Story of the fight inside COVID ward #Indian express


 

At this time, where  CELEBRITIES and REEL HEROES are fighting the war on Television to prove their real worth in CORONA-TIMES as if they are of some use to society; entertain.  Trying to prove as if the name, fame and wealth  showered on REEL HEROES was not an overhype, INDIAN EXPRESS has been wise enough to publish the real fight in the wards and plight of REAL   HEROES. As the stories of the real plight remains confined to medical groups only.  This article has appeared on 12 April Sunday.  Now the time has come to worship the  REAL HEROES and not use them as sacrificial lambs, otherwise in next pandemic only REEL HEROES will be available for good dialogues, and not the saviors.

      The hazmat suit can get oppressive, the separation from loved ones painful, and fear of the virus paralyzing. The Indian Express recounts 24 hours in the life of four doctors and nurses on the frontlines of the battle against coronavirus in the Capital, armed with a few PPE kits, bottles of sanitizers, and — when the stress gets unbearable — Mohammad Rafi songs

Soaked in sweat after a grueling shift, every night, she returns to the Dental Block of her hospital to sleep.The goggles and mask stretched across her face all day leave bruises; the heat, she says, has set off pimples. Her limbs ache from wearing a PPE suit a size too small. What she craves then is a bath, but dreads it too.

“My room is not a dormitory, it’s a laboratory. There are three toilets, no bathroom… I use the jet spray to take a shower. Then I wash my clothes near the toilet and hang them on a railing where clothes of 17 other nurses — all of them exposed to  COVID 19 patients all day — are also left for drying. That’s the moment I break down every day,” says the 50-year-old nurse who was assigned to the special ward of a dedicated COVID-19 hospital. “Dar lagta hai, rona aata hai (I feel scared, I feel like crying)… But I just take a painkiller and sleep.”

 

In another part of the city, a 25-year-old doctor, who has been working in the COVID-19 ICU of a Delhi government tertiary care hospital since March 26, is relying on a pill to stay safe. “I have been taking a dose of  HCQS,  I went to 15 shops to get it, but it was not available anywhere. I finally had to borrow from a friend.

Its effectiveness in treating COVID-19 has not been proven but it’s recommended. I know it can have serious side effects. I read that a doctor in Guwahati died after consuming it. But I am taking my chances,” he says.
On a continuous 14-day shift in the COVID-19 ward before he gets a break for a fortnight of quarantine, the post-graduate resident doctor from the internal medicine department says he loves his job, but fears putting the lives of his elderly parents in danger. “The ICU is the most infectious zone. I have to insert tubes through the patient’s mouth into his airways, put food tubes, catheter, if needed… I am constantly exposed to their body fluids,” he says, adding, “My parents are very paranoid, and insisted on taking the hydroxychloroquine tablets too. But I didn’t let them.”

As the country remains in lockdown, with people barred from stepping out of their homes, a large army of doctors and nurses have been making their way to COVID wards each day and night, treating patients even as they fight their own fears. With the novel coronavirus cases in India crossing 6,000, the burden of treatment has largely fallen on the country’s creaking government healthcare system and its over-worked staff. In Delhi, with over 20 virus hotspots and 14 deaths, at least six hospitals/blocks have been dedicated to the treatment of nearly 1,000 COVID-19 patients, and thousands of suspected cases.

 

the six floors of my hospital are brimming with people, there’s hardly any social distancing that happens. Ambulances are dropping off family after family, all suspects. I am not in a PPE kit all the time, so when I first come in contact with suspected cases, I usually have only a surgical gown and a three-layered mask for protection. If any of them coughs, I shudder… At times such as these, I simply plug in my headphones, listen to Mohammed Rafi songs for a few minutes, calm down, and return to the job,” says the 50-year-old nurse.

Before the shift

These days, the 25-year-old doctor begins his day with a WhatsApp video call to his parents. Since the Cardiac Care Unit at his hospital was transformed into a COVID-19 ICU, he has moved to a separate floor of his house.

“I tell them to prepare my food and leave it at the door. I was given the option of staying at a hotel, but my family got extremely worried and insisted that I stay at home,” he says. He also makes calls to a few friends, mostly doctors, across the country, to catch up with them. “They have been my support. I have to admit that I have been calling them more than usual,” he says. The post-graduate resident doctor, who is now three years into his job, has been working in three shifts — 9 am to 3 pm, 3 pm to 9 pm, and the night shift every third day, from 9 pm to 9 am, after which he gets a day off.

Given the infectious nature of the disease, separation from family is a reality for many doctors across the country, like for a 40-year-old cardiac surgeon from a Delhi government hospital who has also been staying on a separate floor of his house.

