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Dead Body swap # Covid; unprecedented stress- Bizarre mistakes


Two incidents of dead body swaps have happened in last few months. Strangely two mistakes out of   correct millions  are enough to label hospitals, doctors  or health systems  as  callous. Covid times are  toughest times for health care staff and hospitals as well.

   Definitely it is sad and  painful  incident. Without doubt, swapping bodies and causing distress to relatives is really shocking.  There will be a  demand for exemplary  punishment to  health  care workers involved. There is a little doubt that they will meet the stringent punishment, as this is regarded as unpardonable, given the involvement of health care staff.

  But is that the right way? Will chopping the hands, that were trying to rescue, is of help?

          No one will like to see, how health workers have been  stressed. Under the unprecedented circumstances, how fewer number of frontline workers have been battling the pandemic.

      Armchair preachers cannot imagine the stress and the hard work, these   warriors are burdened with. There can be multiple ways to look at these unforeseen mistakes.

  1. Punish the health workers, make an example by taking away their jobs. So everyone  will learn.
  2. Check the faults in the system, make the whole system fool-proof by learning from the mistakes, so it becomes more robust with times to come.
  3. Counselling   of the personnel involved along with improving the system.
  4. Understand the stress and circumstances of front line workers and improving their working conditions, so as to reduce their  burden.
  5. Check the past record, if someone has done thousands right things, do not hang him for a single error, especially intoday’s unprecedented circumstances.  

Most desirable  at such crucial times will be encouragement and psychological support to front line workers.

Bodies swapped at private hospital in Delhi,

NEW DELHI: A private hospital in southwest Delhi’s Dwarka committed a grave error by handing over the body of a Christian woman to the family of a Covid-positive Hindu woman. The 69-year-old woman, Garikapati Parisuddam, was not infected with the novel coronavirus and had passed away on Monday morning.

AIIMS sacks one, suspends another for swapping of dead bodies

An ambulance with four corpses – including that of Anjum B – left from the hospital on Tuesday afternoon. Three of the persons who had died were Hindu and were taken to a crematorium before the van left for the ITO burial ground.

  Just  delivering professional death sentence for  single, system errors  or unforeseen mistakes will have  future implications.  It is like chopping the hands,  that were trying to help.

           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.

  Advantages-Disadvantage of being a doctor

   25 factors- why health care is expensive

   REEL Heroes Vs Real Heroes

Doctor’s death: saved uncountable lives- still not counted


In an era, where Reel Heroes are worshipped and Real Heroes are not    counted even after sacrificing their lives, is an unfortunate  and disheartening for  the whole community of doctors and nurses. It is surprising that  doctors, who saved uncountable lives, did not move the administrators enough  to get them counted.  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 disposable remains as  a deep hurt within.

         But at the same time, mere tokenism as an expression of concern is also not desirable. What is really required is a sincere effort to reduce the mortality of health care workers, to provide them better working conditions. An honest effort to find the cause of mortality among doctors and reducing it, help to the families of the health care workers is required. Due acknowledgement and true  respect to their sacrifice  is expected from civilized society.

“382 Doctors Died Of Covid”: Medical Body Says Centre “Abandoning” Heroes

Indian Medical Association has shown its displeasure over  the Government  statement on coronavirus in parliament, which had no word on the doctors who died in the line of duty, and the  statement that the Centre had no data as health is a state subject.  Accusing the government of “indifference”, “abdication” and “abandonment of heroes”, the country’s top body of medical practitioners said in such a circumstance, the government “loses the moral authority to administer the Epidemic Act 1897 and the Disaster Management Act”.

So far, 382 doctors have died of coronavirus, the IMA said. In the list it released, the youngest doctor to lose his life was 27 years old and the oldest was 85.

But while acknowledging the contribution of healthcare workers during the pandemic, the health minister made no mention of the medical professionals lost to the disease, the IMA said.  

“To feign that this information doesn’t merit the attention of the nation is abominable,” the IMA statement read. “It appears that they are dispensable. No nation has lost as many doctors and health care workers like India,” the statement added.

The IMA pointed to Union minister Ashwini Kumar Choubey’s statement that the Union government does not have any compensation data as public health and hospitals comes under the states.

