Allopathy-Ayurveda debate: Media’s Misplaced priorities


The doctors, nurses and healthcare system have been relentlessly hauled over the coals for last one year and further battered emotionally by the cruel adverse media insinuations and taunts. At the peak of pandemic, when the powerful media should be discussing the core issues to control pandemic; issues like oxygen supply, vaccination and improving the health infrastructure, it has found more interest in a futile Allopathic-Ayurveda debate. Even if someone wants to start this kind of discussion, media should have shown more wisdom not to make it a dominant issue. There are more important, urgent and pressing issues where media can play a vital role.

By many media narratives, an impression is being fostered that doctors have made a mess and forfeited their moral right to treat. Suggestions of ineptitude were gleefully aired, causing demoralization of the warriors, who were immersed in the pool of Covid patients, trying to save them.


         Their role should be as facilitators to help doctors to save more lives. One hospital death of out of millions saved, is projected as failure of doctors. They are so distant from the ground reality.  To control the health system, media has a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses.

 Hence by selective projection the blame for deficiencies of inept system, powerful industry, inadequate infrastructure and poor outcomes of serious diseases is shifted conveniently to doctors, who were unable to retaliate to the powerful media machinery.   

        The demonstration of the cleft that separated doctors from the actual overpowering controlling medical industry and administrators is not given, in order to maintain the prejudice with its dangerous bias towards doctors, who are in forefront and are visible to public.

      Media people, who have never treated a patient in their lifetime, sway opinion and treatments of the millions just by game of projection and perception. The news items and the content are guided by idea of creating sensation in a quest to sell news, be it a selective negativity. Such  negative and selective projections are causing discouragement and demonization of the medical profession. It is the biggest  tragedy to the medical profession in present era.

      Normal treatment of the sick patients is being projected as gruesome atrocity, inflicted by doctors. Media could have done better in helping to take off spectacles fogged with bias against doctors and recognizing them as real saviours, just as deserving of justice.

       National Media could have helped, had they fueled the right and constructive discussions. The TV channels  could have countered the pandemic with better imagination, sobriety, and exemplary performance rather than creating sensation by cynical and futile debates, which are absolutely inappropriate at this time.  

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Facilitators turn administrators: Biggest tragedy to medical profession in present era


14 Doctors in rural Unnao resign alleging mental harassment and misbehaviour by administrative officers over COVID-19 work.

       Administrators, who have never treated  a patient in their lifetimes, but control treatment of thousands of patients. The  biggest tragedy to the medical profession in present era, causing discouragement and demoralization of medical profession.
         Their role should not have been more than facilitators, but they have become medical  administrators. They are so distant from the ground reality.  To control the health system, administrators have a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses.
The vulnerability that is  intrinsic to the  doctors’ working makes them sitting ducks, an easy target for harassment and punishments and  is exploited by everyone to  their advantage. Administrators use this vulnerability to  suppress them. It is used by  media and   celebrities who projected  themselves as Messiah for the cause of patients, and  sell their news and shows by labeling the whole community of doctors as dystopian community based on just one stray incident.

     The blame for deficiencies of inept system, powerful industry, inadequate infrastructure and poor outcomes of serious diseases is shifted conveniently to doctors, who were unable to retaliate to the powerful administrative machinery.   

        The demonstration of the cleft that separated doctors from the actual overpowering controlling medical industry  and administrators is  not given, in order to maintain the prejudice  with its dangerous bias towards doctors, who are in forefront and are visible to public. Clearly separating the role of health workers and the hidden administrators would not only settle the matter, but is actually essential to project the reality. The correct perception of two fundamentally different components would reveal a real gulf and would help to address the core issues.

    A wish to govern, regulate and punish the medical professional by administrators is not new. Hammurabi 4000 years back had initiated to write the cruel rules of the game, which possibly initiated a change in the global perception and regulatory system and formed the basis for cruel regulation in radical and unprecedented ways.

      In  a quest to control  this difficult area,  which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and relief, sadness and happiness, smiles and sorrows and uncountable emotions, intertwines with financial aspects and  the  amalgamation of intricacies of science with legal complexity, doctors are burdened with over-regulation and administrative pressures.

               Consequently the  doctors are the sufferers, as they feel enslaved and suffocated. But ultimately who would be the sufferer, does not need an Einstein brain to guess.

14 doctors resigned, alleging harassment and misbehaviour by administrative officials.