“In the mornings, my daughters, 5 and 8, come out in the balcony and we shout out and talk to each other. They have also invented a game — they have named me corona and pretend like they are out to catch me,” says the doctor, who volunteered for a position in the COVID-19 ward in early March.

 

“The distance was necessary because my father, in his 70s, has both a lung and heart condition… I have worked in tuberculosis wards earlier, so my family is used to me taking precautions. But this time it’s a pandemic and so the stress levels are higher,” he smiles.

For the 50-year-old nurse, a diabetic mother and a 10-year-old son at home made her opt for the hostel facility at her hospital. “I have been in the profession for 22 years. I married late to focus on my career. My shifts have usually been long, but this is the first time that I have been away from home for this long,” says the nurse who hails from Goa

So now she spends her mornings talking to her child and husband, often “hiding my worries”. “They read about the staff at the Delhi State Cancer Institute getting infected, they ask me all kinds of things. I just say everything is fine. I have also told them that I don’t have a phone with me, so don’t call me till 10 pm. But I have one; I just don’t want them to call me when I am busy with the patients or when I am too stressed,” she says. “Since it’s Lent season, I also pray for the safety of my family before leaving for work. I have bought some dry fruits and fruits from outside which I eat to strengthen my immunity,” she says.

 

As she enters the toilet in the Dental Block to freshen up, she says, she cringes at the sight of the bucket, mug and towel. “They were used by the staff here before us. I don’t know if they have been disinfected,” she says.
But she is relieved that she does not have to go back home after the shift. “Two nurses at the hospital have been travelling from Noida every day. Their families are exposed to the virus. Once my 14-day duty ends, I hope they test me before sending me home. The 50 nurses who worked before us were not tested, just sent for 14-day quarantine.”

Inside the ward

As per norms, and accounts by doctors and nurses that The Sunday Express spoke to, the COVID-19 wards in the Capital are “well-ventilated spaces with beds placed at least six feet apart and no extra furniture”. They are disinfected with sodium hypochlorite several times a day. Separate toilets would be ideal, but at most places, at least three to six patients share a facility.

“The rooms cannot have air-conditioners because that would lead to stagnant air, an ideal environment for the virus to thrive. This also means that a doctor or nurse can’t wear a PPE suit for more than two hours, because it gets very uncomfortable in this weather. It is easier in colder countries,” says the 40-year-old doctor, whose first challenge upon arriving at the hospital is ensuring social distancing among the large groups of patients who arrive at the reception every morning. The 450-bed hospital he works in has 200 COVID-19 patients now.

“I take two rounds of the wards in the day. I use the stethoscope for auscultation, I have to come in contact with positive patients and suspected cases,” he says.

Around seven people, including nurses, security and cleaning staff, are present in the hospital’s COVID ward at any given time. When not in the ward — there are six COVID wards at the hospital, including the ICU and Flu Clinic — the doctor works from a ‘COVID-19 office’ that has been set up at the hospital recently.

“Recently, a man who had returned from Thailand and had COVID-19 symptoms kept holding his little son in his arms. I had to counsel him for long before he agreed to let him go,” he says. Patients with fever, cough and sore throat first arrive at the hospital’s Flu Clinic to get tested. At least 50 patients have been testing positive at the hospital every day.

 

“I then move on to take stock of PPE, about 15 of which are used in each shift, and then go through patient files, and finally brief all my staff — nurses, ward boys, cleaners — on how to deal with COVID-19 patients. I can also easily tell when one of them is scared, it’s on their faces. I try to be jovial with them, that helps,” says the doctor.

For the Goa nurse, the “fear” is mostly a sinking feeling as she slips into the pink kurta-pyjama uniform at her hospital every day. “It’s washed with clothes of all other nurses. I rub a lot of sanitiser over it,” she says. Her hospital has 600 active and suspected COVID-19 cases, while her ward has six positive patients.

“We are four nurses on a shift, and only the one who goes into the ward gets a PPE kit. The rest are in surgical gowns and masks. But suspected cases are walking into the hospital all day long,” she says. She is part of a group of 120 nurses working at the hospital in three shifts — 7 am to 2.30 pm, 2.30 pm to 10 pm and 10 pm to 7 am.
For a 32-year-old nurse, who is now at home after completing her 14-day shift, it was the “donning and doffing of the PPE that left me anxious… We didn’t have a separate room for changing, about six of us did it together. I washed my hand after removing each part of the equipment,” says the nurse who hails from Kerala and has been working at a Delhi government hospital for the past six years.

A single parent who lives with her elderly mother and child, she says she stays in a separate room at her house, uses a different toilet, and pours Dettol all over her shoes and clothes every day. “Unlike doctors, nurses are not tested after the 14-day shift ends. There was no thermal screening facility at my hospital either. So I am continuing with the precautions,” she says. However, she says, she is relieved that she doesn’t have to wear gloves until her next 14-day shift. “I am allergic to latex powder that is used while wearing gloves. My hands would remain itchy all day. I would wash them all the time.”

