Doctors and Nurses in Tamil Nadu and Telangana allege that there is a lack of sufficient protective gear even as they fight a healthcare crisis.

Who will protect us Doctors and nurses in TN Telangana allege lack of safety gearImage for representation
Delve Health Wednesday, March 25, 2020 - 20:51

On Monday evening, Tamil Nadu Health Minister Dr C Vijayabhaskar sent out a warning.

He tweeted, "There is false information on social media that few government hospitals are running short of masks, gloves, PPE, etc. Tamil Nadu has more than sufficient stock in hand that can comfortably run for the coming days. Strict action will be taken for spreading rumours.”

His tweet came in the wake of multiple complaints online about the shortage of protective gear, from postgraduate medical students and resident doctors in Government hospitals across the state which were either gearing up or already treating COVID-19 patients.

Several doctors who contacted TNM within minutes of the tweet alleged that this was a deliberate attempt by the government to stop the medical fraternity from raising their voice. Several sources in Tamil Nadu's government hospitals have confirmed that there is not enough safety gear - specifically N-95 masks given to practitioners unless they worked in the isolated ward with COVID-19 patients.

According to the U.S Food & Drug administration website, an N-95 respirator is a protective device 'designed to achieve a very close facial fit and very efficient filtration of airborne particles'. Even the Centre for Diseases Control has stated that N-95 masks are the most effective gear for medical practitioners. When properly fitted and worn, it has minimal leakage and almost all the air is directed through the filter media.

"Let's say a patient in Chennai has all symptoms of COVID-19 and even travel history. They are advised to go to a government hospital immediately. They choose either the Rajiv Gandhi Government General hospital (RGGGH) or Stanley Medical college. As soon as they enter, the first person they come in contact with is a doctor from the Out Patient Department (OPD)," says a doctor from Stanley Medical College, on the condition of anonymity. "And these doctors are not given the N95 mask," he alleges.

The doctor insists that all patients with symptoms of even flu must be treated as COVID-19 positive unless the test proves otherwise. “In such a case, shouldn't these doctors be given protective gear? The only ones who get the gear, be it the suit or even a mask, are the ones working in the isolation ward," says the doctor. "This is the case across hospitals in Tamil Nadu and if we question the administration, there is no proper reason given. There are at-least 300 patients coming to the OPD everyday, and doctors who are sitting there are exposed to them," he adds.

Another doctor from Stanley Medical College states that despite asking for gear, practitioners are given only cloth masks, which serve no purpose against the virus. "We are very scared," says the doctor, who sees patients on a daily basis. "We are not directly involved with isolated patients but even the ones coming to us, we don't know who could possibly be a carrier of the virus and who is not. How can we do our jobs without fear?" she asks.

Visible signs of shortage

"In the Chengalpattu government hospital, there is a sign on the notice board saying that 'Everybody should wear their own face mask due to non-availability of government supply', " says Dr. Shanthi, the secretary of Doctors' Association for Social Equality.

She further shared a note from the Director and Superintendent of the Institute of Obstetrics and Gynaecology, Government Hospital for Women and Children in Egmore which instructs postgraduate Medical students to "Have personal protective equipment on your own."

However, after the letter went viral on social media, the director of the hospital recalled it and said that the hospital had sufficient supplies.

"They are putting the burden of avoiding infection on the doctors without even investing in the right protective gear for them," says Dr.Shanthi. "There should be an open forum in which medical students and doctors can actually complain. A common online forum should allow them to complain without their identity being revealed. A second step that must be taken is to at-least tell doctors exactly where, what protective gear is available and make sure they get preference when buying these," she adds.

Several doctors further pointed to a picture posted by the health minister recently, which depicts the existing situation in government hospitals.

In the photo, the minister is seen wearing an N-95 mask as he speaks to a doctor outside a fever special clinic. The doctor addressing him is wearing a cloth mask while all the other doctors behind him are in either 2 ply or 3 ply masks. "If this doesn't explain the situation in our hospital," asks Dr.Shanthi, "then what will?"

In Telangana too the situation is worrisome, say medical practitioners, but not for the doctors.

Nurses not protected

It’s not easy being a nurse at Chest Hospital at Erragadda in Hyderabad, one of 52 hospitals where an isolation ward was set up to treat COVID-19 patients. “The doctor stays only till 2 pm and is only available on call after that, the COVID-19 patients are then managed by the ward nurses. The ward attendees and sanitation staff have not been trained on how to deal with COVID-19 patients. There is no protocol established yet for protecting hospital staff working at OP section from COVID-19, all cases arrive there first,” a member of the staff at the hospital told TNM on the condition of anonymity.  About 19 coronavirus positive patients are undergoing treatment at this hospital.

When these shortcomings were highlighted, the medical superintendent reportedly told the staff, “Not to make it an issue”.

On March 21, the staff of Chest Hospital wrote a letter to their medical superintendent, with 20 points, highlighting the problems faced by them at the COVID-19 isolation ward. The hospital superintendent gave assurances. However, the staff were told not to leak the contents of their letter to the media.

Nurses have also written to the authorities requesting the government to establish protocols to work in COVID-19 ward at different stages: OP-based care, suspect cases, and confirmed cases. They are also asking for demonstration of doffing and donning procedure in the ward.

“Apart from the nurses, other staff who come in contact with COVID-19 patients have not been trained in this procedure. We are asking for proper PPE according to the size of the staff with zip, including slippers, that the WHO recommends. The patient first comes to the OP ward, we the nurses and doctors are the ones who get exposed first,” the staff adds.

They also allege that the isolation ward is not being cleaned regularly, on the hour. Further, they allege that there are no Tympanic thermometers or biohazard waste bins. Patients also request basic provisions such as soap, toothbrushes, and Wi-Fi. The staff also say patients panic when electricity, water supply, food supply are disrupted or when there is a lack of personnel to distribute food to them. Infection control measures have not been taught to the fourth class workers including daily wage workers and IP patients. The existing staff nurses have also called for more staff to be deputed. At present there is no provision for hand washing with elbow taps in most hospitals, say the nurses in charge of the COVID-19 ward.

When asked if the Chest Hospital has adequate PPE to manage a rise in positive COVID-19 cases, the hospital Medical Superintendent Dr Mahaboob Khan said, “We have adequate numbers of PPE. We have 500 Level 1, and 150 Level 2 (N-95) PPEs at our hospital. These are adequate. Both can be used against COVID-19. For a suspected case we can use Level 1 and for a positive case we can use Level 2.”  Dr Khan said. He was clearly unhappy that the letter had reached the media.

Nurses at hospitals fear authorities would jeopardize their pension and benefits for highlighting the shortcomings at the COVID-19 wards but have no choice but to ask for help. 

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