Doctors demoralised

The summary transfer of the doctor heading the Army’s Base Hospital in Delhi hit the headlines this week. While the Defence Ministry brushed it aside as routine, doctors wondered why an ‘honest and competent’ doctor, who had seen through the first wave of Covid as Commandant of the hospital, should get the marching order at this point of time. More so because he was due to retire in August.

The inside story was soon circulating among doctors. The Commandant, it was claimed, had refused to oblige a cabinet minister for an out-of-turn injection of Remdesivir to a patient known to the minister. While his stand was endorsed by his fellow doctors, some of them have reportedly begun to entertain thoughts of quitting from the service, if not the profession.

As many as 14 doctors serving in Unnao district of Uttar Pradesh actually submitted a collective letter of resignation, complaining of harassment. They were not only being blamed for the surge in Covid cases, they confided to the media, but were actually being threatened with imprisonment and police complaints. Even in cases where patients could not be traced because they had furnished wrong phone number or address, the doctors are being held responsible.

“After we visit the villages, identify Covid cases, arrange for their isolation, medicine and counselling, in the evening we are summoned to review meetings with the SDO at the tehsil HQ which are sometimes 30 kiloemtres away,” complained one of them.

A joint letter was also sent to the Director-General of ICMR and the Principal Scientific Advisor to the Government on clinical guidelines issued for ‘convalescent Plasma therapy’. What treatment to offer to which patient and at what stage are complex decisions best left to doctors, the letter said. But with no scientific evidence that Plasma therapy helps, the guidelines have merely added to the confusion and harassment of patients and their relatives, it went on to say. The WHO endorses neither Remdesivir nor Plasma therapy but the Government’s silence or complicity have added to the confusion, doctors complain.

In a scathing letter to the health minister earlier this month, the Indian Medical Association (IMA) asked the ministry to wake up from its slumber. Suggestions of its members were being "put into the dustbin" and decisions regarding the pandemic were being taken without understanding ground realities, it alleged.

The IMA also said that in the last 20 days it has been insisting on a planned, pre-announced lockdown, as opposed to separate lockdowns called by different states for 10-15 days. This, the association said, would give the medical infrastructure and personnel time to replenish and prepare itself for the increasing case load. It will also stem the spread of the virus, they said.

Doctors also feel demoralized when the so-called Yoga Guru Baba Ramdev mocks them and modern medicine. “Ramdev spreading deadly misinformation about O2 saturation, role of yoga in severe covid19 & also mocking common people’s sufferings due to shortage of O2 & hospital beds. He is not afraid of the government or the Epidemic Act. Why there is no action against him?” tweeted Dr Harjit Singh Bhatti this week, demanding legal and police action against the bearded, ‘breathing Baba’ under the Disaster Management Act.

The Yoga Guru has been unabashedly marketing his trade and craft on television channels, claiming they could cure Covid-19. In a viral video he made the fantastic claim that his breathing exercises could increase oxygen saturation level “from 80 to 98 or even 100”. Mocking at people complaining of oxygen shortage, the Baba said the atmosphere is full of oxygen and God had gifted mankind with their nose as cylinder to draw it in.

Nobody seriously expects the Government to take action against the Baba. And with his Patanjali Yogapeeth being one of the biggest advertisers, mainstream media too have no incentive to ask hard questions. What is more, the unscientific and untested cures fit the Modi government’s policies on science.

Not only has the Government funded research on the efficacy of the Gayatri Mantra on Covid-19 patients, it has taken no action against people promoting cow dung and cow urine as cure. Instead, at Banaskantha in Gujarat, a Covid hospital has been set up for treating Covid-19 patients with ‘panchgavya’ derived from the cow. People in Gujarat have been visiting stalls to administer ‘steam therapy’ and cow-sheds for having bath after rubbing cow-dung paste on their body.

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“It is demoralizing to see the government, which uses the Epidemic Act to slap cases for violating the lockdown or for not wearing masks, taking no action against these quacks,” says a doctor from Gujarat, confirming that even patients in ICUs in Gujarat often insist on taking off the oxygen mask in order to sniff at potlis, small pieces of cloth filled with camphor and herbs. They do damage to themselves, erode trust in modern medicine and make doctors feel helpless.

The mismanagement of the pandemic has been marked by headline and media management. The Government, both at the Centre and in the states, have been busy announcing new 500-bed hospitals with ventilators, ICUs and oxygen beds. Most of these ‘hospitals’, it is promised, would come up in a week or ten days. But they are never accompanied by announcement of any mass recruitment of doctors, nurses, technicians, ward boys or sanitation staff. How then are these hospitals expected to function?

Bureaucrats in the health ministry have been busy issuing unrealistic guidelines like keeping a distance of six feet between two beds, while ordering hospitals to increase the number of beds. Ironically, having a doctor as the health minister appears to have made things worse. Not only has the health minister been busy presiding over meetings to explore the magical curative properties of the indigenous cow but he has also been seen promoting untested medicines and recommending dark chocolates to get over Covid tension. Marie Antoinette?

Doctors are also demoralized because of not just the shortage of oxygen but also the shortage of operators and technicians to handle oxygen supply, cylinders and ventilators. There are multiple reports of ventilators dumped in hospital stores while patients are dying without ventilator support. While both Gujarat and Madhya Pradesh have dismissed such reports by claiming that the ventilators were defective and not functional, an even higher probability is that hospitals do not have trained technicians to operate the ventilators.

A ventilator is more complicated than a microwave which you can just switch on and off. Not knowing how to operate the ventilator and how to regulate the pressure can be fatal and take patients’ lives, say doctors. One of them confided how a doctor died because of the wrong pressure put by the ventilator operator, resulting in the lungs collapsing.

The healthcare system does not comprise only doctors and nurses. “I have seen so many tweets from the educated and well off urban middle class people defending Mr. Poonawalla's vaccine pricing ostensibly because he took risks & must earn a return. But I have never seen the same folk also tweeting in support of ASHA workers who risk their lives for Covid work & are paid a pittance of ₹2000/month,” tweeted a doctor this week. Indeed ASHA workers have been risking their lives for Rs 30-35 every day and that too without protective gear.

At the same time, doctors and nurses are being forced to work between 90 to 120 hours a week instead of 48 hours a week. Each doctor is said to be doing the work of three and each nurse the job of five nurses. The Prime Minister’s plan of showering flower petals on hospitals in recognition of the service and sacrifice of health workers does not even amuse health workers anymore. Another of the government’s scheme of conferring the ‘Prime Minister’s National Covid Samman’ is adding insult to the injury.

“It takes decades of hard work to become a doctor & build up the expertise and experience. But we have lost some of the most brilliant Indians because we are ruled by semi- literate, arrogant & ignorant politicians,” says an irate doctor. Pay us three times more along with Covid risk allowance and mental health assistance, he adds in the same vein.

A 2018 Lancet study had placed India at the bottom of 136 countries rated for their healthcare system. It had found that 2.5 million Indians died every year due to treatable diseases. The Government spent a little over one percent of the GDP on public healthcare while individuals and families spent three to four times as much. More than half the population are believed to depend entirely on quacks and half of the just seven lakh hospital beds were in private hospitals.

Neither politicians nor bureaucrats are equipped to manage and administer the public health system, say doctors. The Indian Medical Association (IMA) has renewed its demand for an Indian Medical Service (IMS) to administer hospitals across the country.

The pandemic has served a warning. But the Government shows no sign that it has been able to read the writing on the wall.