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.

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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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Potential Ray of Hope: Highly effective coronavirus antibodies


        Identification of highly effective antibodies, will not only provide a passive immunity, but can be helpful in developing vaccine as well. This discovery may be a potential ray of hope against Covid war.

Highly effective coronavirus antibodies discovered may lead to passive Covid-19 vaccine

     BERLIN: Scientists have identified highly effective antibodies against the novel coronavirus, which they say can lead to the development of a passive vaccination for Covid-19. Unlike in active vaccination, passive vaccination involves the administration of ready-made antibodies, which are degraded after some time. However, the effect of a passive vaccination is almost immediate, whereas with an active vaccination it has to build up first, the researchers said. The research, published in the journal Cell, also shows that some SARSCoV-2 antibodies bind to tissue samples from various organs, which could potentially trigger undesired side effects. The scientists at the German Center for Neurodegenerative Diseases (DZNE) and Charite – Universitatsmedizin Berlin isolated almost 600 different antibodies from the blood of individuals who had overcome Covid-19, the disease triggered by SARS-CoV2. By means of laboratory tests, they were able to narrow this number down to a few antibodies that were particularly effective at binding to the virus.  Highly effective coronavirus antibodies identified, may lead to passive Covid-19 vaccine The researchers then produced these antibodies artificially using cell cultures. The so-called neutralising antibodies bind to the virus, as crystallographic analysis reveals, and thus prevent the pathogen from entering cells and reproducing, they said. In addition, virus recognition by antibodies helps immune cells to eliminate the pathogen. Studies in hamsters — which, like humans, are susceptible to infection by SARS-CoV-2 — confirmed the high efficacy of the selected antibodies. “If the antibodies were given after an infection, the hamsters developed mild disease symptoms at most. If the antibodies were applied preventively — before infection — the animals did not get sick,” said Jakob Kreye, coordinator of the research project. The researchers noted that treating infectious diseases with antibodies has a long history. For Covid-19, this approach is also being investigated through the administration of plasma derived from the blood of recovered patients. With the plasma, antibodies of donors are transferred, they said. “Ideally, the most effective antibody is produced in a controlled manner on an industrial scale and in constant quality. This is the goal we are pursuing,” said Momsen Reincke, first author of the research. “Three of our antibodies are particularly promising for clinical development,” explained Harald Pruss, a research group leader at the DZNE and also a senior physician at Charite – Universitatsmedizin Berlin. “Using these antibodies, we have started to develop a passive vaccination against SARS-CoV-2,” Pruss said. In addition to the treatment of patients, preventive protection of healthy individuals who have had contact with infected persons is also a potential application, the researchers said. How long the protection lasts will have to be investigated in clinical studies, they said. “This is because, unlike in active vaccination, passive vaccination involves the administration of ready-made antibodies, which are degraded after some time,” Pruss said. In general, the protection provided by a passive vaccination is less persistent than that provided by an active vaccination, the researchers said. “It would be best if both options were available so that a flexible response could be made depending on the situation,” Pruss added.

Financial complexity of Modern medicine: 25000 hospitals near closure


Financial and legal complexities have been the major side effects of modern medicine, especially for doctors. They are facing  complex  environments,  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 despite their sacrifice and treating the patients, media insults are adding to their disillusionment and possibly  a withdrawal response.

Rates for Covid hospitals: IMA doctors across Maharashtra threaten to stop work if demands not met in 7 days

Doctors with the Indian Medical Association across Maharashtra have threatened to stop work indefinitely if their demands are not met within the next seven days. On September 15, all IMA members who are hospital owners will submit copies of their hospital registrations to the IMA branch offices at various places. These branches will appeal to the state government that they are unable to manage the hospitals with the new rates. “We will urge the state to take charge of the private hospitals,” said IMA Maharashtra president Dr Avinash Bhondwe.

The IMA is protesting against the “unaffordable rates forced by the state government” for Covid hospitals and said it is increasingly difficult to meet the expenses to run the small and medium-sized private hospitals. It has demanded that the government should run all private hospitals.

