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Last line of defence: How healthcare workers soldier on in the Covid fight

Nandana James Mumbai | Updated on May 21, 2020 Published on May 21, 2020

Separation from family, long work days, mental distress and even social ostracisation — despite facing all these, healthcare professionals continue to fulfil their duty

Naina*, a 25-year-old medical officer working at a coronavirus quarantine facility in Maharashtra, feels getting infected is probably inevitable. Once she returns home from work, she stays in her room, avoiding contact with the rest of her family as far as possible. “We just have to,” she says, before adding quietly, “I am honestly very scared for my mother.”

As the rest of the country stays indoors amid the coronavirus-induced lockdown and social distancing measures, many healthcare workers like Naina brave the insidious virus head-on, stifling the gnawing fears about their safety.

Duty-bound professionals

While life has ground to a standstill for most people, an army of healthcare workers is toiling quietly and stoically, with their personal protective equipment (PPE) keeping them obscured from the ones they are saving. The risks they are putting themselves at also remain just as obscured.

As Ravi*, a resident doctor at All India Institute of Medical Sciences (AIIMS) Bhopal, puts it, healthcare professionals like him are bound to work even if it means coming face-to-face with the insidious, monstrous virus. “Everyone’s families are scared. They will want us to be safe at our homes. But, we can’t do that. It’s our responsibility to treat patients,” he says.

“Even if we don’t work, someone else has to — someone like us (doctors) only. So, it’s not like we can sit at home and escape from this,” he says.

The healthcare workers’ battle against this virus is fraught with many ordeals. The mental and physical ravages of tackling a novel virus, while being subjected to daily occurrences of infections and deaths, is coupled with fears of contracting the virus themselves and endangering their close ones. Aggravating matters are the stigma, ostracisation and even assault they are forced to endure.

The dearth of adequate PPE is another concern flagged by healthcare workers across the country. Ravi, for instance, talks about how doctors have been coming up with innovative ways to protect themselves in the absence of proper PPE, by using everyday items as substitute. “We don’t have any other option. As doctors, we can’t just sit and complain that because we don’t have proper PPE, we can’t treat our patients. It’s our duty to treat them.”

Working with honour

Tanvi Grover, a 25-year-old post graduate resident doctor at Safdarjung hospital, Delhi, recalls life before the pandemic, which feels like a bygone age. “It used to be a normal life initially, wherein we used to get up, go to the hospital, have shifts, come back, study, and do our thesis — this used to be the normal life schedule for everybody.” Post the outbreak of the coronavirus, things have turned topsy turvy.

Now, she goes to the hospital with the gravity of the task she is faced with weighing on her; the surreality of the matter giving her goosebumps. “When I was told that I would be posted in the coronavirus intensive care unit (ICU), I definitely underwent a mix of emotions, from being petrified at one end to feeling honoured at the other,” says Grover.

“The goosebumps you get while you are putting on the protective gear before entering the ICU — it somehow gives me a gratifying, ‘honoured’ kind of feeling as well. Because I feel proud; I feel like I am doing my part for humanity. It’s a mix of emotions, but honour definitely takes the front seat somehow,” says Grover.

The precautionary measures that the public is asked to abide by pale in comparison with the kind that healthcare professionals like Tanvi have to take up. She decided to stay away from her family lest they be put at risk too, and rented an apartment close to her hospital. Meals at the hospital canteen with others have also been replaced by meals cooked by herself at her apartment. She has to make sure she doesn’t carry things like bags, watches or earrings so that no possible source of contamination is carried back home.

Once the PPE is donned, which all the healthcare workers describe as being stifling and uncomfortable, it is not possible to eat, drink or use the washroom. Grover likens it to wearing multiple layers of clothing, saying that it leaves her feeling hot, stuffed, dehydrated and even dizzy sometimes. You have to make sure you are hydrated well before, she says. Once she is back home, she has to pay heed to not touch anything at all, before heading straight to the shower to disinfect.

“The mood in the hospital is definitely gloomy, I must say. We have to constantly make sure we don’t touch anything. We also have a fear of catching the virus because we deal with the patients directly,” says Grover. But, she has found ways to remain upbeat. “Sometimes, I break into dance for a few minutes at the hospital just to relieve some of the pent up stress and bring my energy up. It helps,” she says with a laugh.

The days go by like a blur, says Sajith Kumar, the nodal officer for Covid-19 management at the Government Medical College, Kottayam, Kerala. Kumar, who is also the head of the infectious diseases department at the college, has been working in the medical field for over 35 years now. It’s a 24-hour long commitment for doctors, who are pulling out all stops to tackle the virus, he says.

Though this has always been the case for doctors like him, earlier, he used to delegate work to his juniors, leaving some hours at night free of the possibility of being summoned to the hospital. “These days, because it’s a confusing issue for a large number of doctors, I have permitted literally anyone to wake me up at any time if they are confused. I don’t want confusion or doubts to come in between our efforts to tackle the virus,” he says stoically, a strong sense of conviction underlying his words. Even if it’s a case of an accident in the middle of the night, one has to be mindful of whether the person has had any travel history and can be possibly infected, he explains.

In fact, the readiness and willingness to accept calls and to help each other while dealing with this virus has increased among doctors, he points out. Apart from the work at the hospitals, he has meetings to attend, with the district administration, the State administration, ministers, politicians and the like; each day is riddled with at least 2-3 virtual meetings, he adds.

A good night’s sleep has almost become an elusive construct.