More than a dozen doctors posted in rural hospitals in Unnao district of Uttar Pradesh collectively resigned, alleging harassment and misbehaviour by administrative officials.

The doctors, numbering 14, posted at community health centres and primary health centres submitted their resignation letters to the chief medical officer (CMO) of the district on Wednesday. Speaking to the media, one them said that while their teams would work on the field from noon to 4-5 p.m., isolating COVID-19 positive cases in their home, distributing medicine and carrying out sampling, the local SDM would summon them after that seeking a report of their work. The doctors would have to drive back several km to the tehsil from their place of work just to “prove that they are working,” said the doctor. “Despite continuously working, it has been made to appear like we are not working and that due to this, the COVID-19 situation is going out of control,” he said. The doctors also alleged that they were not provided sufficient drug supply from the government and often faced verbal harassment at the hands of the CMO and the CMS. If the field teams were unable to trace down patients because of submission of wrong phone numbers and addresses, they should not be held responsible for it, said the doctors.

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Financial complexity of MIDDLE-MAN in Medical Industry # Insurance pays 45 -80 % of Covid bills


     

 Medical care  intertwined with health business, further braided with changes in medical law presents a more complex problem rather than   just treating a patient well. In present era, many kinds of organizations have positioned themselves between doctor and the patient.

      This era  belongs to a transitional phase, when  gradual  conversion of doctor-patient interaction to a business transaction  is being controlled by industry’s middlemen .  One such middle industry is Insurance industry. The medical industry, insurance, law industry and administrative machinery remain hidden in the background and enormously benefitted at the cost of doctors and nurses, who suffered at the front, as face of the veiled colossal medical business and remain the only visible components.  Insurance industry is in a position to extract business from doctor as well as patients.  One such example is published in Times of India, where insurance company  has paid bills between 45-80%.  Each one of the medical industrial component trying to have their pound of flesh, will not only push  the cost of health care upwards, but would leave  both the main stakeholders, doctors and patients feel dissatisfied.

Policy holders get only  45 -80 % of Covid bills TIMES OF INDIA

As the number of people hospitalised due to Covid rise, many find that they have to settle a big chunk of the bill out of their own pockets despite having health insurance. Policyholders are again caught in the crossfire between hospitals and insurers over the treatment of consumables like personal protection equipment (PPE) kits resulting in only 45% to 80% of hospital bills being recoverable by customers. For 81-year-old diabetic and hip fracture patient K Saraswathi, who was treated for Covid-19 for eight days got only Rs 56,500 reimbursed of the total Rs 1.18 lakh bill from third-party administrator Raksha. Among other things that were disallowed included Rs 17,600 for PPE claims. While insurers cite General Insurance Council (GIC) norms their argument may not hold water as IRDA has not approved any norms. “How can a hospital treat a patient without PPEs?” asked an official at the Insurance Ombudsman office which is snowed under with complaints for short-settlement. “We used to get a few cases last year, now we have 88 pending cases, 70% to 80% of which are short settlements,” the official said.


For some insurers, the exclusions amount to a third of hospital bills. Liberty General officials said around 35% of the bill does not fall under the ambit of insurance coverage. Its VP and national claims manager for accident & health, Amol Sawai said, “On the industry level, the average Covid claim severity is Rs 1,40,000, the settlement severity is about Rs 95,000 of the claimed amount. We have seen almost 20% of the total bill is attributed to PPE costs.” India’s largest health insurer Star Health settles nearly 80% to 90% of claims under cashless settlement within two hours of receiving claims. S Prakash, MD of Star Health said, “One doctor who takes a round in the same PPE kit, cannot charge for each of ten patients he visits. The controversy is not in the reimbursement for PPEs, but in the number of PPEs covered. One cannot claim for ten PPEs per day. For ICUs, we allow a higher number of PPE kits compared to the ward,” he said.


According to the GIC officials, the referral rate for PPE kits is Rs 1,200 per day for moderate sickness and Rs 2,000 per day for severe sickness.


“We also see a spike in claims made for CT scans per person. We allow maximum two CT scans per patient,” he added. Officials at the GI Council blamed the hospitals for this situation. “Why are no directions given to hospitals on billing?” asks a council official. He points out an instance where a Tamil Nadu hospital charged Rs 14,000 for medicines, Rs 55,000 for diagnostics and Rs 50,000 for PPE besides room rent. When the insurer raised a red flag, the bill was halved to Rs 1.5 lakh.