Bhondwe said at least 25,000 mid-sector hospitals are on the verge of closure. “The government had accepted the proposal to increase the rates for the ICU and give concessions in biomedical waste disposal charges and electricity bills. The government had also agreed to cap the rates of PPE kits and masks for doctors and the rates of medical oxygen used by hospitals were also to be reduced as per the central government’s regulations. This was to be finalised in a proposed meeting with IMA before September 1,” Bhondwe said.

However, IMA officials said the state unilaterally came out with new rates on August 31 and the IMA decided to start their protest at a meeting on September 4. On September 9, all the 216 IMA branches paid a tribute to doctors in Maharashtra and burnt symbolic copies of medical council registrations

IMA Maharashtra convened a meeting of 14 different medical organisations of all the pathies, including Ayurveda, homeopathy, yunani and dentistry, all the disciplines of modern medicine and specialties on September 12. These organisations have supported the agitation and decided to form a joint action committee to work together.

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Covid pandemic to infected plastic pandemic


Now, while we are fighting the COVID-19 pandemic, plastics use is increasing again. But, while the pandemic is just temporary, plastic pollution will be long lasting.  

For our current battle to fight the COVID-19 pandemic, we see a dramatically increasing demand for personal protective equipment (PPE) which comprises various plastic and rubber items. Moreover, there are many other fresh, clean plastic items widely used in medical applications for creating a sterile environment, such as pill casings, disposal syringes, catheter, and blood bags. These items are also made of synthetic polymers such as polyvinyl chloride (PVC) and PP, which are not biodegradable. Therefore, it would be not surprising to see that the COVID-19 pandemic is generating tons of medical waste.

dumping Covid-19 infected waste in public places

               The Biomedical Waste Management Rules, 2016, define biomedical waste as“any waste that is generated during the diagnosis, treatment or immunisation of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps.” Therefore, broadly, any waste generated from treating patients comes under the ambit of biomedical waste.

As per available data, India produced approximately 600 tonnes of biomedical waste per day before the coronavirus first hit.

However, ever since Covid-19 showed up on our shores, the amount of biomedical waste produced in India has increased exponentially. This is mainly due to two factors:

  • Medical facilities themselves are producing far more biomedical waste as they battle the virus. As of August 30th, more than 4.14 crore tests to check for the virus had been conducted in India. Further, with over 36 lakh persons having tested positive for the virus, medical facilities have also been producing a lot more medical waste as they treat these patients. Therefore, all of the cotton swabs, samples, injections among other medical inputs necessary to test and treat these patients become highly contagious bio-medical waste that needs to be treated and disposed of with utmost caution.
  • Due to the infectious nature of the coronavirus itself and the strategy of home quarantining of asymptomatic COVID-19 Positive patients, adopted by the country, a major part of affected household waste has now become biomedical waste. The amount of waste that is hazardous is large due to the fact that India has some of the worst waste segregation numbers in the world. This forces infrastructure that is already burdened beyond capacity to handle mixed waste that it is not equipped to handle.


Treatment facilities and growth in biomedical waste

A factor that infinitely complicates India’s fight against Covid-19 is that as per available data, India, a country of more than 1.3 billion people, has only 198 Biomedical Waste Treatment Centres (BMWTCs) and 225 medical centres in the country with captive waste treatment facilities. Simple maths tells us that India’s infrastructure to process biomedical waste was already inadequate during pre-Covid times. However, post-Covid, India is truly staring at a disaster of alarming proportions if it does not rapidly increase its biomedical waste treatment capacity.

There have already been multiple instances of Covid-19 infected waste being dumped in public places including in Delhi and Vijayawada. In addition to this, due to the rapid and sustained increase in biomedical waste due to Covid-19, most BMWTCs are running out of capacity to handle the waste. For instance, the two BMWTCs in Delhi have a combined capacity of handling 74 tonnes of biomedical waste in a day.