Washing his hands 20-25 times is also among the many precautions that the 25-year-old doctor takes every day as he begins duty. “Even in the 20 minutes that it takes to wear the PPE, I wash my hands five-six times. I then head to the ICU, where I have four patients now,” he says.

His three years in the job have seen him being posted in infectious wards before and he is “not scared of the work anymore”. “I once got pricked by a needle used for a suspected HIV patient. It was 3 am and I rushed to get a test. It took six hours for the results to come. Fortunately, it was negative. Such incidents will happen, you can’t avoid it,” he says. He will be tested for the virus when his 14-day duty ends.

With no family attendants for the patients, doctors and nurses end up doing a lot more work. “Changing diapers of elderly patients, emptying urine bags… all of this carries chances of infection.”

And then there are the “VIP patients”. “Some of these patients are frustrated at not having found a place at private hospitals. Food complaints are a constant,” he says.

 

VIP patients have made the 50-year-old Goa nurse’s “life difficult” too. “They all have mobile phones, and they keep calling the landlines and our mobile phones, asking for chai, juice, their reports. Once, a patient accused me of hiding his reports… They complain about the cleaner, electrician, ward boy, and they blame nurses for everything. Hum kisko bolein (Who do we complain to)?” she says.

She serves food to patients three times a day in disposable plates and glasses. “It comes from the hospital kitchen — roti-sabzi, dal-chawal. If a patient is diabetic or has any other underlying condition, the diet is changed accordingly,” she explains.

The 40-year-old doctor says it’s normal for patients to be frustrated.

“They are away from their family, there is no emotional support. For a significant part of my shift, I double up as a counsellor. Recently, a young patient sat on the window sill, flung his legs out and threatened to jump. I had to pull him in. I later realised he was a drug addict and was experiencing withdrawals,” he says.

As for his own mental health, says the 40-year-old doctor, “Knowing the science behind the spread of the virus, and not relying on ‘WhatsApp and Facebook science’ keeps me sane. I have been following reports from Wuhan and Italy. It’s going to be a long journey. We can’t lose steam this early. My thoughts are similar to that of any soldier.”
To keep his staff healthy, the 40-year-old doctor also ensures that they eat on time.

“I get my food from home,” he says, adding that the staff takes turns to eat, and ensure social distancing.
The 50-year-old nurse says food is one thing they don’t worry about. “We recently got meals from Taj Hotel. It was very tasty,” she says. However, she has been taking care not to drink too much water so as to avoid using the toilet. “We have to remove the entire suit to use the toilet, and then disinfect. Plus, going to the toilet, which the other nurses have also used, only adds to my stress. COVID shift mein physical se zyaada mental stress hai (There’s more mental than physical stress while in COVID shift).”

So what does she do to fight it? “Apart from listening to old Hindi songs, I lean on my friend of 22 years. We started out together as nurses. We share our concerns and motivate each other,” she says. “I like to take care of people and that is why I became a nurse. But we need some care too.”

After the shift

After a long day at the hospital — that can range between six and 14 hours — the 25-year-old doctor begins his “return home routine”. “I first take a shower at the hospital and inform my parents that I am leaving so that they can leave my food outside my room. There is a sanitiser in my bag, in my car, at entrance of my house, at the door of my room and in my bathroom. I use them all. I keep the used plates and my clothes in a polythene bag outside my room. There is a separate bathroom for washing these,” he says. “My parents often ask me if the risk is worth it. I think it is.”

How often does the fear of contracting the virus cross his mind? “I have thought about it many times. If that happens, I will get admitted at Max or Medanta Hospital,” says the 25-year-old.

As for the 50-year-old nurse, when she returned to the Dental Block on Thursday night, she was filled with hope. “There was a protest by off-duty nurses for accommodation. The doctors are being put up at five-star hotels, why not us? Today we were told that some of us will be shifted to a new place, where there will be two nurses per room and an attached toilet,” she says. “I want to take a proper bath.”

Till then, the painkiller and Mohd Rafi melodies will keep her company for another night.

 

Strengthen hands of medical staff

Over 150 healthcare workers, including doctors and nurses, have tested positive for coronavirus so far. On the frontlines of the battle against COVID-19, the country’s health professionals have so far flagged issues such as shortage of personal protective equipment and lack of accommodation, besides being stigmatised as carriers of the virus.

 For the government, this then is the time to acknowledge some of these concerns and strengthen the hands of the medical fraternity. The ordering of 1.7 crore PPEs in the past week is a step in that direction.