“Is it okay for hospitals to loot with such high bills, whose money are we paying? It is the public’s money. If the premium doubles next year, will anyone even think of medical insurance. If we raise our hands and give up covering medical insurance, can anyone force us to provide a cover,” the official asked. The short settlement by insurance companies is resulting in a rise in complaints at the office of Insurance Ombudsman in Chennai.


“Insurers are citing some GI Council norms for claims settlement. Whatever they are saying does not hold water as IRDA has not approved any norms. How can a hospital treat a patient without PPEs?,” an official at the Insurance Ombudsman office said. Hospitals on their part blame the westernization of healthcare where insurance companies call the shots. “How can an insurance company decide on medication? A Dolo works for some while a Combiflam works for another, both these have a price differential. Now to say I will pay Dolo charges for a Combiflam or vice versa is plain stupidity. We need someone who looks at the bill and the patient and not one size fits all,” a MD and head of infectious diseases in a private hospital said. “The need is a regulator who understands medicine,” he said.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

New book: ‘The Real Issues’ through ‘fictional narratives’


“AT THE HORIZON OF LIFE AND DEATH”

Find it on Amazon :

Description

         This book comprises of stories that capture the pivotal moments in the treatment trajectory of the critical patients facing death.  The times that force the doctor to confront the saddest moments, while battling a terrifying, unbeatable foe, the death monster alongside families’ fears, gloom, indecisiveness, dilemmas about future and saviour’s own predicaments intertwined with medico-legal intricacies and consequent complex emotional interactions.  

        The situations depict ‘the real issues’ through ‘fictional narratives’. 

       The stories reflect life of a doctor in the present era, amidst sick patients in an imposed legal milieu, a mystic journey, an arcane odyssey punctuated with pain and pleasure in the narrow and uncertain lanes at the horizon of life and death, carrying the burden of various vicissitudes like consumerism, legalities, unpredictable course of diseases, mistrust and blame for poor outcomes.   

        The narratives try to unmask the eternal latent vulnerability that is intrinsic in doctor’s work, which is exploited by media, law industry and even celebrities to sensationalize and sell their news and shows. The vulnerability turns more evil as the delineating cleft that separates doctors from the invisible overpowering medical industry is not shown, thus ensuring to sustain the prejudice with its dangerous bias towards health care workers. 

        One negative news story through a ‘portrayal effect’ generates unbridgeable gap in doctor -patient relationship, painful burden of mistrust loaded on doctors, that would heal only if millions of unfettered, unprejudiced, unbiased facts are clearly projected. 

           The book tries to highlight a seemingly illogical and contrary nature of the conflict; the doctors are finding themselves increasingly being engaged into. The dense mazes of consumerism, extensive communication, documentation, unrealistic expectations, negative media insinuations, legal complexities are demoralizing to doctors and certainly counterproductive for patients.

         The futile discords emanate frequently, that are mundane in reality when compared to the actual disease and the real point of intention which is ‘The Treatment of the Patient’.

         But is this what the patients actually need? Does the entanglement of doctors in such a maze help the patients in real sense?

        The author felt morally compelled and attempted to find answers, embedded in a journey that was wondrous and inspirational, but with horrifying moments as well.

        Has the decision to treat human fragility become a mistake in present era?  No reward, if you win the match of life and death but sword hanging; if  one were to lose?     

       Patient will need to decide someday, whether to be a consumer or just remain a patient. 

       Being a consumer may be an overall loss-making deal for the patient.

Disclaimer

   The stories are fictional, but the depiction of the problems to the doctors, nurses and patients are real, based on day to day routine incidents. The episodes do not pertain to any single particular person, patient, doctor, nurse, hospital and organization. All the characters, names and dialogues in the book are figment of imagination of the author and similarity to any person, any situation or organization may be co-incidental.

            The stories are not against any law, word of courts, profession, any government or any organizational set up or rules of any country. They depict the problems commonly faced by doctors in performing their duties hence are likely to affect the patient directly.

Ayurvedic Surgery: who should be concerned?


         A strange situation has cropped up after the claim of Ayurvedic doctors doing surgeries has got the CCIM approval. Serious doubts has been raised by Allopathic medical organizations about the consequent safety issues.