“This amounts to abdication of duty and abandonment of the national heroes who have stood up for our people. IMA finds it strange that after having formulated an unfriendly partial insurance scheme for the bereaved families to struggle with the ignominy of the Government disowning them altogether stares at them,” the statement read.

Such a circumstance also exposes the “hypocrisy of calling them corona warriors on one hand and denying them and their families the status and benefits of martyrdom,” the IMA said.

Doctors and nurses dispensable disposables

Reel Heroes vs Real Heroes

25 factors, why medical treatments are expensive

Pros-cons of being a doctor

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.

25 factors- why medical treatment expensive: are doctors responsible

Advantage disadvantage of being a doctor

Expensive medical college Fee

Salary cut for doctors; other paid at home

Aspiring Doctor: Watch the naked administrative oppression


 

Covid has been treated by doctors at great personal cost. It has resulted in even death of healthy doctors and nurses, thousands of them have stayed away from their families, for the  sake of patients. But does that kind of unparalleled sacrifice has resulted in any enhancement of  respect or prestige to the medical  profession. Has the death of medical professionals, while serving ailing fellow human beings  was enough to halt the oppression of this gentle and humble  community by administrators. Was it enough to stop physical or verbal assaults, legal or financial  exploitation. Was it enough to alter the course of oppression  by medical  industry 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 want to put  themselves on high moral  pedestals.

This order of district collector to arrest a doctor for raising a voice for raising serious administrative issues, for speaking the truth and not for some alleged mistake. one naked example of how medical fraternity is being suppressed.
The young aspiring doctors need to watch these times carefully, to understand completely, what they are getting into. Even while embracing death for welfare of other human beings, does not get them deserved respect, one needs to be careful about the coming times.

The contribution of doctors towards society is not recognized rather defamation of medical profession as a whole continues unabated.Doctor's dignity is sacrificed blatantly to prove greatness of administrators.General behaviour of people is far from the sense of decency towards doctors and nurses. Aspiring doctors need to watch bashing of medical profession and all such factors. There is possibility that earning a medical degree puts them at a lower pedestal in society.
 










 
 

Plasma therapy- life saving for Covid?


  Few months ago, there was a hope and  presumed scientific reason to believe that plasma therapy will be a wonderful option in Covid pandemic. But the said belief needed to be strengthened by robust trials. As trials continue, the belief that plasma therapy will save lives, have not been proved  clear. Now again there is a doubt in the mind of doctors, whether it will save lives or it may not. What ever future may hold, it is clear that it needs more trials, more evidence. Covid virus has again proved to be more smart.

Delhi: Plasma therapy’s life-saving abilities in question, doctors caution on its use (Times of India)

NEW DELHI: A day after TOI reported about an ICMR study that showed administering convalescent plasma to Covid-19 patients did not reduce death risk, top doctors of AIIMS, Institute of Liver and Biliary Sciences (ILBS) and Lok Nayak Hospital stressed the need to rethink who should get the therapy. In the trial by Indian Council of Medical Research, which involved 464 hospitalised, moderately-ill Covid-19 patients, researchers observed that some participants had higher antibody positivity than their plasma donors. “The difference in age and severity of illness, with donors being younger and having milder disease, could have driven this difference. While all Covid-19 survivors were encouraged to donate plasma, an overwhelming majority of the donors were only mildly sick, young survivors. Recovered patients who had moderate or severe disease were generally reluctant to return to hospitals for plasma donation,” the ICMR study noted.  Earlier the institutes  did not check the level of neutralising antibodies in the donor, which led to poorer outcomes. “The ICMR study re-affirms our assessment based on a trial conducted on 29 patients who received plasma therapy at ILBS. It showed no mortality benefit. However, there was significant benefit in terms of clearing of viral load in those who received the therapy in addition to standard care compared to who received only standard care,” he said. The ILBS director added that only patients with mild-to-moderate illness should be given convalescent plasma. “The therapy has to be given within 24 to 48 hours of diagnosis. Also, detailed assessment of presence of sufficient levels of neutralising antibodies in the donor should be mandatory,” Dr Sarin said. At least 100 Covid-19 patients at the state-run Lok Nayak Hospital have been given plasma therapy till date. Dr Suresh Kumar, its medical director, said larger studies might be needed to assess its benefits. “Remdesivir did not show significant benefit in Covid-19 treatment in some studies. Still, the drug is being used in select patients because it has certain benefits and there is no other known cure. Similarly, plasma therapy may not help reduce death risk but our experience shows it does help in faster recovery in a small subset of patients,” he said. ILBS and Lok Nayak Hospital are conducting a study involving 400 Covid patients to assess the benefits of plasma therapy. Rajiv Gandhi Super Specialty Hospital is also taking part in the study. The ICMR study was conducted at 39 tertiary care hospitals — 29 teaching and 10 private — across the country. According to the study, released on MedRXIV, a preprint service for medicine and health sciences, mortality was documented in 13.6% patients who received plasma therapy in addition to standard care and 31 (14.6%) patients who received only standard care. The trial results also indicated that there was no difference in progression to severe disease among moderately ill patients treated with convalescent plasma along with the best standard of care.