 

Inside the COVID ward- Indian Express

Reel Hero vs Real Hero

21 occupational risk to doctor and nurses

Russian Doctor arrested for Challenging Virus data. Administrator’s refrain


The police held overnight an outspoken Russian doctor, Anastasia Vasilieva, who was trying to deliver masks to an impoverished rural town.

MOSCOW — Russian authorities detained the leader of an independent doctors’ union, an outspoken critic of the Kremlin who has dismissed as “lies” the country’s low official numbers for coronavirus infections.

Anastasia Vasilieva, the head of the Alliance of Doctors, was stopped by the police on Thursday and held overnight while traveling from Moscow to an impoverished rural town to deliver masks, gloves and other supplies to a local hospital, a colleague who was traveling with her said.

Earlier a Chinese doctor Li Wenliang, one of the eight whistle-blowerswho warned other medics of the coronavirus outbreak but were reprimanded by the police, died of the epidemic on Thursday, official media reported. Li, a 34-year-old doctor who tried to warn other medics of the epidemic, died of coronavirus.

       Administrators and regulators refrain to study data that would establish and quantify the occupational hazards of being a doctor and nurses. Some of these hazards may be known, but there is no comprehensive analysis of workplace risk for physicians and nurses, like those that have been done for other professions. Perhaps society prefers to remain blissfully ignorant of the sacrifice and risk their doctors  and nurses take on.  Perhaps we  all despise to let reality and data shatter the illusion

The detention of Dr. Vasilieva, an eye specialist who has been highly critical of Russia’s response to the pandemic, added fuel to already widespread skepticism, particularly among Kremlin critics, about the accuracy of official figures showing relatively few cases of the virus in Russia. Her detention also increased skepticism about the readiness of Russia’s health care system to cope with the pandemic.

A group of doctors at a hospital in St. Petersburg, Russia’s second biggest city, released a video on Friday appealing to the public for help in obtaining the protective equipment they said they needed to treat coronavirus patients.

Maria Bakhldina, the head doctor at the hospital, speaking to Fontanka, a news site in the city, dismissed the doctors complaints as “untrue.”

Views on how far the virus has really spread in Russia and how prepared the country is have been largely determined by political leanings. The general public, which mostly supports President Vladimir V. Putin, has voiced little concern while many of the Kremlin’s opponents suspect a cover-up.

Aleksei A. Navalny, Russia’s most prominent opposition leader, recently accused the authorities of lying about the number of tests carried out and suggested that, as a result, the number of cases could be much higher than reported.

Russia has sharply stepped up testing and now says it has conducted more than 575,000 tests, but this includes cases of multiple tests on the same person, lowering the head count.

In an address to the nation on Thursday, President Putin, holed up for most of the past week in his country residence outside Moscow, praised health workers for “holding the line of defense against the advancing epidemic” but acknowledged the worst is yet to come.

Dr. Vasilieva, the detained physician, set up the Alliance of Doctors last year in part to counter the Kremlin’s claims of dramatic improvements in funding and other support for hospitals. She has treated Mr. Navalny as a patient and affiliated her group with his. The authorities arrested her last year for rallying opposition to the closure of a tuberculosis clinic in a poor region of southern Russia.

Mr. Putin’s approval rating, according to a recent survey by the Levada Center, a respected Russian polling organization, fell from 69 percent in February to 63 percent in March, near to what it was in 2014 before a surge in the president’s popularity after Russia’s seizure of Crimea from Ukraine.

In his last public outing early last week, Mr. Putin visited a new state-of-the-art infectious diseases center, Hospital No. 40 in Moscow, escorted by its head doctor, who this week tested positive for the virus. The Kremlin said that Mr. Putin has been tested regularly and that “everything is O.K.”

Russia on Friday reported 601 new infections, down from 771 new cases reported on Thursday, bringing the total number to 4,419. This is a fourfold increase over the past week but still far fewer than the more than 245,000 cases reported in the United States and nearly 118,000 in Spain and 115,000 in Italy.

Critics of the Kremlin, however, have questioned the official figures. Dr. Vasilieva, the detained doctors’ union head, said in a video late last month that authorities were lying about the true number of infections, accusing them of deliberately misclassifying people who had developed the disease as victims of ordinary pneumonia.

A few days later, she said she had been called in for questioning over her comments, declaring defiantly in another video that “You can send whomever you want to get me — the Federal Security Service, the fire service — but the truth will not change.” The real number of coronavirus cases, she said, “is much higher than the authorities say.” She provided no evidence of any cover-up.

Her medical workers’ union, warning that Russian hospitals were desperately short of masks and other protective equipment, recently started a fund-raising drive online to raise money from the public to buy supplies for hospitals and clinics.