       There would always be claims or counter claims about who should be allowed to do surgeries.  But there has to be a neutral and competent authority to decide, rather than claiming the competence.  After all it is question about safety issues of millions of  people.

      Who should really decide about it?

     NABH  has raised concerns about the issue.

    Although it has limitations and can be applicable only to a fraction of hospitals, but still a larger network of hospitals or clinics are not covered by NABH.

      In such situation, who should be worried about the safety? Strangely the stakeholders, who would be affected most are silent on the issue: the patients.

      If patients  have nothing to protest and they feel safe or do not anticipate any danger, why allopathic doctors should make a noise about it? They would be seen as a Jealous cat.

     Use Ayush docs for clinical work and you could lose ACCREDITATION: NABH TO HOSPITALS

         The National Accreditation Board for Hospitals and Healthcare providers (NABH) has warned allopathic hospitals accredited with it that they could face withdrawal of accreditation if they were found employing Ayush doctors for performing clinical duties in ICUs and other patient care areas in place of MBBS resident medical officers (RMOs) and emergency doctors. A “cautionary notice” the board issued on Thursday said, “This is a blatant violation of NABH standards for healthcare accreditation and very much against patient safety norms and compromise quality of modern medicine clinical care outcomes.” TOI had, in October, reported on the use of Ayush doctors in ICUs for night duty being a fairly common practice in many private hospitals, particularly in Maharashtra and Gujarat. Thursday’s notice stated that the NABH has taken a serious note of the matter and reiterated that deploying of Ayush doctors in allopathic hospitals for writing independent orders and clinical work without the supervision of allopathic doctors is not permitted. In case the allopathic hospitals are employing such doctors to work as clinical assistants, under applicable state laws, they should not be involved in direct patient care and should strictly follow job responsibilities as defined by hospital management, it added.  Ayush doctors working in allopathic hospitals will not be considered by the NABH as RMOs during the process of assessment and for the purpose of grant of accreditation, stated the notice, adding that any violation may invite adverse decision by NABH, including withdrawal of accreditation. However, even as the NABH has been carrying out surprise inspections in hospitals in this matter, it is yet to have a definite list of states that allow Ayush doctors to be employed in allopathic hospitals to either prescribe a pre-defined set of allopathic medicines or to do clinical procedures after completing a bridge course. NABH officials clarified that the board’s legal team was in the process of determining the status of the law in different states.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Challenges of Covid Vaccination-2021


If 2020 was consumed by Covid Virus ,  the next year 2021 will be  for Covid vaccination.

All over the world, billions of people are going to get vaccine.

Corona vaccination is one of the most anticipated events in every country. in coming weeks, multiple vaccines   are likely to get regulatory approval. 

    However, while making a good vaccine was the difficult part, earning  trust of public in vaccine is going to be another one. Especially the hurried development at Pandemic speed  and lack of awareness about safety issues will be areas of concern.

  The adverse events, which are unexpected medial problems that occur with drug treatments, are unavoidable part of any treatment, including vaccine science.

    The system need to be in place to identify  the causal relationship between vaccine agent and  the adverse event.  The objective criteria have to be in place to identify and treat, as the population to be vaccinated is also very large.

 The main hurdles equally challenging will be sourcing, distributing and giving the actual vaccination doses.

The preparation for mammoth exercise will also be a herculean task. It may take months to get ready to supply and build the chains and preparation for this need to begin now.

A systematic approach needs to be ready, so that the process of vaccination gets on smoothly and quickly, as soon as the doses are available. For example, the need for transport vehicles and the storage facilities for billions of doses at distant places will be one of challenges.

It will take mammoth number of healthcare workers, who will vaccinate people at different towns and cities.  

This exercise, if not done in a well-planned manner, could result in chaos.   The failure to set up a system will not only result in suboptimal vaccination but also non uniform supplies. Maintaining the cold chain will be crucial for effectiveness.

 People should get it based on needs rather than black marketing or money power.   The issues which look insignificant like the financial complexity among various stake holders or customer clearances need to be settled first, as they may become significant hurdles for smooth distribution.

    Most important would be to safeguard citizen’s faith in vaccine and clinical trials. As for the future science to develop, would   require people’s co-operation, faith and participation.

