What fuels a doctor?


You have to live a doctor’s life or to very closely watch one’s to understand it.

As a young overburdened doctor, still undergoing the rigours of academics, I used to commit certain silly mistakes of commission and omission which my watchful patients and their attendants would easily catch. And they would gladly discount it or let me know not grudgingly. From a twenty year old boy to a fifty plus oldie – that has kept me going.

It is hard getting into medicine. Equally hard studying it and even harder practising it. The litmus test was declaring a patient dead. Even harder , declaring a neonate dead with its face beautified by the large dead pupils. As if it is going to cry just ! It takes quite some heart to do the ultimate job of declaring the undeclarable. And then you come across patients and people your age who tell you they get all sorts of symptoms upon hearing someone die !!

Doctors live fast, age fast and studies have confirmed, they die faster than the general population. Their youth is almost completely absorbed by the vast study material and rigours of one of the most difficult courses.

Once as a house physician, I encountered a school girl with fever admitted in my ward. As a routine I used to check the vitals of around 30 patients morning and evening before the rounds. She used to laugh at me saying that I had nothing better to do than a nurses’ job. It took us almost a week to diagnose her with a blood cancer. She happened to be a cousin of one of my friends. She lost her hair to chemo drugs. Tired of the disease and confines of the hospital, one evening she insisted to go out.  She was so insistent that her mother requested me if I could take her from the hospital to my room. I refused to oblige her under a veil of principles and legality. After the whole night of  confusion, whether to accede to what may be one wish in her last days, I decided to take her out of ward. I prepared  myself  for a reprimand, I would face in the department. Next morning when I reported for duty , her bed was empty. She had massive bleed at night. I cried. That was about 25 years back. I still cry though very sparingly now, on losing a patient.

Only a doctor would understand this.

Looking back , it is not money , it is not anything but a glint of gratefulness in the eyes of my patients and it is the tolerance of my patients to my mistakes that has kept me going all these years. But that desired emotions are lacking somewhere and myself, at times do not feel the zeal  to continue anymore.

  A sense of gratitude in the  eyes of patients that fueled the doctor inside me,  is no more visible now.

Dr Sandeep Chaudhri

Consultant Internal medicine, Karnal (Haryana)

The Visionary princess who built AIIMS :Rajkumari Amrit Kaur


The pages of history celebrates Amrit Kaur’s determination to drive out the British, her feminist zeal, and also the many contributions she had made to the health infrastructure of the country.

Most of people know about the OPD block of AIIMS (premier Institute of India) named after Rajkumari Amrit Kaur, but how the vision of having an institute of excellence was converted into reality is largely unknown. The Indian Express carries a beautiful report about how the visionary Princess and Health Minister of India turned a dream into reality.

On February 18, 1956, the then minister of health, Rajkumari Amrit Kaur, introduced a new bill in the Lok Sabha. She had no speech prepared. But she spoke from her heart. “It has been one of my cherished dreams that for post graduate study and for the maintenance of high standards of medical education in our country, we should have an institute of this nature which would enable our young men and women to have their post graduate education in their own country,” she said.

The creation of a major central institute for post-graduate medical education and research had been recommended by the Health survey of the government of India, a decade ago in 1946. Though the idea was highly appreciated, money was a concern. It took another 10 years for Kaur to collect adequate funds, and lay the foundation of India’s number one medical institute and hospital.

Kaur’s speech in the Lok Sabha sparked a vigorous debate in the house over the nature of the institute. But the bill moved fast, gaining the approval of members of both the houses, and by May that year, the motion was adopted.

The All India Institute of Medical Sciences (AIIMS) was born. “I want this to be something wonderful, of which India can be proud, and I want India to be proud of it,” said Kaur, as the bill was passed in the Rajya Sabha.

In the past few months, as India has been battling a global pandemic, the role of the country’s apex medical body has come under discussion on several occasions. Significantly, it is the first prime minister of the country, Jawaharlal Nehru, who is credited for the heights reached by AIIMS. It is true that AIIMS came to be under the Nehru government. However, the real driving force behind it was Kaur.