The government, too, seems worried that it may need to do more to control the virus. On Friday, it suspended the last remaining flights into the country, halting even special flights bringing Russians home from abroad, the Interfax news agency reported. All land borders have already been closed.

Moscow, St. Petersburg and many Russian regions this week ordered residents not to leave their homes except to buy food and medicine or walk their dogs close to their residence.

Dr. Vasilieva was stopped by police officers on Thursday while attempting to deliver supplies by car to a hospital in Okulovka, northwest of Moscow, according to Natalia Kolosova, a colleague who was traveling with her. “They were clearly waiting for us,” Ms. Kolosova said, noting that police officers had set up a check point at the entry to Okulovka but stopped no other vehicles.

Dr. Vasilieva appeared in court on Friday charged with disobeying police orders and violating quarantine restrictions. She was released on Friday evening after being ordered to pay a small fine.

Natalia Zviagina, director for Amnesty International in Russia, condemned the detention, saying in a statement that: “It is staggering that the Russian authorities appear to fear criticism more than the deadly Covid-19 pandemic” caused by coronavirus. By detaining Dr. Vasilieva, she added, the authorities show “they are willing to punish health professionals who dare contradict the official Russian narrative and expose flaws in the public health system.”

Okulovka hospital’s head surgeon, Yuri I. Korvin, also a critic of the authorities, had been ordered to stay away from the hospital and self-isolate for two weeks because he had had contact with Dr. Vasilieva, Mr. Sokolov said. Police officers involved in her detention, however, were allowed to keep working, he added.

Mr. Sokolov said “nobody knows the real number of infections” and added that residents in Okulovka were alarmed by a recent flood of people arriving from Moscow and St. Petersburg. Fleeing quarantine restriction and high infection rates in their home cities, urban residents have been fleeing to rural towns like Okulovka to take shelter at country homes.

“None of us know where these people have been or whether they have been tested,” he said.

reel heroes vs real heroes

21 occupational risk to doctor and nurses

administrators refrain to study  risk to doctor and nurses

Lock-down essential to prevent knock-down


Imagine what would have happened if religious functions, social functions, conferences, marriages and birthday functions,  social gatherings or normal transport would have continued for many more days.

Social distancing is the key element to prevent the Coronavirus spread.  But not everyone among the masses has the ability to understand the urgency from the very beginning and own up responsibility for social distancing. It is the responsibility of each and every human being to prevent the spread. But a significant number of people failed to do it from the time that was crucial. The time for basic understanding and wisdom to prevent at individual level varies from person to person.

Social distancing to be successful has to be strict and imposed in a totality. Police patrolling, drone surveillance, camera surveillance may be needed for a longer duration in view of the current crucial phase that may lead to community transmission.

Online consultation or teleconsultations need to be strengthened to avoid unnecessary contact.

Doctors and nurses need to be protected as they can be crucial links for treatment.

As it is a totally preventable disease, so lock-down has to be more complete and strict. It cannot be left to individual wish to quarantine. Once it happens, doctors can not treat it, whereas people can prevent it from happening.

So strict Lock-down is much needed to prevent Knock-down from community spread.

How to implement strict lockdown

Global clap-doctor and nurses

Global clap for Doctors-Nurses; ‘God in only Corona-times’==Looks opportunistic & temporary


 

In times of Corona- war, what doctor and nurses really wish and need is uniform applause all times, genuine legal regulations,  freedom from industrial enslavement and sensible or true projection from media. Much needed are PPE’s,  good protective gear and an environment, where the voice of “every worker with patients” is heard.

An applause or clap for a specific and short time under the shadow of Corona looks opportunistic and temporary. The continued attacks on doctors, even on the doctors looking after Corona patients, just indicate, how deeply disrespect and hatred for saviours have been encrypted in the minds of people, especially by insensible statements from media and celebrities. The hatred and instigation had come from the people, who have not treated a single patient in their lifetime.

Before Corona episode exploded, doctors and nurses continued to work with the burden of mistrust, legal complexities and hurt. They were working and saving lives before as well. Despite doing good they were on receiving end of imposed consumerism, battling legalities, subject of public violence without much support from any quarter. The insult and assault on doctors were considered business as usual. The ridiculous attitude and beating of doctors were thought of as natural reactions of emotional mobs.

Most of Media and Celebrities earned applause, fame, money,  for themselves by spewing venom and citing stray incidents as generalization against the medical community.   Hence instigating and turning the opinion of masses against health workers.

Although it was good to see an overnight change in the attitude of people and media, as Corona-war was declared. But at the same time, continued episodes of violence against doctors gave an indication that it may be a temporary satisfaction for doctors and claps or applause may live only till Corona fear.