     Government regulators and Vaccine makers need to recognize the utmost importance of the communication about the true results of trials and effective communication with the public.  The misinformation and distrust should not  undermine the good work of medical science and advancements.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Authorities mum on Adverse Event at Covid Vaccine Trial


Safety data of Covid Vaccine- need disclosure

   There are two important aspect of a successful vaccine,

1. Efficacy  for the prevention

2. Safety

       Given that the Covid vaccine is needed urgently and will be developed within a years’ time, some doubts about the safety aspect are natural. But safety can be assured, if the data about side effects is made public.

   All  the  companies  in a bid to rush their  vaccine into the market, are eager to  create an hype. But a caution need to be exercised against such hyping, especially when long term safety data is not available.

  Even the sparse details of the severe side effect,  that leak into the public domain, may be just tip of the iceberg, as far as long term safety data of a vaccine is concerned.

   All the side effects, mild or severe, need to be made known  and  in public domain, rather than exposed later after the use.

More than a month and a half after an adverse event occurred in a clinical trial in India of the AstraZeneca vaccine, the Central Drug Standard Control Organisation (CDSCO), the regulator for vaccine trials, has not issued any statement on the occurrence. It also did not respond to queries about whether it has completed its investigation to determine if the trial participant’s illness was related to the vaccine. Serum Institute, which is partnering the pharma MNC and Oxford University for producing the vaccine in India, has also refused to comment. This is in sharp contrast to AstraZeneca and Oxford University going public when one of the trial participants in the vaccine trial in the UK fell ill and halting the trial till an independent safety monitoring board and UK’s regulatory authority gave safety clearance. Information about the occurrence of the serious adverse event (SAE) during the vaccine trial in India came from the family of the trial participant, which has sent the company and the regulators a legal notice. Serum Institute merely stated that it would issue an official statement next week. AstraZeneca had issued a statement within days of the trial participant in UK falling ill and halted the trials across the world in the UK, Brazil and South Africa. The trial was resumed within a week after the independent safety review committee and national regulators gave clearance. The Indian Council of Medical Research is a co-sponsor of the trial along with Serum Institute.

According to the ICMR, it is for the DCGI to take a call on whether or not to halt the trial. The DCGI heads the CDSCO.

The 40-year-old trial participant, a business consultant with an MBA from New Zealand who says he took part in the trial deeming it his duty to help such an important venture, was administered the vaccine at SRMC on October 1. Eleven days later, he woke up with a severe headache, and progressively lost his memory, showed behaviour changes, became disoriented and was unable to talk or recognise his family members, according to the legal notice. As soon as he fell ill he was admitted to the ICU in SRMC.

“Though the legal notice we have served talks of a compensation of Rs 5 crore, our focus is not on monetary compensation. It was sent just last week, more than a month after the occurrence when we saw that none of the authorities was making the adverse event public. They ought to have warned other participants so that they could watch out for similar symptoms. We want to know why the occurrence of the adverse event has been kept under wraps and why the trial was not halted like it was done in the UK. Is an Indian life of less value than that of an UK citizen?” asked a close family friend who has been helping the family cope with the illness.

WHO says more data needed on AstraZeneca dose

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Penal Servitude for Doctors, Nurses- Administrators Delight


                         Life for health care professionals like  doctors and nurses is hard in present era, right from getting into medical college, passing the exams, gaining experience, work under new imposed legal environment, with  over-regulation and under the moral burden of over-expectations of society. The benefit of these difficult situation is reaped to the maximum by administrators and overpowering medical industry.

            Despite working amid of a national emergency in Covid-times, the meagre salaries of hundreds of doctor and nurses are not paid for months in Hindu Rao Hospital, Delhi

         Ironically where doctors are punished for small genuine mistakes or even poor prognosis during  medical treatment, the blunders of health  administrators are taken as trivial issues.  More ruthlessness, cunningness or cruelty towards health care workers is possibly becoming an appreciated quality of health administrators.  Why no punishment for the administrators for such blunders?

     Consequently, with no support from society, to whom they serve, doctor and nurses gradually are pushed to a penal servitude. If this is regarded as normal in present era, anyone would wonder, what does slavery constitute?

   No salaries  for doctors for four months

The doctors alleged negligence and apathy on part of the government and said that they were unable to run their basic errands and accomplish their daily routine due to non-payment of salaries.

