It has been exactly two months since Prime Minister Narendra Modi announced the nationwide lockdown to break the chain of transmission of deadly coronavirus disease (Covid-19). Sitting on the floor of the Safdarjung Hospital’s Out-patient Department (OPD) building, 68-year-old Ram Charan, a heart patient, and his wife feel lucky that they would be finally able to consult a doctor again. It has been tough 60 days for them. The couple had reached the city from Uttar Pradesh’s Badaun district for better treatment. But a few days later, the lockdown was imposed, forcing them to stay back.
“My treatment started and then got delayed due to the lockdown. The services were closed...we had no other option left but to take a flat on rent for temporary accommodation here,” Charan said. His son, Mohit, said since medicine shops on the hospital premises, that provide medicines for free, were closed, he had to spend around Rs 4,000 to buy them. “Despite the risk of getting infected, we had to consult doctors at the emergency services as the OPD was not functioning,” he said.Major hospitals in the national capital such as Safdarjung, Dr Ram Manohar Lohia (RML) and GTB have opened their OPD services with limitations.But the real challenge for the healthcare workers (HCWs) at these hospitals, all dedicated for Covid-19, is the lack of proper safety kits, besides maintaining social-distancing norms by patients.
“Most of us don’t have N-95 masks, we are using face masks of poor quality and throw them away once used. Personal Protective Equipment (PPE) kits are for those who are closely working with Covid-19 patients. We understand that there is a shortage of kits, but at least the government can think of some other measures to contain the spread of the virus at hospitals. How many times do we buy N-95 masks and face shields…and not all patients are aware of social distancing. How do we deal with such situations,” said a resident doctor on duty.
Many patients coming to the hospital are aware of the crisis. In the same OPD building, Iqra Abbasi, who came from Seemapuri with her one-and-half-month baby for getting a vaccine, said she fears that the baby may contract the virus.“But then how long can we wait…getting the vaccine at the right time is also equally important. We keep hearing that doctors are getting infected, yet we have no option but to come to the hospital. Had the services not resumed, it could have further delayed,” she said.
Another doctor from the hospital said if an HCW is infected the person puts patients on more risk and, therefore, the government must consider providing adequate safety kits to all doctors and medical staff.
Less rush at RML
At the RML, which is also a nodal hospital for the Covid-19, there is less rush at the OPD as compared to normal times.Rajesh Das, an autorickshaw driver, who had an injury in his back, was struggling for his treatment. He had first visited the emergency department, and after the hospital resumed its OPD services, he is getting better treatment.
“Many private clinics are still closed, it is turning out to be a huge problem for patients. My health deteriorated as I didn’t get any treatment for three days. Eventually, I had to come to the emergency ward. Thankfully, it has resumed again,” Das said.
The doctors at this hospital, who were attending the OPD services wearing face masks and gloves, said maintaining physical distancing with patients at times becomes a real challenge.
“The patient rush is much less as compared to normal days, although we apprehend that since many private clinics are still shut, there will be a surge in numbers soon. We have already announced that only those who are in urgent need for treatment will visit the hospital. This is also a reason why we are being able to manage the situation,” a doctor, on condition of anonymity, said.
“As a doctor, we have to touch the patient’s body when needed. How can we avoid that? And as the majority being asymptomatic, there is no other way to identify if the patient is infected,” the doctor said at the OPD.
Mohalla Clinic re-opens
Dr Deepti Ojha returned to her Mohalla Clinic in Inderpuri’s Buddh Nagar after keeping it closed a few days during the lockdown. As she returned, the locals breathed a sigh of relief as Buddh Nagar has been a containment zone and the clinic was the only ray of hope for them.
“I couldn’t come out as the public transport was not available. Now that the cab services have resumed, I re-opened the clinic. Soon, several people with some health issues thronged the clinic. In fact, some of them had coronavirus symptoms. I immediately referred them to the RML hospital,” she said.
Ojha knows the risk she is taking by visiting the locality and interacting with patients. Hence, she has prohibited the entry of patients inside the clinic and has shifted to a room with a window through which she checks her patients.
“There is, of course, high risk as the virus is contagious. But how can I ignore my duty? This is the need of the hour and as a doctor, I need to be by the residents’ side,” she said.
Rage at govt’s order
On May 16, the Delhi government issued an order directing hospitals, nursing homes, dispensaries, mohalla clinics and COVID Care Centres to follow the central government’s instructions on the use of PPE kits.
The order laid down the break-up on the use of PPE and safety kits amongst the HCWs based on their activities and exposure to the coronavirus. While the low-risk and mild-risk HCWs are to be provided with a triple-layer mask and latex examination gloves, for the moderate-risk category, N-95 masks, goggles, latex examination gloves and face shields are to be provided.
Reacting sharply to the order, Dr Shivaji Dev Barman, president of the Federation of Resident Doctors Association (FORDA), said the N-95 masks should be used in the emergency department in any situation.
“Knowledge regarding Covid-19 is always evolving. Guidelines for mask and PPE kits usage should be evidence-based. Many asymptomatic patients are turning out to be positive for Covid-19 leading to difficulty in delineating Covid-19 and non-Covid-19 areas. HCWs are always at high risk of contracting the infection. The N-95 masks should be used in all hospital settings (wards, labour room, operation theatres). Also, any emergency case may soon become serious and might need the aerosol-generating life-saving procedure. It will be hazardous to manage with the triple-layered mask in the emergency block,” Barman said.
Hospitals or hotspots?
Many of the city-based hospitals had shut their OPD services after many of their HCWs were infected by the coronavirus. Staff at AIIMS, Safdarjung, Babu Jagjivan Ram Hospital, RML, Ganga Ram, Baba Saheb Ambedkar, Hindu Rao and many others got infected. In the last two months over 300 HCWs have tested positive in the city. A month ago, a doctor at the Delhi State Cancer Institute had tested positive for Coronavirus. The hospital authorities had to shut the OPD to sanitise premises
Mohalla Clinic: First confirmed case among healthcare workers
On March 26, a doctor working at a Mohalla Clinic, which provides primary healthcare to patients, in Maujpur tested positive for the coronavirus. The doctor had come in contact with a woman coronavirus-infected patient from Dilshad Garden. His wife, who also works at a Mohalla Clinic at Babarpur, and daughter tested positive, too.