However, a report submitted by the Environment Pollution (Prevention and Control) Authority to the Supreme Court of India showed that Delhi’s biomedical output had risen from 25 tonnes per day in May to 349 tonnes per day in July. Similarly, Covid-19 related waste in Mumbai rose from 12,200 kg per day in June to 24,889 kg per day in August, essentially doubling in three months. A similar situation has arisen in West Bengal as disposal facilities there too have reached maximum capacity.

Proper waste segregation and disposal is need of the hour. Disease burden may keep on rising, if proper steps are not followed.

Covid paradox: salary cut for doctors, others paid at home


What a paradox!!  Firstly the doctors were employed on contract basis at meagre salary, only for Covid. At a time when other employees of government getting salaries while sitting at home while doing nothing, these contractual doctors were  drowned in pool of Covid patients, risking their lives.

        Cruel heights of insensitivity and  as an epitome of poor governance,  salaries of these 900 doctors were subjected to  massive deductions. They had no choice, but to resign.

       Ironically, on one hand every one appears to rue about  non-availability of doctors, but on other hand they are given a shabby treatment. For example everyone wants to employ doctors on contractual basis and hence paying them poorly and clearly with an intention to “ use and throw policy”.

Salary cut, 900 Kerala Covid doctors resign
THIRUVANATHAPURAM: Nearly 870 doctors appointed to Covid first-line treatment centres (FLTCs) across Kerala have tendered their resignation over deductions in their salary. They were among the 1,080 MBBS graduates who passed out of government medical colleges this year and appointed on Covid duty on a temporary basis. While they were promised Rs 42,000 a month, what each finally gets is Rs 27,000. “From the amount, Rs 8,400 was deducted in the name of the government’s salary challenge, apart from TDS and professional tax. Now, we are getting only Rs 27,000,” said , state president of Kerala junior doctors association 2020-21. The association has fired letters to the chief minister and health minister seeking their urgent intervention.

being a doctor,a disadvantage

pros cons of medical profession

Financial complexity of expensive medical college Fee


Why it is not worth it..

    The value of putting a money on something is judged by the return it gives, or a status, it confers to the candidate. The fee of medical colleges is exorbitant in many medical colleges and may not be worth buying a seat, because it may take, whole years of  life  working to even recover the fee or repaying the loans, amidst the present era of complex working scenario for doctors.

Private medical colleges may charge fee of 5 million to 10 million rupees or may be more.  There are glaring financial complexities arising out of the huge amount.

1. The aspiring  doctor will not add that much to his worth, because in case he loses his life in Covid (for example), the family  will not receive that much compensation. Compensations for doctor’s death are  lower than the fee charged by  medical colleges.   Not to talk about hard work and years spent and the sufferings of years to become a doctor. So a doctor’s life still remains cheaper than money spent on purchasing a medical degree.

2. Fee paid for education purposes may be worth, if the person is able to earn it back in one or may be two years. In present scenario, some lucky doctors will be able to earn that much amount in 5 to 10 years, by honest means. Rest, not so lucky, just try to repay loans, all over their life span. Any business done by use of that money will pay more than what a doctor will earn.

3. Doctor spends his life, treating hundreds and thousands of patients and saving uncountable lives, but one patient may sue the doctor for millions of rupees, mistake or even a unsatisfied patient. These compensations sought and given by courts are much beyond the money given as compensation in case of doctor death. Just proves that doctor’s as a person and with the degrees earned is not worth spending that huge amount.

4. So money demanded from doctors, be it for medical education or malpractice lawsuit, is multi-fold of what is given to them. There can be   various pretexts  to exploit doctors. They pay thousands of times of the amount they charge from patient, to lawyers, in medical malpractice lawsuit and insurance companies, just to save themselves.

5. After paying millions to medical institutes, putting themselves to hardship of years, provides them degrees. But simultaneously they become target for medical lawsuits, verbal abuse, administrative pressure and sometimes physical assaults. Getting a degree and having a healing ability does not enhance their respect in present era.

The lack of sense of gratitude towards doctors takes away the last inspiration to spend millions for the expensive medical college seat.

  Paying huge fee to medical college will make a person poorer, especially honest people. One has to apply wisdom, how buying an expensive medical college seat is going to be beneficial.

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

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