  Irked over non-payment of salaries for over four months in a row, doctors at Delhi’s Hindu Rao Hospital announced that beginning Saturday, October 10, they would stop attending to patients including those suffering from Covid-19. Hindu Rao Hospital, the largest municipal hospital in Delhi with 900 beds, is currently a dedicated Covid-19 facility.The doctors alleged negligence and apathy on part of the government and said that they were unable to run their basic errands and accomplish their daily routine due to being unpaid for months.Abhimanyu Sardana, President of the Resident Doctors’ Association (RDA) of the hospital, said that several letters and reminders had been sent to Delhi Chief Minister Arvind Kejriwal regarding the issue faced by the doctors, who are frontline warriors at the Covid-19 dedicated facility. “Don’t ignore the basic needs and rights of doctors,” wrote the RDA-Hindu Rao.

            Be it any circumstances like working without any facilities, poor infrastructure, non-availability of drugs, inhuman duties hours over 48-72 hours or poor pay, the administrators would say, “you are a doctor, it is your moral responsibility.”  Armchair preachers and administrators will always remind them of moral duties, but easily forget their own.

   25 factors- why health care is expensive

   REEL Heroes Vs Real Heroes

   21 occupational risks to doctors and nurses

   Covid paradox: salary cut for doctors other paid at home

advantages disadvantages of being a doctor

Covid effect: Reasons for costly oxygen


 

Oxygen has been a essential lifesaving therapy for covid patients. As large numbers require oxygen for prolonged periods because of post covid lung damage, the requirement has increased manifold. So it is in short supply and there is no dearth of people want to monetize the need. There are multiple reasons of shortage.

 The Indian express explains

   The delay in transportation of oxygen to dealers, conversion into cylinders and supply to hospitals can get long if even a tiny link in the supply chain falters.  

As Covid-19 sweeps across the country, urban and rural areas alike face an unprecedented spike in oxygen use. Around 3-5 per cent (over 50,000) of active Covid-19 cases in India have lung tissues damaged enough by the virus to require external oxygen support.

Since March, medical oxygen demand has grown from 750-800 to over 2,500 metric tonnes, and now, hospitals are struggling.

The supply 

In an ideal scenario, it takes 3-5 days for oxygen to journey from a manufacturer to a patient’s bed. But delay in transportation to dealers, conversion into cylinders and supply to hospitals can take longer if even a tiny link in the supply chain falters.

India’s big oxygen manufacturers, such as Inox Air Products, Linde India, Goyal MG Gases, National oxygen, use cryogenic distillation technique to compress air, feed it into distillation columns and get liquid oxygen. It has 99.5 per cent purity. This process, an official from Inox said, can take two-and-half-days.

The liquid oxygen is filled into special cryogenic transport tankers that maintain -180 degree centigrade temperature to travel to smaller plants in hinterlands, where liquid oxygen is converted into gaseous form, fed into cylinders and transported to the final destination – hospitals.

India has the capacity to produce 6,900 metric ton of liquid oxygen daily, health secretary Rajesh Bhushan said in a media interaction. According to the All India Industrial Gases Manufacturers’ Association (AIIGMA), over 2,500 tonne is being directed towards hospitals, most consumed by coronavirus patients, and another 2,000-2,300 tonne is industrial requirement each day. So if India is not exhausting its capacity of 6,900 metric tonnes, why is oxygen suddenly a concern?

Logistics

Medical oxygen demand has grown threefold in six months. “The issue is not of supply, it is of transportation and storage,” says health secretary Dr Pradeep Vyas, Maharashtra, which produces one-fifth of India’s oxygen capacity.

As demand surges, logistics are falling short. India has roughly 1,200-1,500 tankers for transport. Before the pandemic, the tankers were enough, but now they are difficult to hire and cost more.

Inox is the biggest manufacturer of liquid oxygen in India, with capacity of 1,911 metric tonnes per day. It currently supplies 1,400 tonnes, and has 550 transport tanks and 600 drivers to supply to 800 hospitals across India. But this may soon fall short.

It can take 5-6 days, for instance, for oxygen to travel from Inox Pune plant to Osmanabad, where a dearth of oxygen has emerged. The Centre is now working to utilise nitrogen tankers to transport oxygen. In just Maharashtra, 10 more tankers have been roped in.

Then there is the problem of storing this huge quantity of oxygen, says Saket Tiku, president of AIIGMA. Most rural hospitals do not have oxygen tanks as the need never arose before. A critical Covid-19 patient can need 30-60 litres of oxygen in a minute. One cylinder can run out in 15 minutes to an hour, depending on oxygen directed to patients.