If it was a true applause, why it was not done before Corona exploded. After all,  doctors were doing their work before as well.   Sudden applause comes now in view of the risk to their life as a professional obligation, without proper PPE’s and deficiencies in protective gear.

Doctors and nurses just need PPE’s, good protective gears and a  safe environment.  Children of today, who inspire to be doctors, are watching with anxiety, the treatment given to saviors. An opportunistic or temporary applause without any concrete support will  not inspire good doctors or nurses in the future.

 

 

Reel Hero vs Real Hero

Blaming  doctors for the death of coronavirus patient family members attacked them Hyderabad 

“Battle of Corona”-Win or loss in People’s hand: not doctors or Governments


 

This is a disease that people can prevent, but doctors cannot treat.

Prevention is better than cure

In this era with knowledge of modern medicine, we know how to prevent the infection from Coronavirus. This is a completely preventable infection and everyone has enough knowledge about it. Heads of Governments requesting people to follow rules of prevention. Strangely these rules are not difficult. Hon’ble Prime minister Mr. Modi has himself requested people to follow simple precautions. Imagine if just by following simple rules can prevent a catastrophe in countries, world and families,  there should be no reason to not follow them.  If it happens, it shows the sheer carelessness and irresponsible attitude of people.  The success or failure or winning the battle against Coronavirus will not be of doctors, but people themselves.

This is a disease that people can prevent, but doctors cannot treat.

India Ahead News Video

Corona Virus unmasks danger to nurses and doctors, which administrators prefer to refrain or oppress


 

Working of a doctor and nurses has never free from risk to themselves. The risk is generally underestimated, although it often involves major  risk  to their  life. Problem is that  majority of people, society, governing bodies  and even doctors themselves do not perceive or acknowledge  many times  the risks seriously.  Deadly Corona virus has unmasked and unveiled the danger to nurses and doctors,  the topic often suppressed, shunned by administrators and those who govern.

    An extreme example is the Chinese doctor, who was reprimanded, humiliated and made to apologize for doing right.  But this one example  is tip of the iceberg, for the Global phenomenon, where risk to front line workers is ignored routinely. They are just taken as  the routine workers, who have consented to be sacrificed. Chinese doctor Li Wenliang, one of the eight whistle-blowers who warned other medics of the coronavirus outbreak but were reprimanded by the police, died of the epidemic on Thursday,

 

  As per reports, 40 staff members of Wuhan hospital are  infected with Virus.

    Administrators and regulators refrain to study data that would establish and quantify the occupational hazards of being a doctor and nurses. Some of these hazards may be known, but there is no comprehensive analysis of workplace risk for physicians and nurses, like those that have been done for other professions. As physicians, we have a sense of the risk, and yet we remain engaged, continuing to care for our patients as we know  “these things” happen. Perhaps society prefers to remain blissfully ignorant of the sacrifice and risk their doctors  and nurses take on, comforted by the fantasy of the serene  hospital. Perhaps we  all despise to let reality and data shatter the illusion.

   But since  these risks are increasing exponentially every day, because of unknown and mutated germs (bacteria and viruses),  awareness is needed.  There are lesser set procedures, lack of awareness, not protective equipment or supportive society, governance and  laws, at most of  the places globally.  doctors  and nurses continue to work  in danger zones. These risks can be of varied types and contracting the diseases is just one of them.

Patients carrying specially unknown germs are  handled by doctor and nurses, who have no clue, what they are dealing with.   Time gap in such  patients coming to the  hospital  and  the exact diagnosis of finding a dreaded disease, may be  quite dangerous to doctors and nurses. To add to the problem, In  large number of patients, exact viruses cannot be diagnosed or even suspected. In many cases of ARDS, the causative organism cannot be  isolated or identified.  It is important for  doctors and nurses  to take universal precautions at every level. There can be many more viruses or germs which are yet to be discovered or mutated ones that  are unknown.

H1N1, Zika,  Ebola,  SARS  are few examples,  just to imagine that they existed and handled by health workers as unknown germs, till they were discovered.

Worst part is that our systems are not defined to prevent, treat or compensate or even acknowledge for these big disasters, if it happens to healers. These problems are not known to students, when they decide to take medicine, nor they are taught in medical school. Most of the time they have to fend for themselves, if problems occur.

Everyday globally, the doctors and the nurses  greet the new day and return to their work of taking care of their patients, knowing well the risk  involved.

Maybe it is time that we are little more aware  and acknowledge that even doing everything in best manner and honestly, they are in a  conflict zone and  are all in harm’s way. Just be careful and be mindful that  doctors, nurses, and healthcare workers,  may get  sickened, injured, disabled even  as they care for their patients in best manner.