A princess of the Kapurthala princely state, a student at Oxford university, a devout follower of Mahatma Gandhi, and an important member of the Constituent Assembly, Kaur was all of this and much more. Members of her family like to remember her as someone who believed in simple living and high thinking. The pages of history, on the other hand, celebrates her determination to drive out the British, her feminist zeal, and also the many contributions she had made to the health infrastructure of the country.

The Kapurthala princess

As a member of the Kapurthala princely family, Kaur had an interesting history. Her father, Raja Sir Harnam Singh, had converted to Protestant Christianity after a chance meeting with a Bengali missionary named Golakhnath Chatterjee in Jalandhar. Singh went on to marry his daughter, Priscilla, and had ten children with her. Kaur, the youngest among them was born on February 2, 1889.

Kaur, therefore, was brought up as a Protestant Christian. After spending her early years in India, she was sent off to England for her education. “Princess Amrit Kaur was as much a product of Edwardian England as she was of India,” suggested her obituary in the New York Times in 1964. She completed her schooling from the Sherborne School for Girls, in Dorset, and then went to study at Oxford University. Thereupon, she returned to India in 1908 at the age of 20, and embarked on a life of nationalism and social reform.

The Gandhian and social reformer

Upon her return from England, Kaur was immediately drawn towards the ideas of nationalism, as she interacted with leaders like Gopal Krishna Gokhale and Mahatma Gandhi. She was mesmerised by the teachings of Gandhi, and shared an enduring, special friendship with him, as is evident from the collection of letters shared between the two, that have been compiled in the book, ‘Letters to Rajkumari Amrit Kaur’.

“What drew me to Bapu was his desire to have women in his non-violent army and his faith in womankind. This was an irresistible appeal to a woman in a land where women were fit for producing children and serving their lords as masters,” she is quoted as having said by American philosopher Richard Gregg in his introductory note in ‘Letters to Amrit Kaur.’

Though she wanted to join the naionalist movement soon after she returned, her family was against her involvement in the struggle, and therefore she kept away till her father passed away in 1930. During this period though, she was actively involved in social reforms particularly those related to women. Consequently, she waged a battle against the purdah system, the devadasi system, and child marriage. In 1927, she helped in the founding of the All India Women’s Conference and later served as its president.

By 1930, as she joined the Gandhian movement, she was imprisoned for her participation in the Dandi march. She gave up all her princely comforts to join Gandhi at his ashram in Sabarmati. “I remember Rajkumari sitting at the spinning wheel and eating along with other ashramites, the simple fare prescribed by Gandhiji,” wrote political activist Aruna Asaf Ali about her fondest memory of Kaur. “Rajkumari Amrit Kaur belonged to a generation of pioneers. They belonged to well- to-do homes but gave up on their affluent and sheltered lives and flocked to Gandhiji’s banner when he called women to join the national liberation struggle,” she added.

In her battle for a free India, she became one of the few women members of the Constituent assembly. She along with Hansraj Jivraj Mehta were the only female members to be ardently in support of the uniform civil code in the constitution.

The passionate health minister who created AIIMS

Nihar Mahindar Singh, the 58-year-old grand niece of Kaur, recalls that as a child she would visit Kaur’s house in New Delhi frequently, as she was getting treated at AIIMS. “I never received any preferential treatment for being her family member. I remember spending hours at a stretch on the corridors of AIIMS. I didn’t even know back then that aunt B (as Kaur was referred to in her family), had created the hospital,” she says, adding that it was much later, and by word of mouth from her family members that she learned of her grand aunt’s contribution in building AIIMS.

As an institute of healthcare and medical research, AIIMS had to have some unique features. To begin with, it was the first of its kind in Asia to prohibit doctors from private practise of any kind. Secondly, the doctors at AIIMS were to devote their time not only to treating patients and teaching, but also to carry out research. “All the staff and students were to be housed in the campus of the Institute in the best traditions of the Guru-Sishya ideal to stay in close touch with each other,” writes V. Srinivas, the deputy director of administration at AIIMS in his article, ‘The making of AIIMS: The parliamentary debate’.