States are looking at alternatives, from buying extra dura and jumbo cylinders to installing oxygen tanks as buffer stock. Inox has got the contract to fix 64 jumbo tanks across Covid hospitals to store 4 lakh litres.

Several states have also begun construction of oxygen generation plants that convert air into oxygen, and provide 93.5 per cent purity. But this construction will take months. The AIIGMA states that across India, 500 oxygen plants are in the process of construction, of which two major ones will be in Pune (Maharashtra) and Modinagar (Gujarat).

The price rise

Oxygen is generally quite cheap, but suddenly it has become expensive. A cylinder that would earlier cost Rs 100-150 now costs Rs 500-700 for refilling. With this, hoarding has begun. Fearful of not getting a Covid bed in hospital, people are keeping oxygen cylinders at home.

Before the pandemic, it would cost Rs 1.5-2 to refill a cubic metre of oxygen. But the cost of logistics has risen, so now Delhi will find refilling costs Rs 10-15 per cubic metre, and Mumbai Rs 15 per cubic metre. The government has fixed the cost of refilling at Rs 17.49 per cubic metre.

Several private hospitals charge patients Rs 1,500-3,000 for oxygen per day. “Based on our analysis, oxygen cost cannot exceed Rs 300-400 per patient per day in a hospital,” said Dr Sudhakar Shinde, IAS officer in-charge of fixing price cap for hospitals.

The industrial sector is bearing the brunt too. Requirement for oxygen had dipped to 250 metric tonne per day in March after lockdown. As restrictions were lifted, industries restarted work. Now, the industrial requirement is at 2,00-2,500 metric tonne. But there is limited supply.

Madhya Pradesh relied on Maharashtra and Gujarat for oxygen – as supplies from these states reduced, it has turned to Chhattisgarh for supply. In some states like Maharashtra, only 20 per cent oxygen produced can be directed for industrial purposes, rest are reserved for medical use.

What government is doing

There is also the wastage of oxygen – mild cases who don’t need it are put on oxygen support, sometimes leakages are reported from oxygen pipelines. An expert committee under MoHFW has fixed oxygen supply to 40 litres in intensive care units and 15 litre per minute in normal ward per patient per minute.

It has advised to monitor patients on oxygen support daily, and only put those with oxygen saturation levels below 94 on oxygen support. As per the committee, 20 out of 100 patients turn symptomatic and three of them critical. This is the pool that may require oxygen.

In Numbers 

India’s per day oxygen production capacity: 6,900 metric tonne

Current requirement: Over 2,500 metric tonne

Oxygen Transport tankers: 1,200-1,500

Active Covid cases: 9.75 lakh

On oxygen: 5.8%

25 factors why medical treatment are expensive

90 doctors in Maharashtra resigned due to harassment by administration


      

     

      Unparalleled sacrifice by medical community during pandemic  has not  resulted in any enhancement of  respect or prestige to the medical  profession. It was not enough  to stop physical or verbal assaults, legal or financial  exploitation. It was not sufficient  to alter the course of oppression  by administrators or moral blackmail by society. Sadly it is getting more worse. Doctors and nurse have been reduced to sacrificial lambs, that are easily slayed, when administrators tend  to put  themselves on high moral  pedestals. 

Financial and legal complexities have been the major side effects of modern medicine, especially for doctors. They are facing  complex  environment,  which are beyond their control. Besides financial and legal complexities, moral dilemmas, facing verbal and physical assaults are creating  complex working conditions. But if doctors are not able to work, who will be the sufferer, does not need an Einstein brain  to guess. Criticized  by administrators despite their sacrifice, media insults are adding to their disillusionment and possibly  a withdrawal response.

90 doctors in Maharashtra  resigned  due to harassment by administration

Over 90 gazetted medical officers posted in Yavatmal district of Maharashtra have resigned today from their service allegedly due to consistent harassment by the administration and District Collector MD Singh. 

These doctors have been serving at the civil hospital, sub-district and rural hospitals and primary health centres in various capacities. 

In a letter written to the government today, Dr Rajesh Gaikwad and Dr Pramod Rakshamwar, both office bearers of the Maharashtra Association Of Government Medical Officers, says, “Despite marathon efforts by the doctors throughout the pandemic, administrative officers and DM is mistreating the doctors which has led to resentment among entire fraternity.”

     Such  incidents  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 everyone else. Such indifferent   attitude 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.

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