In Uttar Pradesh, doctors engaged working in coronavirus testing centres of the state have to face manifold challenges. They are not only at the risk of contracting the contagion but also have to battle administrative apathy and insults from neighbours; add to this the lack of standard personal protection equipment.
We surveyed two COVID-19 testing centres of UP—the King George’s Medical University (KGMU) in Lucknow and the Jawaharlal Nehru Medical College (JNMC) in Aligarh—to assess the conditions in which healthcare professionals operate; both institutions were found wanting.
King George’s Medical University, Lucknow
At the King George’s Medical University, doctors and residents are being threatened for asking for WHO prescribed N-95 masks. On the 28 March, I received a call and a text from a senior resident doctor from the KGMU: Requesting anonymity, she told me that the doctors working in the coronavirus ward do not have N-95 masks or Personal Protective Equipment (PPE) units. This becomes even more critical as a doctor working there was tested positive.
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She said doctors there work using a makeshift safety kit and put on triple-layered surgical masks to stave off infection. The doctors and hospital staff claimed that they were neither provided with proper shoe covers nor headgear while working in the coronavirus ward.
On 27 March, a circular was issued by the Chief Medical Superintendent (CMS) claiming that a day’s salary of all the doctors, nursing staff, and even the 3rd and 4th - grade employees would be deducted to cover the cost of procuring the three-layer surgical masks. I have reviewed this circular.
The doctors of KGMU are upset not just because the three-layer surgical masks are ineffective against the coronavirus but they were aggrieved as none of them was consulted before making the decision.
After the intervention of the Resident Doctors Association and the KGMU Employees Union, the order was rescinded with a separate notice. The notice stated that the requirements for masks and other equipment have been fulfilled, but in reality, the hospital authorities only procured surgical masks.
Resident doctors told me university administration and hospital authorities are now threatening to dismiss or suspend those who maligned the image of the university and are blaming the doctors for refusing to cooperate.
This is the subsequent order rescinding the prior order. Courtesy @Avanish53464570 pic.twitter.com/DmW9Y1M0hd
— Rudrarpan Chatterjee (@reallyrudi91) March 28, 2020
Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh At JNMC, doctors and the residents said they have to "fight with their consultants, the university authorities as well as risk exposure to coronavirus" in order to fulfil their duties. They have recently managed to obtain N-95 masks while working in or near coronavirus wards. Kashif (he uses just one name), the secretary of the Resident Doctors’ Association (RDA) said, “We had to fight with the heads of departments and the CMS for two weeks continuously to get the basic supply of masks and an acceptable replacement for PPE. That too, they give us bare minimum. We have been supplied 150 masks even as there are 300 residents on duty every day and a total of 750 on campus.” Rehan (he uses just one name), from the Department of Medicine, said the masks are "just enough to cover" doctors treating patients in the coronavirus and fever wards, but they have none to spare for the nurses or the supporting staff. “It is like they forget they are humans, too. They have much more exposure to the patients than any regular doctor, and yet, they are made to be much more vulnerable,” he said. “The fight with the hospital authorities wasn’t just a verbal spat. The CMS never directly told us he would not fulfil our rightful demands of being given proper equipment. He just failed to do so each time until we were forced to go on strike,” said Kashif. “On 27 March, we were forced to shut down the fever clinic as we had no protective equipment and no consultants were sitting with the residents at the OPDs. After five hours, we resumed our duties on the assurance of the principal, JNMC that our demands shall be met. However, it has been some time since the assurance and nothing has been done as of now,” he said.
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"हमको डर है कहीं बेमौत न मारे जाए" आरडीए जवाहरलाल नेहरू मेडिकल कॉलेज के जूनियर रेजिडेंट बिना ज़रूरी सुरक्षा के ड्यूटी करने पर मजबूर हैं।जिसको लेकर पिछले कई दिनों से जिम्मेदारों से इसकी बात की जा रही है, लेकिन मांगो के ना माने जाने पर आज डॉक्टर मजबूर होकर कोरोना क्लीनिक से ड्यूटी खत्म करने पर। जेएनएमसीएच के रेजिडेंट डॉक्टरों की मांग है कि हॉस्पिटल पर्शाशन उन्हें PPE दिलाए तभी वो काम पर लोटेंगे। #PPE #Protection_for_protectors A post shared by JNMC,AMU Bulletin (@jnmc_bulletin__amu) on
On being asked about PPE, Rehan said: “We have lost hope of getting PPE practically speaking. The first kit that the college had provided us with was a joke. It was a piece of cloth, or plastic covers, to be put over our coats, as PPE.”
Doctors working at the fever clinic with cloth head covers. Image courtesy Ansab Amir Khan
“Then, they had asked us to work with HIV suits, which have the entire area around the neck and the head exposed. While taking throat swabs, it makes the doctor extremely vulnerable to catching the virus,” Rehan said.
Kashif said that the university was now providing them with a modified version of the kits, with a scarf and an added headgear to act as makeshift PPE.
“We weren’t even sure they would do as much, considering their attitude. They have 40 PPE units but they are not letting us use them, saving them for ‘worse times’. We had been notifying them since January to update their stocks, but they kept asking us to not panic. Now, we need the equipment to work without panic, but it is nowhere to be found,” he said.
A young Junior Resident (JR) doctor, not wanting to be named, told that consultants were threatening JRs to “not be a worthless doctor” by trying to avoid working without PPE, and “dared” them to speak about this again without consequences. He showed the correspondent the WhatsApp group where duties are assigned to each doctor and the messages of the consultant verbatim.
(Image 9) The Makeshift PPE at JNMC, AMU
The RDA says they have been notified about this issue, and they plan to take it to higher authorities.
Tip of the iceberg for medical professionals
Medical facilities in other parts of the country face such shortages as well. In Maharashtra, Bihar, Tamil Nadu, for instance, hospitals are working with little or on medical safety equipment, and there is a reason that number is likely to increase.
India has a requirement of around 38 million masks and 6.2 million pieces of PPE to take care of COVID-19 patients, according to a Reuters report quoting another internal report from ‘Invest India’. Invest India said it contacted 730 companies for ventilators, ICU monitors, protective equipment, of which 319 firms had responded so far.
What makes matters worse is that India did not preserve its supplies of PPE as per WHO recommendations and the sweeping lockdown has hindered the manufacturing and the production of medical equipment severely.
The struggles for medical professionals are not limited to their workplace itself. Many healthcare workers at Lucknow and Aligarh have been stigmatised in their locality simply for their profession.
At the Medical Colony of Aligarh, Rubina resides with her two children and her husband. Ever since the lockdown, people have avoided talking to her with her neighbours choosing to not stand at the same grocery store if she is there for fear of being contaminated with the virus. All over India, doctors and other healthcare staff are being ostracised by their neighbours or housing societies, fearing they would spread the coronavirus to their places of residence.
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