As health minister, Kaur was the pivotal force in ensuring the unique status enjoyed by AIIMS. Yet, it is worth noting, that she was in fact not the first choice of Nehru to be part of the cabinet. “In August 1947, for the woman member of the cabinet, Nehru thought of Hansa Mehta, but took Rajkumari Amrit Kaur at Gandhi’s insistence,” writes author Sankar Ghose, in his book, ‘Jawaharlal Nehru – A Biography’. Writing about why Kaur was not preferred, he explains, “she was sometimes indiscreet and intemperate in her criticism of Congressmen.”

source –The Indian Express

Are Doctor & Nurses Dispensable Disposables?


 

It is surprising that  doctors and nurses, who can save many lives, have to put their own lives at risk for the want of proper PPE’s. The cost of PPE’s is not more than few hundred rupees.  Even such a cheap facility is not available to the saviors for their own protection. Such episodes are not only  painful to the medical fraternity but also expose the hypocritical  attitude of the administrators as well as  the insensitive approach of society towards health care workers, although everyone expects doctors and nurses to be sensitive towards every one. Such incidents demoralizes and causes deep discouragement to the front line doctor and nurses, but sadly remains a routine business for administrators. The pain of being  treated like a dispensable disposables remains as  a deep hurt within.

10 govt docs, 70 private nurses have quit in Telangana over safety, hospital infra.   (Times of India)

 

At least 10 senior resident doctors deputed on Covid-19 duty at government hospitals and 70 nurses in private facilities have quit their jobs, with most citing poor protective gear to combat the virus as a reason.

While the senior residents said they were dejected with the poor state-of affairs at hospitals and the looming threat of contracting the infection, some individual doctors and nurses took a break from the profession, until the pandemic, gets over. These doctors are from the Osmania Medical College (OMC) and Mahatma Gandhi Memorial (MGM) hospital Warangal among other government hospitals. So far, 300 doctors and other medical personnel in the government sector alone have contracted the virus, with worries of sub-standard protective gear and long working hours, forcing doctors to even go on strike. Some senior resident doctors deputed from the OMC to the Chest Hospital never reported for duty, while others served for one or two months before putting in their papers. “The problem is not just that there was a threat of infection and we didn’t get proper personal protection equipment (PPE) kits, it seemed like a waste of effort. Even if a patient was dying in front of me, I could do nothing at all,” said one of the senior resident doctor who had resigned from the OMC .

“We didn’t have staff, we didn’t have the infrastructure, we didn’t have proper PPE kits or any other provision required. It seemed like a futile effort,” he said. Despite the guilt of having resigned in the middle of an ongoing pandemic, the doctors said that their presence or absence hardly made any difference to the situation. Authorities ignored repeated complaints It was like there is everything wrong, but no one was there to take responsibility. I felt bad about resigning but after over a month of working and making repeated requests for additional doctors and nurses, there was no difference. It was just a blame game,” another doctor told TOI. From the medicine department at Osmania General Hospital (OGH), six senior residents have resigned, while few others have resigned at the MGM hospital, said Dr Mahesh Kumar, president, Healthcare Reforms Doctors Association (HRDA). “At the beginning of the pandemic, there was a lot of issues with PPE kits and infrastructure and despite repeated representations they were not sorted out. Most of the residents resigned in the first two months of the pandemic, discouraged by the situation and fearing for their personal safety,” he added. Apart from doctors, 70 nurses who are at the frontline have gone missing from work too. “A least 30 of these nurses went missing from a single corporate hospital. Currently, there is a huge shortage of nurses as most are reluctant to do Covid-19 duties,” said Laxman Rudavath, president, Nursing Officers Association of Telangana.

 

25 factors, why health care is expansive

21 occupational risk factors for doctor and nurses

Altruistic professions are not cherished

Administrators refrain risk to doctor and nurses

REEL Heroes Vs REAL Heroes

Covid war- unhappy soldiers: says Supreme court


 

In present era, these are toughest times for health care staff and hospitals as well.  Warriors on the front lines are doctors and nurses, whereas hospitals are grappling with financial constraints.  What should have been most   desirable at this crucial time, was the   encouragement and psychological support to these warriors.  Administrators were supposed to give some moral boosting and financial support or at least, the rightful, so that health staff  should work willingly and inspire next generation for future catastrophe like this.  Instead of armchair preaching to health care staff, there should have been robust  rules and guidelines to protect health care staff and health systems as doctors and nurses are working under tremendous psychological pressure.

