Raouf Rasool

COVID-19: Praise them as warriors, but doctors are not Kamikaze

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A bomb disposal squad being summoned to go and inspect and then also neutralize a ticking bomb is normal. What is, however, not be normal is to ask the bomb experts to do it with bare hands, without proper tools and necessary protective gear that are needed to carry out this dangerous job.

This is exactly what seems to be happening today. The doctors, paramedics and other support staff are asked to deal with the COVID-19 pandemic without being given the PPE that would ensure their own safety while they are on the job.

“Doctor, you will go to the quarantine centres and check on the people housed there.” This phone call from the Director Health Services to a senior consultant unnerved the poor medic. “It will be done sir, but I will need PPE for it.” But the person on the other side of the phone simply laughed it away. “Where do you think I could get it from? We don’t have it right now. You better go and do what you have been told!”

Pushed to the wall, the doctor couldn’t argue much, because he knew that those placed higher up in the administrative hierarchy are not habitual of listening to reason and logic. They only issue orders down the string and then expect compliance from subordinates – no “excuses” please!

“We are being put in the harm’s way. We are not even being given N-91 masks leave aside other protective gear, and yet they expect us to be of help,” lamented the doctor as he left his office chamber to head for the quarantine centres.  Now it is not known how far he will be able to deliver – because after all, he has to fend for his personal protection too, which unfortunately seems to have slipped off the official priority list.

Occupational safety and health of the health professionals, including the infection prevention and control (IPC) and personal protective equipment or PPE (masks, gloves, goggles, gowns, hand sanitizer, soap and water, et. al) seemingly never really figured among the essentials. This is why there is increasing incidence of health-care providers also falling prey to the corona pandemic.

It is the same situation everywhere, including in the developed West where the medical professionals are similarly grappling with the shortage of PPE, for instance. But here the situation is far worse.

Thus far the response to the disease in India, and particularly in Kashmir Valley has been more on politico-administrative levels than dictated by the medico-scientific needs. Politicians and bureaucrats, given their limited understanding of scientific management of the emergent crises, are actually creating more problems than solving any.

Now see if a doctor or other support staff is without the necessary PPE, which is the reality on ground, expecting them to be of any help to the corona positive subjects or the suspected cases housed in official quarantine centres, is outlandish. This way the authorities are not only putting the affected subjects at risk but also risking the lives of the medical staff.

Unfortunately, it seems that the doctors and their support staff, who are being eulogized, and rightly, as “frontline warriors” in the fight against COVID-19, are expected to work like Kamikaze. It needs to be understood that doctors and paramedics are, by orientation and training, predisposed to save lives. Warriors we may choose to call them today so as to encourage them, but we cannot imagine them to behave like a suicide bomber or a soldier on the frontline. Job profile and training of the latter prepares him for taking away enemy’s life or laying down his own. We cannot expect a doctor to put his own life and that of his/her family on the line. Their worldview of life and job is different than that of a soldier. And it is this difference which makes them who they are. If we expect them to be of help, we have to support them with whatever they need. And they need PPE more than the public praises, noisy claps, beating drums and ringing bells!

Another important area is that of isolation and quarantine. A cursory look on the meaning of the terms shows that these are public health practices used to protect the public by preventing exposure to people who have or may have a contagious disease (say COVID-19). While ‘isolation’ separates sick people with a contagious disease from people who are not sick; ‘quarantine’ is a procedure that separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick. These people may have been exposed to a disease and do not know it, or they may have the disease but do not show symptoms.

What is happening in the quarantine centres here is that people suspected of having contracted the infection are brought to the facility and housed there in small batches of few individuals and then watched – to see if any of them develops symptoms. Based on what’s currently known about how long symptoms of COVID-19 last, the recommended length of quarantine is 14 days. The goal is to prevent spreading of the virus by separating infected or those suspected of being infected from other people long enough to determine whether or not they show symptoms. However, the way quarantine facilities are functioning here, there is every chance that someone carrying the infection but not showing any symptoms as of now, may pass on the virus to others while being quarantined with them.

Without ascertaining who is affected and who is not as the requisite tests are not being conducted as extensively and as promptly as required, authorities are creating conditions for more infections by indiscriminately putting together all sorts of people in quarantine centres where each room houses several people – sometimes as many as a dozen or so.

Until now, globally, the only effective tool to deal with the COVID-19 is social distancing. But this rule is observed in absolute breach here even inside the designated quarantine centres. This is dangerous. And this is perhaps why that people are not heeding repeated appeals to volunteer for quarantine, and are instead doing whatever they can to avoid it – creating still more dangerous situations.

At a place where public healthcare system is in shambles, people look with suspicion at the government’s efforts to battle the Covid-19 disease, creating a multitude of very tricky complications for health authorities to grapple with. This was illustrated by the past week’s incident in the Srinagar’s JLNM Hospital where some people housed for quarantine went on rampage and destroyed hospital paraphernalia before making good their escape from the place. Absolutely deplorable their action is, and merits all condemnation, but it is also a reality that the facilities that have been put up to deal with the pandemic are far from being satisfactory.

By the way JLNM hospital incident is not the only such case. There have been countless such incidents elsewhere as well. On March 09, a coronavirus suspect escaped from a government hospital’s isolation ward in Mangaluru, arguing that he preferred to seek private treatment. At the Indian Army’s quarantine facility in Manesar, patients created a ruckus for better facilities, and police had to be called in to control the situation. In Agra, unsanitary conditions of the city’s Kasturba Hospital, which is acting as an isolation ward, went viral. People have been complaining about the sanitation in isolation wards at other places as well.

So low is the trust in public healthcare that people have been trying to avoid the public system even when they know that private healthcare does not have the capacity to tackle the problems posed by Covid-19.  This extreme lack of trust in public health system is not surprising. India has one of the weakest health systems in the world, with abysmal health indicators. India spends only 1.28 percent of GDP on public health, which is lower than the proportion of national income spent by the poorest countries like Liberia, whose per capita GDP is one-seventh that of India. Pertinently, as per the World Bank, countries classified as lower income spend 1.57 percent of their GDP on public health.

Being in the proverbial backwaters of political executives’ priorities, Kashmir’s public health infrastructure is bad at the best of times, and could be catastrophic during a health emergency like Covid-19. This is the unfortunate reality that is winking at us!

The public nature of the COVID-19 infection demands that public health authorities take the lead, as “frontline warriors” in real sense. But they can do so only when they are properly handled, guided, trained and equipped with the necessary wherewithal, and not just made into sitting ducks before a deadly virus which does not differentiate its victims on the basis of their professions or other markers of their respective identities.

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