least in Bangur, the fabric doesn’t feel right. The idea is to protect us from exposure, so in that case, the kit should look like the material used for the ambulance sheets. What we have is very different, and I could wear one of my clothes and report to the service, “says nurse W. The nurse is among the many Health professionals at the center who have not had the opportunity to participate in any of the COVID-19 training sessions that have been provided so far. “Only those who were on” leave reservation “until before April 9 could take advantage of them. “

A junior resident at RG Kar Medical College and Hospital mentions the sensation of “hot air passing through PPE” provided at his facility. Choosing to remain anonymous, Doctor B, as he will refer to the person hereafter, has been posted to the hospital’s fever clinic, where the proper PPE arrived just two weeks ago. “We are all in this together, but if the doctors do not have the arsenal required to face this crisis, who will benefit? OPDs normally run everywhere in all scopes, with no PPE in most of them. For example, even in the fever clinics at our hospital right now, almost everyone who comes in is a suspect, ”says Dr. B. Despite the fact that only a handful of nurses, elevator operators, and other ancillary staff are posted in These fever clinics at RG Kar Hospital all operate without protective equipment.

Doctor B mentions that it will be interesting to see how many healthcare workers across the country become ill with the virus, despite following government orders for PPE, after more than seven members of the RG Kar hospital were admitted to MR Bangur for give positive. “The PPE we have is not the triple layer infallibles,” says the doctor.

Arun Agarwal of Green Packaging House, a Kolkata-based manufacturer and supplier of EPP, weighs in and mentions how his gears are made of non-woven material, disposable after single use. “These are made specifically for the coronavirus, and are naturally waterproof, but cannot be reused,” he says. But security guards posted at North Bengal Medical College and Hospital (NBMCH) in Siliguri Bengal, a testing center, have been advised to do the opposite.

Armed with two sets of PPE each, the guards, stationed at the first entry point for all categories of patients in the facility, have been asked to alternately use each set, washing them upon returning home. “At this time, at least the doctors, nurses, and other personnel who come into direct contact with COVID-19 suspects or positive patients are receiving adequate PPE,” says one doctor, who wished to remain anonymous, and will be referred to as Doctor C below: Posted in an Intensive Care Unit COVID-19 on NBMCH. Earlier last month, the institute made national headlines after reports of doctors and medical personnel emerged at facilities that received raincoats instead of PPE.

Subsequently, in an attempt to address this increase in demand for personal protective equipment across the state, the Mamata Banerjee government agreed to Tantuja, a leading manufacturer of sari and textiles under the West Bengal State Loom Weavers Cooperative , which reconfigured its existing machinery to meet prevailing needs. .

According to Doctor C, the situation at NBMCH has improved, albeit marginally, with PPE kits carefully rationed by the hospital administration today. “Initially, we also received PPE that was used during the treatment of HIV patients, which does not prevent the transmission of drops because they only block blood,” he says.

Dr. C hails from Kolkata and has elderly parents who have not seen him in months. The presence of a diabetic father in the home, who is especially vulnerable to infections, makes the doctor doubly insecure about returning to his family any time soon, even after the closure. The fact that he works in a “high risk area” only adds to his family’s growing anxiety.

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“A couple of doctors from the anesthesia department have been tested and found negative. However, these tests are not routinely performed as of now. A doctor, three nurses and a technician from our hospital have tested positive so far, so nobody really knows what will happen tomorrow. Right now, we are all fighting in the dark and we are newbies. The primary symptoms (of the disease) have also changed over the weeks, “says Dr. C, adding that although he has been taking hydroxychloroquine as a preventative medication, after the ICMR suggested it might be effective against coronavirus, “still may not be completely sure of being immune to contagion.

He currently resides in his university hostel, where cleaners cannot enter, but guests continue to share kitchens and bathrooms. NBMCH medical personnel, except those working in general practice wards, have not been granted alternative weeks of “quarantine leave” due to the lack of adequate isolation facilities for staff.