But the desired did not happen, as the chaotic management due to economical compulsions or just trying to be projected as an outstanding administrator turned out to be a real possibility rather than exception.

Moral and legal compulsions thus caused  immense pressure on health care workers  and  they became an  easy  subject  to moral and legal blackmail.  The  pressure to perform their duties in sub-optimal and below par conditions became a new norm.  

Every day when doctors and nurses, while going to work have this thought in mind. But still they continue to work amid their own tensions, worries about families.

The non-payment of salaries, disrespect to health care staff and being made to work in below par conditions, without PPE’s at some places has caused tremendous discouragement to the medical profession.

 

In war, you don’t make soldiers unhappy, says SC on non-payment of salaries to doctors

The courts should not be involved in the issue of non-payment of salary to health care workers and government should settle the issue, it said.

NEW DELHI: “In war, you do not make soldiers unhappy. Travel extra mile and channel some extra money to address their grievances,” the Supreme Court said on Friday taking serious note of non-payment of salary and lack of proper accommodation to doctors engaged in fight against Covid-19.

The courts should not be involved in the issue of non-payment of salary to health care workers and government should settle the issue, it said.

The top court was hearing a plea by a doctor, who alleged that front line healthcare workers engaged in fight against Covid-19 are not being paid salaries or their salaries are being cut or delayed.

The doctor also questioned the Centre’s new SOP making their 14-day quarantine non-mandatory.

“In war, you do not make soldiers unhappy. Travel extra mile and channel some extra money to address grievances. Country cannot afford to have dissatisfied soldiers in this war which is being fought against Corona,” said a bench of Justices Ashok Bhushan, S K Kaul and MR Shah.

Solicitor General Tushar Mehta, appearing for the Centre, said that if there are better suggestions coming forward, they can be accommodated.

The bench said that there are reports coming that many areas doctors are not being paid.

“We saw report that doctors went on strike. In Delhi, some doctors have not been paid for past three months. These are concerns that should have been taken care off. It should not require court intervention.”

The bench further said, “You (Centre) need to do more. Must make sure their concerns are addressed”.

The bench posted the matter for further hearing next week.

On June 4, the Centre had told the top court that a “large number” of make-shift hospitals will have to be built in the near future to accommodate the constant rise in the number of newly infected people.

The Centre also contended that though hospitals are responsible for implementing the Infection Prevention and Control (IPC) activities, the final responsibility lies with the health care workers to protect themselves from COVID-19.

It further said mandatory quarantine for 14 days after the duty of healthcare workers of 7/14 days is “not justified and warranted”.

“It is most respectfully submitted that number of cases of COVID-19 are constantly increasing and at some point of time in near future, apart from existing hospitals, large number of temporary make-shift hospitals will have to be created in order to accommodate COVID-19 patients requiring admission, medical care and treatment,” the Ministry of Health and Family Welfare said in an affidavit.

The affidavit was filed on a plea by Arushi Jain who questioned the Centre’s new Standard Operating Procedure (SOP) of May 15 for front line COVID-19 healthcare workers by which it ended the 14-day mandatory quarantine for them.

The ministry in its reply affidavit had said healthcare workers (HCW) are properly protected by Personal Protective Equipments (PPE) in workplace settings and carry no additional risk to their families or children.

It had said grievances raised by the petitioner alleging infirmities in the May 15 guidelines of the health ministry are completely presumptuous, vacuous, ill-founded and sans any empirical or medical evidence.

Justifying its advisory and SOPs, the health ministry said it is a step in the right direction and that the guidelines emphasise the role of taking adequate preventive measures by all health care workers in the hospital setting against the likelihood of contracting infection at their work place.

On April 8, the apex court had observed that the doctors and medical staff are the “first line of defence of the country” in the battle against COVID-19 pandemic, and directed the Centre to ensure that appropriate PPEs are made available to them for treating coronavirus patients.

