Makeshift Covid hospitals are useless without medical staff


At 7 pm, an elderly patient with breathing difficulty and a Covid-positive test report reaches a tertiary care government hospital. There is no problem in getting admission and the family is informed that treatment is free. Though the emergency doctor asks for oxygen saturation monitoring and for oxygen to be provided, a nurse turns up to check oxygen saturation one and half hours later at 8.30 pm. After this, the patient is shifted to a room and left to his devices. He finds that rooms around him are empty and panics as no one comes to check on him or provide oxygen. It is only after the patient’s family protests that a doctor sees him at 1 am and he is finally provided oxygen five hours after admission. The next day, when the patient’s son meets the doctor in charge of the Covid facility, he is told they have equipment and beds but no manpower. “The doctor said, ‘bed hai, staff nahin.’ They could not even get a CT scan done as there were no technicians available. The doctor seemed helpless,” says the son.

 

Same path: Last year, the occupancy of such banquet halls and hotels was abysmal

Major cities across India are reporting record numbers of Covid cases. Every government has responded predictably, announcing immediate increase in “Covid beds” including ICU, ventilator or oxygen beds. Yet, there has been no big-ticket announcement or mass recruitment drive to find and hire trained personnel, including doctors, nurses, ward attendants, technicians and sanitation staff without whom these beds are of little use.

“Beds do not treat patients” is an oft-repeated adage in this pandemic but it still rings true. If it wasn’t enough that the staff in existing hospitals is stretched, governments are making hare-brained announcements of attaching banquet halls with beds to government hospitals and hotels to private hospitals. Is a bed in a hotel equivalent to a hospital bed? A hospital bed requires trained staff and equipment to monitor patients. You might buy the monitors and ventilators, but how do you find trained staff overnight? Last year, the occupancy of such banquet halls and hotels was abysmal as the inferior care provided was obvious to all. All it did was distract doctors and staff from patient care within hospitals. Yet, having learnt nothing from last year, governments are doing it yet again even as their own hospitals are unable to operationalise beds optimally due to acute staff shortages.

To make matters worse, the central government has announced that it is postponing the NEET post graduate entrance exam. Over 1.7 lakh doctors across the country are now sitting at home preparing for this entrance, while the worst pandemic in a century rages in the country. “You trust those attending election rallies and religious gatherings in huge numbers without following Covid protocols (more) than young doctors trained in scientific medicine,” tweeted a senior doctor, terming the decision illogical. Another senior doctor in a government medical college hospital pointed out that the current batch of post graduate doctors would graduate in May but there won’t be a fresh batch to join because of the entrance exam being postponed. “That will be a shortfall of over 20,000 doctors straight away, which includes medicine and anaesthesia undergraduates who would have been directly involved in Covid care. Instead, the government ought to have held the entrance exam and fast-tracked the counselling process so that these doctors, currently sitting at home, could have joined the workforce,” said the doctor.

As pointed out by innumerable papers on pandemic preparedness of health systems, you might build a hospital in 10 days or convert a school or exhibition hall into a hospital facility and you might even be able to buy the required medical equipment, but such facilities are useless without healthcare staff and training and producing medical staff cannot be done overnight.

Vacancies and shortage of staff in the public health system is nothing new. “Keeping the regular salaried workforce small” has been projected in economic and social policy as a virtue. “But such minimalist design cannot handle a pandemic like this, which is a maximum event,” pointed out a paper by the People’s Health Movement, a global network of health activists and civil society organisations. “Ideally public hospital networks should be built with excess capacity, i.e. unused beds and equipment. This planned “slack” or “redundancy” is essential so that in times of crisis the surge in cases can be addressed,” stated the paper. And how much a country can reduce mortality depends on this ‘surge’ capacity. The perils of failing to build it are evident everywhere, though manifested more dramatically in Delhi where the government is having to expand the capacity of its crematoria along with adding Covid beds. The body count is growing even as you read this.

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Views expressed above are the author’s own.



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