What of critical care?

by May 1, 2020 0 comments

Hospitals are turning away serious patients with other conditions because they don’t have a COVID-free certificate

With a death rate ranging between 2.3 and five per cent in the worst case scenario, the Coronavirus pandemic has us all hunkering down in our homes with the medical fraternity primed in battle mode. To the extent that all other patients are being told to stay away from hospitals and use telemedicine facilities instead. But now an extended lockdown and the fear of contamination mean that emergency rooms at most hospitals are turning critical care patients away unless they have a COVID-free certificate, which can take days to come. However, before the Coronavirus reared its ugly head in China and subsequently in India, a whopping 5.8 million people in this country were dying each year due to Non Communicable Diseases (NCDs), as indicated by a 2015 World Health Organisation (WHO) report. So now, we also have to think of the millions of patients who till now made up the disease burden of the nation. Cancer, heart, respiratory diseases, diabetes, malaria, TB, dengue, stroke, renal diseases, endocrine and infectious diseases to name a few have not disappeared overnight. They are still very much in the country, people are suffering and yes, they are dying from them. But are they being treated? For instance, last month, private hospitals in Vizianagaram stopped new admissions of non-Corona patients and discharged many in-hospital ones. Out Patient Departments (OPDs), too, were non-functional as many doctors and staff showed little or no interest in extending their services. The Government itself has asked hospitals to stop OPDs and elective or non-emergency surgeries. As a result, private hospitals around India are reporting a sharp drop in footfall — as high as 70 per cent to 80 per cent, says a FICCI study. Many patients, who were ailing from diseases other than the virus, were evicted from their rooms at some hospitals as well. So what of the plight of non-COVID patients? What of the people who have been diagnosed with cancer and have travelled to metropolitan cities to seek treatment? Are they to be left to die and their relatives who accompanied them left if the lurch, forced to fend for themselves amid a nationwide lockdown? Or even if they belong to the city where the hospital is located, what of their trauma? Are they being looked after, their treatment continuing?

2018 saw 2.15 million new cases of tuberculosis diagnosed in India. The predicament of these patients, countless of whom would be on treatment at DOTS (directly observed treatment short-course) centres and additionally at hospital OPDs, which are currently either closed down or difficult to reach because of the rigid time limitation, is unimaginable. The resurgence of TB — multiple drug-resistant TB — because of not following treatment conventions is notable. It is significant that the wellbeing of TB patients during the lockdown is monitored. The dread of Coronavirus and the requirement for isolation must not stop individuals from getting treatment for non-COVID medical emergencies. Both the Government and the hospital administrators must understand that people are rushing to hospitals only when the scenario is beyond redemption. Also, since all the hospitals and numerous smaller clinics are shut, a significantly high number of patients with cardiac, neuro, stroke, gastro, diabetic and orthopaedic complications are getting zero or delayed intervention that will prolong the recovery process. While the PM’s idea of clapping and clanging of utensils to recognise the efforts of those fighting the battle against COVID-19 was a noble one, the on-ground reality still appears to be grim and disappointing. Doctors have been assaulted by citizens as well as police forces for ‘breaking the rules of the lockdown’ while trying to reach their respective workplaces to continue serving patients. At this moment, the noise created by the clanging utensils is the last thing medical professionals want. Instead, demands are being made for better hardware and Personal Protective Equipment (PPE). Social distancing is a basic step to check the spread of the infection. Yet, the lockdown could have been executed with more thought for people already suffering from various ailments. The healthcare machinery of a country ought not to be decided by its reaction to a pestilence but by its promise to save lives in the long haul. A fully functional healthcare system framework would have been helpful in crises such as these. So we have to take stock of what we are doing. Are we exchanging one disease burden for another and ignoring the chronic, pre-existing one, thereby making India a sicker nation than it was before? It is time we got a bit real.

(Courtesy: The Pioneer)

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