Altruistic professions not cherished in present era

Enslavement of doctor and nurses

 

21 occupational risk to doctor and nurses

 

Immunity business in corona times


About the medicines and substances, that  are consumed by masses under a false hope of immunity enhancement. Every substance, which claims to alter human physiological functions should undergo strict international neutral trials and not allowed to be sold by mere advertisements.

Tremendous misguidance is propagated by giving a false hope to people of doing some treatment.

Every day we read in media the various pronouncements claiming to enhance the immunity especially in the  days of Covid-19. It automatically implied  or interpreted that the said product will save  the people from Corona and hence a brisk business starts. No one has studied the real effectiveness, correct  doses or side effects of preparation in real sense.

 

A myth, that any plant extracted drug is useful, free of side effects, is a belief ingrained deep in the minds of people. Such unscrupulous  advice is followed blindly without even verifying the authenticity of the source. A hope of miracle is flashed to patients who perceive  a “no hope” by scientific medicine, are an  easy prey for such fraudsters.

Another major problem  is that medicines and syrups distributed in such manner often  are without name of drug, contents and doses. It is not uncommon to get lethal substances like steroids, hormones and heavy metals in dangerous doses.   Such acts  are  real crime to society, done with an intention to cheat rather than treating them.

Any one selling  medicines in name of alternative medicines, food supplements or medical advice of any kind, has to be registered with a council, for those particular medicines. advertisement of such drugs or products should be on some scientific basis and neutral trials.

 

Most of these are not validated at all by international or national authorities, not even considered as drugs. No impartial, neutral trials conducted about effects, side effects or toxicity. Mere media or social media words, which are paid, are considered as  Gospel  Truth  and substances are consumed by masses under a false hope of immunity enhancement. Most of them marketed as herbal or alternate medicines, which are advertised as harmless but beneficial. They are sold by propagated words of benefit  and advertisements rather than a solid proof.

Slowly these medicines become part of conventional wisdom rather than  considered as drugs and chemicals or heavy metals.  In reality, being a settled medical science issue, it remains a fake news at the basis.

There is no dearth of quacks, who sell unknown and unlabelled substances, merely  to earn money, but the dangers of such products are high and unassuming consumers remain oblivious to side effects.

   Any substance is considered effective only after rigorous testing through randomised clinical trials  and additional laboratory analyses.  The substances that are merely propagated on social media or claims of company or advised by quacks will not help and merely remain as part of immunity business. They provide a false hope and thereby earn money  because of fear in the minds of masses.

Times of India carries a report about the brisk business being done, while people are looking at ways to enhance their immunity.

Any substance which claims to alter the physiology of a person or patient, cannot be consumed  without undergoing rigorous, neutral and international  safety trials. If found to be good, all  homo sapiens in the world should be benefitted. If not,   let the gullible masses not be misguided and trapped into a false hope. There has to be a strict Government  control about the products to be consumed, which claim to alter human physiology.

Balancing immunity in Corona times

 

Who will treat people in next Pandemic?


Pandemic has unmasked the real risk to doctor and nurses. The occupational risk of being among the diseases, that was known to them, has been unveiled to everyone. That should have generated respect for health workers in a civilized society. What was actually desirable, was the encouragement and psychological support to these warriors. Good administrators were supposed to give some moral boosting and financial support, so that health staff should work willingly and inspire next generation for future catastrophe like this. Instead of armchair preaching to health care staff, there should have been robust rules and guidelines to protect health care staff and health systems as doctors and nurses are working under tremendous psychological pressure.

More importantly, among this chaotic situation, whether rules are being followed or not, how administrators are doing can be at the most a guess work, rather than following a uniform system. The possibility of chaotic management due to economical compulsions or just trying to be projected as an outstanding administrator may be a real possibility rather than exception.

Health care workers can be easily subjected to moral and legal blackmail or pressure to perform their duties in sub-optimal and below par conditions. They can be subject to moral, legal, financial or even pressure of physical assaults. Such pressures can be tremendous in health sector because of financial complexities.

Is the payment made to them is commensurate to the risk to their life and work they do? Who will pay them and how much in case harm or death of health care worker, every one refrains to discuss?

Are they given the real respect, what they deserve and are worthy of?

Every day when doctors and nurses, while going to work have this thought in mind. But still they continue to work amid their own tensions, worries about families. While it is clear to them that administrators refrain to discuss the issues, which matter to them the most.