Ask him about sleep and he has a good laugh. “I am used to taking small naps now and then. So that will serve the purpose.”

Distress while on duty

But, increasingly, the resilience of healthcare workers is being put under pressure.

Certain healthcare professionals that BusinessLine spoke to talked about how some of them were evicted by landlords from their rented houses and apartments, apart from being ostracised by the rest of society in other ways. There are also some, like Grover, who have voluntarily shifted to living in the hospital premises, lest their elderly parents be put at risk.

“Being in the confines of the hospital, not going anywhere else and coming back to your room within the hospital campus — it is taking a toll on our mental health as well. There seems to be no way of escaping this,” laments Maya*, an intern at AIIMS Bhopal.

Even those who are living with their families have to ensure that they don’t cross paths with their dear ones. “I am no different from the pet dog in our house. I have a separate plate, food, as well as a separate space to sleep at home,” quips a doctor at AIIMS Bhopal.

In a disconcerting revelation, a letter by the Resident Doctors’ Association (RDA) in AIIMS Bhopal, dated April 9, said that its two PG resident doctors were assaulted by policemen on their way back home at night after duty. Addressed to the institute’s director, the letter also said that the police assaulted the doctors, saying that “doctors are the reason why the coronavirus is spreading to the common man”.

Yuvraj Singh, one of the two doctors who were attacked, in a post on Facebook which was accompanied by a photo of his arm in a cast, said: “The reward!!! This is what we get after putting our lives at stake...The highlight is, this time, it’s from another saviour of our society in this global crisis: the police! Today I was there, tomorrow it might be you ...The whole medical fraternity is working day and night without proper PPE provided to them, by putting our lives at risk. ...and this is what we get!”

The RDA of AIIMS Delhi, one of India’s most premier institutes, had also talked about how its frontline healthcare workers were being targeted by administrative authorities for having come forward with their problems related to the availability of PPE, Covid-19 testing equipment and quarantine facilities on social media, as per a letter dated April 6 addressed to Prime Minister Narendra Modi. “In the face of the corona pandemic, it is the responsibility of the government to ensure that these ‘soldiers’ are heard, their opinion respected, rather than humiliated,” the strongly-worded letter stated.

“I guess we (healthcare workers) are crazy people,” says Ravi. “We know that we are not getting anything back. Even if something happens to a doctor, they will be made a pseudo hero for some days — it will be all over TV, Facebook and WhatsApp posts. After that, everyone will forget,” he says grimly.

“People don’t even realise that it’s not the doctors’ responsibility to improve the healthcare system. None of the government authorities will talk about the healthcare system and no one will question the government about this,” he continues.

Even as healthcare workers endure risks, seclusion, taunts and even assaults amid their efforts to save lives, their fortitude in the face of such adversity is commendable. Maya is now convinced that she wants a career in the public healthcare sector. “I had juggled with this thought previously. I was confused between this and other lucrative specialties like cardiology or surgery. I am now sure though. We need more public health doctors. If they were more in number right now, we would have probably not had to deal with a pandemic like this.”

Stories that instil hope

Healthcare workers also share stories of happiness, gratitude and most importantly, hope.

Greeshma Anoop, lecturer and medical officer, department of general medicine at the Government Medical College, Ernakulam, was in for a pleasant surprise when a British national they had treated and cured of the virus, messaged her after reaching home in Britain. When he had taken her number during the time he was under treatment, she hadn’t expected him to keep in touch. He shared a photo of him and his wife, saying that at last, he could be with her.

A positively beaming Anoop recalled how the patient expressed his gratitude to all the doctors and nurses who had taken care of him, leaving her feeling elated.

Such anecdotes are aplenty. A 32-year-old nurse at Kumar’s hospital, who got infected, recovered in less than a week and was willing to return to work in the same coronavirus ward, he said, adding brightly that this sends a positive message.

An old man who was discharged from the hospital, walked right past the nurses who treated him without recognising them as they were hidden behind PPE. But upon hearing them speak, he instantly recognised them, ecstatic to finally see the ones who had taken care of him. These were the same nurses who would gently placate him while he would ask for food from his own house, which was over four hours away from the hospital.

Another time, there was a four-year-old child who had to be kept quarantined with her coronavirus-infected parents at the hospital, though she never ended up contracting it. Ensuring that a child remained within the confines of a hospital room was a challenge that the nurses and doctors happily took to addressing, keeping her entertained with games, toys and colouring books. “She was very happy during the stay,” Kumar fondly recalls.

Meanwhile, it would be work as usual for these healthcare workers even in the post-Covid world, though they may no longer be on the frontline of tackling a global pandemic. When asked what he would like to do once this crisis abates, Kumar says with an amused chuckle that he has a lot of pending work and commitments to attend to, which have been stalled by the unprecedented virus outbreak. “There is a lot of work to do, it’s not like we are going to relax and enjoy after this.”

Surely, they are in for the long haul. Things are different for doctors compared to people in other professions, Ravi notes. Even before the pandemic, doctors like him were at the risk of exposure to diseases, Ravi points out, though the rate of contraction and the nature of the coronavirus is quite unprecedented. “The only sign of relief is that we are going back to the routine things we are experts at,” he concludes.

Meanwhile, Naina is wistful, albeit with a hint of excitement, when she talks about life after the pandemic. “After all this is over — and I hope I don’t get infected — I am going to hug my mother. I am dying to hug her.”

* Names changed to protect identities

Published on May 21, 2020

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