21 occupational hazards to nurses and doctors

Pay millions to be a doctor?: welcome to “ring on fire” #NEET


Being a doctor has become a disadvantage in itself, thanks to our media and celebrities projecting the saviors  in bad light. They are now seen as harbingers of death. Morale of doctors has been at rock bottom and community is devastated.  A society that believes more in fairy tales told by “Reel heroes” has turned prejudiced and preposterous towards “Real  heroes”.  The medical profession reeks of desperation and desolation with apathy from government, indifference from courts and silence of human right commission to salvage them from decrepit state. At the best, they have been reduced to punching bags and scape-goats for inept medical systems or cheap labour to industry.

Problems faced by doctors are not only innumerable but are also so exceedingly complex and diverse that they are difficult to be analysed. It is common to listen doctors discussing these problems whenever one of these crop up. If so many doctors feel so disgusted about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession. The challenges in this profession are too many and difficult to analyse.
  1.     Medical courses are Comparatively lengthy and expansive study course and difficult training with slave like duties: that I have discussed in one of my previous article on “enslavement of doctors”.
  2. Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialize. Because of lesser seats in post graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice. They have to just flow with system ultimately.
 3. Hostile environment for doctors to begin: Suddenly young, meritorious and bright children who came out of training find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and prejudiced  beliefs of society.

  1. Difficult start of career of doctors: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and half treats them as cheats and dishonest. Their work is seen with suspicion and often criticized.
    5.The fear and anxiety about the actual treatment,  favorable and unfavorable prognosis of patient, keeps mind of a doctor occupied.
    6. Doctors are blamed for all malaise:The society gets biased because of the media reports and some celebrity talking glib without proper understanding of inept medical system , administrative failure and complexity of medical industry.  These lead to formation of generalized sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
    7.Doctor’s personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.
    8.Risk to doctor himself:     Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include tuberculosis and other bacterial and viral illnesses. Radiologists and interventionists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.  21 risks to doctor and nurses
    9.Unrealistic expectations of society: Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative  is enough to spoil the mood for the day.

10.Retrospective analysis of doctor’s every action continues all the life-It could be by patients and relatives every day in the form of “ Why this was not done before” ? Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving. Or it could be by courts and so many regulatory bodies. Unfortunately, if there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.
In these court cases, the doctor is at disadvantage since his decision which is now being questioned was taken at that time in good faith using all his wisdom. The decision in retrospect may not turn out to be the best one, but later retrospective analysis along with wisdom of hindsight over many years, may label it as faulty if a fault-finding approach is used. This along with general sentiment and sympathy with sufferer makes medical profession a sitting duck for punishments and lawsuits. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation will be full and almost permanent. No doctor has time to pursue such things all the time. Even if such events don’t happen to everyone, the very fear of such possible scenarios and their possible complications always lurks in the back of their mind.
11. Physical assault , routine instances of verbal abuse and threat  happen for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. The threat of physical assault is quite real as well. Recently, even female doctors have not been spared by mobs. Silence of prominent social people, celebrities and society icons on this issue is a pointer towards increasingly uncivilized mindset of society.  Even female doctors  are being assaulted.
12. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community, is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.
13. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: I have seen zero fee and fixed commission ads on television by lawyers in health systems in certain developed countries. They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations. This encouragement and instigation of lawsuit against doctors is a major disadvantage for medical profession.

14.Overall, a complex scenario for doctors: There is increasing discontentment among doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients. They are also supposed to maintain meticulous documentation and also supposed to work under norms of medical industry. They are supposed to see disproportionately large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

With so many adversaries, the situation is like sailing a small boat in a tornado.
At present, with this mind-set, the losers are the doctors and medical profession. But the society should be able to foresee its overall loss in the long run if these practices continue.

 

#Expensive-modern-health-care: Reminiscent of an ancient realm of medical regulation #Medical-lawsuits


With the evolution of medical science and medical care intertwined with  medical business, braided changes in  medical  regulation is not an far off expectation. But reticulation of evolution to modern medicine  and health care has not happened  in  isolation. Simultaneously there has been  progressively complex emerging trends in medical business and changing patterns of health investments along with an era of corporate investments in health care  has also ushered.  Every one now wishes  to live longer  and  dreams of better quality of life with support of progressive medical care.  Opportunities projected by advancements in health care, have shown that these dreams can be a real possibility, in many cases. That kind of perception has given patients a hope in lieu of some money. With rich people willing to spend more, the insurance sector and corporate invested money into health care, which was unthinkable few decades back in the  past.  This reticulation of business and  health care really took away the profession from control  of doctors. As it is no more simply treating a disease and involves many more issues.  New model of business in  health care is  still  not a mature process. It has emerged and progressed in  just  for few decades, as compared to  medical treatments and systems that existed since ancient times. It is still in infancy and still has to go a  long way to do real justice to every one.   No one really knows how to regulate 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. Most difficult part is  amalgamation of  intricacies of science with minds of  patient and doctor’s skill in  newly evolved milieu of financial complexities.  Results are not encouraging for the profession.