Times of India carries a report that the interns will be punished, if they become positivefor Covid, while doing duties. Although possibly the circular is withdrawn, but it reflects the deep seated and hidden mental frame of administrators, about the intention, how they wish to behave with doctors. Why such punishments are not for other Government functionaries or officials or even public, who test positive. It is just an example, but there are numerous examples of such kind.

MUMBAI: The department of community medicine at KEM Hospital issued a circular on Thursday asking interns to give a written explanation on how they had been exposed to the Covid-19 infection, after an increasing number of interns went into quarantine. It further said they will be liable to repeat their internship for the duration period of the quarantine if there was any negligence in following “Covid-19 discipline”. The circular was withdrawn within a few hours, after it faced criticism from many. Doctors and students termed the circular “insensitive” and “unwarranted” during a pandemic. Dr Sagar Mundada, psychiatrist and former president of Maharashtra Association of Resident Doctors, called the circular insensitive. “It is a pandemic. Why medical interns should be asked about the source of the infection?” An intern said some of them have been working for three months without stipend while their duty hours have been increased to 12. They collect swabs, blood and insert IV. 6/6/2020 Mumbai: KEM questions interns over quarantine, then backs off – dean Hemant Deshmukh said he had not signed the circular and it will not be implemented. Dr Gajanan Velhal, who signed it, said it was misunderstood. “No such action will be taken against any interns,” he said. Rajvi Bheda, a representative of the Association of State Medical Interns at KEM, said it seemed to be an attempt to ensure interns stay safe. “But it was unfair to the interns too, as it is difficult to identify the source of infection.

As Corona has unmasked the real risk to health workers and society has dealt with heath workers shabbily. Next younger generation of aspiring doctors, who is a witness to the cruelty shown towards health staff, may be forced to think about their decisions to become health workers. Possibly the administrators need to ponder now, who will treat people in next pandemic.

Corona unmasks the risk to doctor and nurses, administrators refrain

Altruistic professions are not cherished in present era

21 occupational risk to doctor and nurses

Being doctor or nurse- a disadvantage in present era

Plight of nurse in Covid ward

Pros-Cons of Covid testing at admission in hospitals


 

Try not to find a hidden explosive can be a disaster. Testing after it has exploded, is of limited benefit.

Going by practical thought, testing for COVID-19 should be a non-issue, as  Up to 44% of the infection may be transmitted by pre-symptomatic patients or asymptomatic patients.

Advantages of   Covid testing at admission in hospitals   

  1. Source to other patients; Any patient  admitted with medical diseases or requiring surgery, if  Covid status  is not tested, the patient  will be mixed with others. Any one patient having Covid infection will act as a source for other patients and health workers.
  2. Further progress of Covid-19 will be influenced by the incidence of infection in the population. The true numbers of spread will be the  key to informed decision making therefore will influence the  trends. Any  orders or intention to restrict testing  defies logic. Inconsistent strategies will result in projecting an incomplete  picture of the transmission.
  3. Difficult to decide on history; It is impossible  to identify all COVID-19 patients based on history alone. One such patient could infect several healthcare workers and can significantly impact hospital services. Thus, the implications of missing a single COVID-19 patient can be enormous, in a hospital.
  4. Clear history not available; Sometimes patients are not always clear  about their history of contact or symptoms because of  many reasons. Doctors also sometimes may not be able to elicit the correct history.
  5. Generation of Data;Testing  at the hospital admission  increases   overall testing figures. It screens a population at risk of infection and source. Undertaking contact tracing and breaking the chain of transmission is helpful.  For same reasons, doctors routinely carry out testing for HIV, hepatitis B and hepatitis C preoperatively for all patients.  It is just another viral test.
  6. Hospitals turning into hotspots and risk to health workers; Hospitals are the only place, holding too many sick people. Chances of harbouring Covid, or catching infections are very high in hospitals. They can actually turn into hotspots, if testing is restricted in the hospitals. Liberal testing is one of the methods to contain infection in hospitals, so doctors can detect and segregate the source.

Disadvantages 0f Covid  testing at admission

There are some equally reasonable concerns about mandatory testing of COVID-19.