The conversation soon leads us to the long process of informing interested parties of a positive test result, where “test samples are sent to Kolkata from NBMCH in Siliguri for reconfirmation. If the result is positive, the patient or even doctors are not notified immediately, to avoid panic, according to a government notice. “

However, this cautious approach may not be the best way to navigate the state’s prevailing situation, where the numbers reflect a rapid rebound in the spread. Not only does it prevent authorities from quickly identifying and cordoning off suspects by tracing contacts of positive COVID individuals, but it also puts health workers at increased risk of exposure to contamination. Dr. B of the RG Kar hospital agrees.

“We have to have more autonomy. If doctors at all levels are not given the authority to declare coronavirus-related deaths, and a high-level panel of doctors is established just to examine these things and look at comorbidities, in addition to being unable to even communicate who they are a positive case and who is not, our work only becomes more difficult. “Other than that, precious time is also wasted. Currently, West Bengal is among the largest states in the country to have the fewest evidence that are carried out.

According to COVID-19 data released by the West Bengal government on April 25, only 9,880 tests have been conducted for the state, which has a population density of approximately 6,915 people per square kilometer (and a total population of more than 90 million). Currently, the figures show 423 active cases, 18 deaths and 105 recoveries in the state.

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The hours seem to melt into each other, just like one’s skin under heavy layers of protective clothing, choking workers by leaving them with no room to eat, drink water, or even urinate. Right now, the outside world seems identically sad and suffocating to these people, leaving much to be desired in their workplaces. At MR Bangur Hospital, Nurse W alerts me to congestion that occurs in a male isolation room, where the stipulated distance of one meter is not maintained between consecutive beds.

“This obviously increases the chances of infection, making the practice of wearing PPE useless,” says the nurse. With approximately 104 beds divided into two halves in that room, overcrowding in this heat only increases discomfort for both hospital staff and patients, making the latter feel restless and rebellious at times. “It becomes difficult to control them, especially male patients,” says Nurse W.

Additionally, the hospital stairs have been blocked, leaving people with no choice but to use the elevators to get around the building. Nurse W admits that this measure is counterproductive. With both protected and unprotected individuals using the same elevators, the increased chances of contamination within confined spaces only exacerbate the situation. “I really hope the stairs are available again.”

One of Nurse W’s colleagues in another COVID-19 isolation room at MR Bangur Hospital, who also chose to remain anonymous, and will be referred to as Nurse X, was recently sent to home quarantine for 14 days. Nurse X came into direct contact with a colleague who tested positive for the virus on April 17, but the first one tested negative. “And thank God for that,” Nurse X heaves a big sigh of relief. The health worker lives alone in the city, with a family residing in a neighboring district.

The nurse informs me of the informal system adopted by the nursing staff at the center, where each takes turns caring for patients with PPE, before or after which they perform administrative tasks without the team. “This ensures that no one has to spend more than three or four hours in the PPE, as it becomes impossible to be in one for more than that,” says Nurse X. The professional was one of the many who missed the sessions. COVID-19 training, thus learning everything on the job. “At first it was difficult since I don’t work in the general medicine room. But now I’m used to it, “says the nurse.

In these hours of crisis, as health systems compete against time to save lives, a resident doctor at the Faculty of Tropical Medicine (Kolkata), currently published in Beliaghata ID and BG Hospital, emphasizes the importance of sharing knowledge freely within from the medical field. community. “Given that there is hardly time to provide adequate training to everyone in the midst of this crisis, it is crucial that we make sure to put on and take off PPE in the presence of someone who knows the method, at least the first few times.” the doctor, who speaks on condition of anonymity, and who will be called Doctor D from now on, mentions. He points to the fact that just providing protective clothing, without educating healthcare workers about proper disposal methods, makes exercise useless, as the chances of contamination due to improper disposal are quite high.

“Currently, I am quarantined at home, living in a separate area from my family. I come from a family of doctors, so it was not difficult to persuade them to let me go to work, but despite that, the first moments at the Beliaghata ID Hospital were very stressful, “says Dr. D, who was trained to treating infectious diseases like HIV, and he doesn’t see this crisis as “something very unknown.”