 An effort to govern or  regulate the medical profession  is not new. Hammurabi  had initiated to  write the rules of the game. This single professional species was managed with cruel regulation 5000 years ago, that initiated a change in the global perception and regulatory system in radical and unprecedented ways.

Hammurabi,  5000 years ago,  was  not even at the   doorstep of medical science, but he  promulgated some rules. It is difficult to say whether he was naïve or  brilliant  enough to make it more mathematical. He fixed  heavy prize for saving lives and used to  cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved.   After thousands of years, with some scientific advancements, our regulation has remained more or less similar in basics. It is still based on principles of revenge and punishments. Now clearly  knowing well the limitation of medical science and the uncertainties and complexities of human body in better way, it still  remains  somewhat  unfair to doctors.  In other words, it has not attained enough  evolution and maturity.

  Hammurabi at the start of civilization believed that doctors needed to be punished in case there was poor prognosis. He failed to understand the complexity of human body and the limitations of medical  science, most of which was unknown at that time. By an application of average wisdom, doctor can be easily blamed for poor outcome, because he is always a common link between treatment and poor prognosis. Stricter punishments were imposed to  regulate medical profession, even  when the medical science was not even developed enough to deal with most of diseases.  Children are always taught in school that medical profession is a noble one. But they are never told, about the cruelty this profession has faced since ancient times.  Almost universally, the earlier work or contribution of  a doctor  to society is  not taken into account.  Even for complexities of medical science and uncertainties of the outcome, blame can  conveniently be  passed on doctors by application of average wisdom.

    Hammurabi’s Codex specified the harshest form of deselection of health providers possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. Therefore, a single mistake can undo all the good work of past or the future good work that could have been accomplished. Problem here is that who can differentiate with certainty the real cause of sufferings of patient, a poor prognosis or a mistake.  Such  regulatory systems will dissuade  other good people joining the profession, again  resulting in  further inhibition and flourishing of profession for the good.  Obviously,  harsher  penalties will discourage a physician surplus.

Today the global  system of medical regulation, is becoming somewhat  similar, to those ancient regulations in  terms of punishment and revenge. Differential payment system for health care also resembles the Code of Hammurabi in some respects. And this is despite the fact that now we are very well conversant with the known uncertainty and complexity of the human body and despite cognizance of the poor prognosis in many disease states.

In an effort to institute  a  well controlled  healthcare, our society is in a way re-entering the realm of an ancient medical regulatory  system. Certain aggrieved health care consumers may welcome a move toward harsh penalties in the name of justice and simply for revenge but we need to keep in mind the  poor outcomes in complex diseases, limitation of science and of course the idiosyncrasies of the human body. Evolution of medical legal system and medical regulation has to evolve and mature, to enjoy  benefits of medical advancement to the fullest. Fear factors and  Impact  of present legal complexities,  on doctors  is  already on a par with that of  Hammurabi  era.

Re-blogged

Working night shifts (#doctor&Nurses) may cause DNA damage, risk of cancer & Heart diseases


        Medical profession getting stressful is nothing new.  There are multiple dimensions to  the multi-pronged stress in present  era.  A new dimension has been discovered. Night shift are integral part of a hospital, doctors and nurses life. But it has shown to be having far reaching consequences. Night shifts have been linked to DNA damage and more serious illnesses.   If these kind of effects prove to be correct in future, it  needs a serious thinking over the issue.

    Researchers found that on-call doctors who were required to work overnight on-site had lower DNA repair gene expression and more DNA breaks than those who did not work overnight.

Working night shifts can damage a person’s DNA, increasing the risk of cancer as well as cardiovascular, metabolic, and neuro-degenerative diseases, a study has found. For the study published in the journal Anaesthesia, researchers analysed blood samples of 49 healthy full-time doctors taken at different times.

“Although this work is very preliminary, it is clear from the results that even a single night of sleep deprivation can trigger events that may contribute to the development of chronic disease,” said Siu-Wai Choi, of the University of Hong Kong.

Researchers found that on-call doctors who were required to work overnight on-site had lower DNA repair gene expression and more DNA breaks than those who did not work overnight. In these overnight on-site call doctors, DNA repair gene expression decreased and DNA breaks increased after sleep deprivation.

Damaged DNA increased after only one night of sleep deprivation. This DNA damage may help explain the increased risk for cancer and cardiovascular, metabolic, and neurodegenerative diseases associated with sleep deprivation, researchers said.

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