  1. First is the cost and the delay in patient management.

 

  1.    Stigmatisation if one tests positive and being refused treatment is a major fear for the patient.
  2. Universal safety precautions are always followed across all hospital surgeries, irrespective of the test result.

There are many reasons for and some against COVID-19 testing of all admitted patients. Doctors will strive to strike the balance between protecting patients and protecting  the healthcare system and workers. While treating any  patient without  delay, a more rational and practical set of comprehensive guideline is needed  for non-urgent or elective admissions from  our national and international organizations to enable health care systems  to practice medicine safely.

Otherwise every one may be at risk including  patients, health care  workers and doctors.

Inconsistent strategies of testing Covid will undermine decision making  (Times of India)

Moral burden of poor quality PPE’s on doctor and nurses#Covid time


Medical industry has found an opportunity to do a brisk business. The norms of PPE are not well defined, from the end user’s comfort,  that is doctor and nurses. Any material is that is converted into PPE and dumped on health workers, adding enormously on their plight.  A moral burden to do their  work in every situation, is becoming difficult to carry on, while the opportunist in medical industry make merry. A sin, which  may look nonpunishable in current era, but should not be forgiven in a civilized society.

Possibly working as a doctor and nurse is going to be most difficult  profession. Working in life and death situations, excessive  documentation, unrealistic expectations from patients and administrators alike, working  under legal compulsions, prone to punishments and complaints on simple human errors,  poorly paid  and facing verbal and physical assaults. Above all despite doing all this, respect and gratitude is scant for the life savers in present era. Adding to all above issues, another problem has been added, the poor quality of PPE, which makes life of saviours a hell.

Times of India  publishes a report on the same, that brings out the plight of doctor and nurses.

‘Some PPEs feel like we’re wearing plastic rice bags  from. Trussed up inside a plastic bag in the summer heat with sweat pouring down the body but afraid to drink water as it is impossible to take a loo break. This is how a nurse described the experience of wearing a personal protective equipment (PPE) suit.

While there is no dearth of PPE any more, doctors and nurses say the quality is such that it’s like wearing a plastic bag. Doctors say hospitals are besieged by companies offering PPE kits. “The quality of most of what is offered is horrible. The fabric of many is like chawal ka thaila (RICE BAG). There is zero breathability and so health workers find it impossible to wear it for long. That reluctance could endanger them,” said a senior doctor. The WHO guidelines on PPE strike a balance between protection against infection and allowing health workers “ease, dexterity, comfort and minimal heat-associated stress”. However, the guidelines framed by the ministries of health and textiles only focus on the need to prevent blood or fluid penetration but have nothing about breathability. So, manufacturers focus on thickness of the plastic rather than the wearer’s comfort. “In the initial rush to overcome the shortage of PPE, it is understandable that the ministry did not think of all aspects. But it is unacceptable to allow people to use this opportunity to make money by supplying abysmal quality PPE and endangering the  lives of health workers.

The government should immediately issue clear-cut guidelines on quality of fabric and stitching and weed out the fake manufacturers cashing in on the sudden demand for PPE,” said a doctor in a Covid hospital. According to a manufacturer of protective wear, cheap plastic laminated fabric costs just Rs 150-200 per kilo. “So even with the cost of stitching, a poor quality PPE suit would cost only Rs 100- 200 to make but is sold for Rs 500-800. With such huge margins, getting even one small order for 10,000 PPE suits would mean a profit of at least Rs 30 lakh. This is why there is a such a huge rush of people getting into PPE making,” he explained Eight labs identified by the textile ministry to do quality checks on PPE have so far issued over 900 Unique Certification Codes (UCC), mandatory for PPE sellers, especially to land government contracts.