However, he also advises in favor of aggressive testing, especially now that the country is said to be on the brink of Stage 3, or community transmission of the virus. “Since we are working with the right personal protective equipment (at Beliaghata ID and BG Hospital), we really don’t need to be tested. But every front-line worker, be it doctors, nurses, or paramedics, needs to handle all patients with adequate PPE. Currently, most young people are asymptomatic carriers, and we have no idea who is carrying the infection, “says the doctor, adding that door-to-door testing at critical points is the only way to flatten the curve.

His teachers asked him to remain calm while on duty, and advised him to treat patients with COVID-19 in the same way that he would treat people with any other infectious disease, but “with activated PPE.” That, Dr. D believes, is the only noticeable difference, but key this time. Fear has long fled from your body. “After a moment, you just want to go out and do your job and save lives,” he says.

However, the chest specialist, Dr. Kaushik Chowdhury, who runs COVID-19 operations at the Beliaghata ID Hospital, has a different opinion on young health professionals in the field. According to Chowdhury, less than a quarter of the workforce is motivated to carry out their tasks, with mounting anxiety that haunts minds. “We constantly have to remind doctors, nurses, and even Group D staff that they need to be encouraged. We, the older doctors who open the COVID-19 wards in this hospital, have to continue showing the way by increasing their morale every day, ”he tells me.

To reinforce this panic, there are several factors, including fear of contamination during sample collection and interaction with at-risk colleagues working in positive rooms. “In addition, there is also the social aspect, where many people in the medical community are being excluded or expelled from their apartments for working on the front line. Some fear transmitting the virus to their families,” says Chowdhury. He observes that the majority of doctors from different medical schools currently posted on their premises are only doing their job on duty, “finishing their six-hour quota and rushing out.” While some, he says, are reasonable and take the opportunity to realize that an increase in cases could result in their own universities becoming COVID-19 centers overnight, others remain fraught with fear.

“The contagion will probably spread everywhere, and even PPE can provide a limited amount of protection. It is this knowledge that makes them nervous, but we are trying to motivate them regularly, “he says, adding that the hospital has employed a team of psychiatrists and psychologists to advise Group D doctors, nurses and staff during the crisis.

Dr. Sisir Naskar, Superintendent of MR Bangur Hospital, echoes Chowdhury’s thoughts. “The process of keeping people’s spirits up and fighting social stigma is ongoing through this pandemic,” he says, declining to disclose more information about cases being handled at his hospital.

For a nurse, who wished to remain anonymous, and will henceforth be called Nurse Y, who works at the IPGMER and SSKM Hospital, this stigma is a reality that affects the lives of coworkers. Nurse Y expresses concern about the fact that several members of the SSKM Hospital group D staff were expelled from their homes in recent weeks, causing very few cleaners to report to work and increasing the collective anguish that hovered over the premises. “What else will they do?” the nurse asks.

Nurse Y, a single mother, left her home a day before the closing of the prison in India on March 24, and has met her school son (who currently lives with an acquaintance) only once since then. Home right now is a distant reality for Nurse Y, whose new address is a quiet corner of the hospital. That’s where the nurse has been living for over a month and the end date is not in sight. “There is no other option than living in the present. I don’t know what will happen tomorrow with me or my son.”

For his colleague, who also wished to remain anonymous and would be called Nurse Z, the pressure to keep the superiors’ lips closed is unimaginable. “We are only allowed to use PPE when a patient is confirmed as a suspect and samples must be collected. Until then, our interaction with the individual is completely unprotected, ”says Nurse Z. The test reports are not passed on to them either. “I suppose the situation is a little better than before, and we are no longer given trench coats. But even so, there is still a long way to go,” the nurse concludes, movingly highlighting the difficult situation of a world in the midst of a novel pandemic deadly that seems far from over.

Update date: April 27, 2020 23:11:22 IST

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