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)

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.

Covid-Death of Doctor, nurses: No uniform support mechanism for families


87k health staff infected with Covid, 573 dead

Society, administrators and  Governments prefer to ignore  the fact that doctor’s  and nurse  life is at as much risk as a soldier while treating   infectious diseases. Corona has merely unmasked the risk but the danger has always existed  with other disease like  HIV, hepatitis B, open tuberculosis, Ebola and  half a dozen more communicable diseases.

Doctors and nurses have continued to work along with such risks  but the apathy shown by everyone towards health care workers, have left them  demotivated and discouraged.  

Corona deaths among health care workers are causing tremendous  anxiety.  Conditions under which they are forced to work  are giving   them a feeling  of being  victimised.  All of their years  of accumulated   medical knowledge does not make them  either invincible or  confident  about the future, as there is no uniform mechanism to support their families. The courts have also  failed to give  assurance of any kind.

Once health care workers, doctors and nurses, become a patient  themselves, they realise that their resources are scanty and they are  neither rich nor VIPs, and their families are not assured of a decent compensation.  In such circumstances they realise that they have been made scape goats due to their call of duty and society has no gratitude. A feeling of deep hurt creeps in. A feeling hurt of being  no more than sacrificial lambs in the end.

They feel let down and  abandoned by the world for no fault of their own.

WHY SUCH APATHY? There needs to be a uniform law to support families of  health workers. Moreover, health workers are crucial  for the society, irrespective of their place of work. They may be in Government sector private or in isolated practices.  The  absence of uniform support mechanisms is becoming evident and is enough to dissuade the aspiring doctors to take up challenging roles.

 Compensation given to family members of doctors after their death because of communicable diseases are trivial and  non-uniform. It is little in monitory terms as well as in terms of respect. Death of doctors and nurses has been passed off as something routine and trivial matter. Just for example, it is less than course fee of private medical colleges  or usual  compensations sought by patients in malpractice suits.

      Future medical students should note the trend and count this factor, when they choose to be a doctor.

87k health staff infected with Covid, 573 dead

NEW DELHI: More than 87,000 healthcare workers have been infected with Covid-19, with just six states — Maharashtra, Karnataka, Tamil Nadu, Delhi, West Bengal and Gujarat — accounting for three-fourths (around 74%) of the case burden and over 86% of the 573 deaths due to the infection, official data showed. Maharashtra alone, with the highest number of over 7.3 lakh confirmed Covid-19 cases so far, accounts for around 28% of the infected healthcare workers and more than 50% of the total deaths, according to the data. While Maharashtra, Karnataka and Tamil Nadu had tested more than 1 lakh healthcare workers each till August 28, Karnataka reported only 12,260 infected healthcare workers — almost half the burden in Maharashtra. Tamil Nadu reported 11,169 cases that included doctors, nurses and Asha workers. The three states together accounted for 55% of the total cases among health workers. A large number of Covid-19 infections and even deaths of healthcare workers in particular states is being viewed with concern by officials and public health experts, who say risks to frontline workers can jeopardise India’s fight against the pandemic.

21 occupational risk to doctor and nurses

Are doctors, nurses dispensable disposables

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