Dr Krishnan* is one among many postgraduate students working 10-hour shifts at a hospital in Andhra Pradesh. Posted to a COVID-19 ward, the young doctor says that the workload is extremely high - the limited number of resources available simply doesn’t match the volume of patients receiving treatment. “There is a shortage of Personal Protective Equipment (PPE) kits in hospitals and this makes it all the more difficult. Only four or five doctors get to wear the PPE kits. A ward with around 200 patients is being taken care of by few doctors,” he alleges, “If a pair of gloves snap or masks are soiled, then we don’t have stock of new ones. We go to work daily worried that we will also get infected.”
The medico’s complaints come even as Andhra Pradesh witnessed a surge of COVID-19 cases this past week, with the total infections crossing the 1.3 lakh mark on Thursday.
Speaking to TNM, PV Ramesh, who was till recently the Additional Chief Secretary to Chief Minister Jagan Mohan Reddy, explains that while a lot of emphasis has been placed in ramping up beds and buying PPE amid the pandemic, a shortage of manpower is the real challenge.
“Medicines, PPE kits, beds, etc can be procured but manpower is the biggest challenge. Today, we have exhausted the manpower deployed. This is a long-term insurgency. Manpower is the biggest challenge. There is a huge demand-supply mismatch in terms of well-trained nurses and doctors. Just having a large number of beds isn’t what is important, whether there are doctors and nurses skilled enough for healthcare management is what is important,” says Ramesh.
Nara Lokesh, TDP’s General Secretary and an MLC, alleges that the manpower crisis in the state is due to fear over contracting the virus. This he tells TNM is allegedly due to a shortage of PPE kits. “Doctors and medical personnel in Andhra Pradesh are not willing to come forward because PPE kits and basic safety equipment for their protection is not being provided to them. Because the government is not fulfilling their requests, they are reaching out to the TDP for the same. We are helping them with PPE kits and other safety equipment to whatever extent we can,” he says.
“One week from now, when the number of cases further goes up, the number of doctors and medical staff will not be sufficient. Andhra Pradesh will also soon run out of hospital beds”, Lokesh claims.
However, denying allegations of a manpower crisis in the state, Dr K Rambabu, General Physician and Professor of Medicine, who is also the state COVID-19 coordinator says, “Medical and healthcare workers never get exhausted. We may be overworked. This is because many in the medical fraternity are in quarantine or have tested positive and hence there is a temporary manpower shortage.”
As on July 26, sources in the Andhra Pradesh Health Department revealed that 328 medical personnel have tested positive for the coronavirus. All those who were in close contact with those who were diagnosed with COVID-19 had to be quarantined.
To address the shortage, Dr Rambabu says the Andhra government has taken up recruitment of healthcare workers on a large scale. “Government has given permissions to recruit Female Nursing Orderlies, Male Nursing Orderlies, staff nurses. Walk-in interviews are also being carried out. Wherever there is a need, Collectors are already doing it. The medical staff may be exhausted because of the continuous efforts that were being put in to vigorously trace contacts. As the numbers go up, priorities and protocol changes.”
So far, around 32,000 beds have been made available in128 district COVID-19 hospitals and 8,000 beds in the state COVID-19 hospitals. In the next six months, the state plans to recruit around 17,000 doctors and staff to treat COVID-19 patients.
Dr PV Madhusudhana Sarma, President of the Indian Medical Association’s Vijayawada unit, however, says, “The government is trying to recruit doctors, but no one is coming forward because of the fear and also because those above 60 are not preferred to work in COVID-19 hospitals.”
As a result, postgraduate students like Dr Krishnan and junior doctors are the most overworked. “Postgraduates, house surgeons and junior doctors are the ones who are the most stressed and overworked during this pandemic. Doctors in government hospitals are working for around 8-12 hours in a day. The nursing staff don’t even have an option, they are forced to work as they don’t have a say,” says Dr Sarma.
According to PV Ramesh, it is time to call for a detailed review. “As a general principle, what is really needed in every state is a team of experts including epidemiologists, virologists, public health specialists, pulmonologists, physicians, critical care experts etc to review the situation on a daily basis. There is a need for a village by village, cluster by cluster review now. It is time to stop the urban-rural movement and intra urban movement too. Schools and colleges should not be opened. Markets should be decentralized. Yes, it will slow down the economy, but it is a bargain. You need to choose between lives and livelihoods, if there are no lives then where is the question of livelihood?”
Dr K Rambabu explains that the spike in COVID-19 cases in the state has forced the government to divert its resources from contact tracing to aggressive testing and treatment. “As part of the protocol that Andhra Pradesh has been following, from the beginning 20 contacts were being traced for every person who tested positive. Ten primary contacts and ten secondary contacts. Even if around 15 contacts were traced it was a good result. Now that there is a surge, huge numbers are being reported, there is a change in protocol that is being followed,” Dr Rambabu says. He adds that the priority is early detection of symptomatic cases, especially those with comorbidities, “Having said that, contact tracing is still very important.”
On Tuesday, Chief Minister YS Jagan Mohan Reddy instructed officials to ensure there is no delay in COVID-19 patients getting a hospital bed and said they must be admitted within 39 minutes. It was during a Spandana review meeting with District Collectors and SPs through a video conference that the Chief Minister emphasized on the same. He also said that Collectors and Joint Collectors would be held responsible for any negligence. He instructed the officials to monitor the facilities being provided to the patients and not to take any backsteps on expenditure.
*Name changed on request