The government says there are 600 companies manufacturing 4.5 lakh PPE suits per day. Many with the UCC have little or no experience in making protective wear. They include chemists, lingerie and footwear manufacturers, tent or tarpaulin makers, wholesale traders of drugs, small-time pharma companies, and even a food company. “Anyone who has a garage to store the stuff can buy some fabric and organize some tailors to copy a PPE suit,” said an industry insider. “One PPE lot supplied to us had electrical insulation tapes used to seal the seams. Obviously, they started coming off when we moved around,” said a doctor in a private hospital. Another doctor in a government Covid hospital pointed out that the government only tested the coverall, but other components like face shields or goggles that came with it were substandard. Almost all hospitals seem to have PPE horror stories to narrate. The government is at pains to reiterate that its certification is only for the coverall and that only a Synthetic Blood Penetration Test (SBPT) has been conducted.

Every UCC states that the certificate is based solely on the sample submitted by the applicant. It goes on to state: “The procurement agency is advised to conduct prior due diligence before placement of supply agreement…including periodical sample tests.

 

25 factors for expensive medical treatment

Altruistic professions are not cherished in present era

21 occupational risk to doctor and nurses

Being doctor or nurse- a disadvantage in present era

plight of nurse who died reusing PPE’s

 

Plight of a Covid-Nurse; who died Reusing PPE


The Covid 19 does not differentiate whether the health worker, who is at war  with the  virus,  is  in a government sector or private sector. Whether it is in Europe, USA or Asia,  although conditions of Covid warriors may differ. Their protective armour may differ from place to place, even hospital to hospital. But the enemy virus remains ruthless and attacks, whenever on slight opportunity.  Although there are plethora of rule and regulations dealing with health care workers and  many times health workers themselves do not know or aware about, what to do in a given situation?

But more importantly, among this chaotic situation, whether rules are being followed or not, how administrators or managers are doing can be any one’s guess rather than an  assumption that of  following a uniform  system. The possibility of chaotic and inept  management due to economical or intentional compulsions  may be a real possibility often rather than exception.

Health care workers may be subjected to moral and legal blackmail or pressure to perform their duties in sub-optimal conditions. Such pressures can be tremendous in private sector because of financial complexities.

Is the payment made to doctors and nurses is commensurate to the risk to their life and work they do? Who will pay them and how much in case harm occurs to saviors   themselves,  administrators refrains to discuss.

 

Nurse’s death: Colleagues say had to wear used PPEs

A senior nurse at   the Hospital claimed, “While the doctors were given fresh PPE, the nurses were asked to reuse PPE. If we raised objections, we were told that since this is not a designated Covid-19 hospital, we are at little risk, and can reuse PPE.”

 

A day after a 46-year-old nurse at a private hospital in Delhi succumbed to Covid-19, her colleagues have alleged that the hospital made nurses “reuse personal protective equipment (PPE), including gloves and masks”.

On Sunday afternoon, a nurse at the  Hospital, was admitted and  died at Delhi’s Safdarjung Hospital, where she was admitted on May 21. She is the first nurse to have died of the virus in Delhi.

The Indian Express spoke to 10 nursing staff at the hospital, where she worked as well as nurse’s son, and all of them spoke about PPEs being reused during duty.

A senior nurse at the Hospital claimed, “While the doctors were given fresh PPE, the nurses were asked to reuse PPE. If we raised objections, we were told that since this is not a designated Covid-19 hospital, we are at little risk, and can reuse PPE.”

The Indian Express spoke to the owner of the hospital, who denied the allegations and said that adequate PPE and hand sanitizers were being provided to all employees. “I have not received a single complaint from any staffer. If there is a single discrepancy, I will investigate and take strict action,” he said.

A senior nurse, who said she was close to the nurse, alleged that on her last day at the  Hospital a week ago,  she  got into an argument with the nursing in-charge about “not getting fresh PPE and masks”. Another senior nurse who worked in the ICU with her  confirmed this.

Her friend and colleague claimed that she was working until May 18, when she did a morning shift and refused to do the night shift as she was feeling sick. “At night, she had fever, a bad throat and body ache, so we advised her to rest. On May 19, too, she was sick, and on May 21, she had difficulty breathing, so she was taken to Safdarjung Hospital,” said the nurse.

She died on the afternoon of May 24.

Her son said “My mother’s condition deteriorated so rapidly… I couldn’t understand how to get here sooner. Over a week ago, she mentioned that the hospital was making her reuse PPE and charging money for masks. I got agitated and told her to just stay at home, but she didn’t listen to me. She continued working, and now she is dead.”

 

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