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On the frontlines: How health-care workers are grappling with the pandemic in Dhaka
“My senior, junior doctors and I need your prayers,” Dr. Shawkat Osman, the C.A. of surgery Unit-5 at DMCH, writes in his Facebook post. Recently, some doctors from DMCH including him were forced to quarantine themselves in their homes as they were exposed to a Covid-positive patient. The patient had deliberately hidden his medical history in fear of overwhelming societal gaze and strict measures.
This trend of deliberately hiding medical history is not an isolated one though.
“There have been such cases,” says Dr. Mirza Muhammad Asif Adnan, Asst. Registrar, DMCH. “A patient, coming from Narayanganj—a highly notorious area, being the epicenter of the pandemic now—may say that he is a resident of Dhaka. That way, he can avoid the rigorous procedures he would otherwise be given if the doctors knew of his original place of residence.”
He adds that earlier, anticipating the spiteful glances they may receive from the society, patients did not reveal that they were abroad returnees, which, of course, heightened the risks of spreading the virus.
They fear lockdowns, and those who live in rented apartments fear removal.
In one instance, a suspected patient from Chandpur under his unit fled. Although she was told to get admitted at the isolation ward, she duped the nurse and fled. He discovered the incident on his routine check-up.
Patients’ non-cooperation not only threatens the health-care workers and other patients, but also the general public. Caving in to stigma and fear comes with heavy, fatal costs, as vital information then remains cloaked in darkness.
“It’s very concerning when patients hide their medical history; it’s just like stepping on a landmine,” says Dr Maruf Hasan, Asst Register, Surgery, working at Corona Unit, Kurmitola General Hospital.
As the virus tears through districts, facilitating lockdowns, fanning the flames of transmission, health-care professionals find themselves dangling above the jaws of risk. In this battle, they are inadequately armed and yet faced with crucial challenges.
“There were allegations that hospitals were not admitting the patients. The truth is they were not well equipped to admit,” says Dr. Ronny*, an Honorary Medical Officer. “Doctors were put under stress to admit suspected patients in ICU wards, and in that case they ran the risk of infecting all the other patients in the ward.”
It is tough dealing with suspected patients, he tells me, because the administration (IEDCR) is sometimes slow in testing and then the patients have to hang in the balance. As a result, the patients suffer, scrambling from one hospital to another, due to the murky waters of confusion surrounding the right hospitals for treatment.
When asked about the challenges the doctors face in treating the patients, he said that ICUs cannot be mixed. The authorities have to consider everyone either positive or negative. There was a case where the patient (not a covid patient) was told to visit Kuwait Maitree Hospital; the authority of Kuwait Maitree told them that they could provide ICU care but they would have to keep the patient with COVID positive patients.
“As a Doctor, you want to help the patients, but the setup is not satisfactory,” he says.
When asked about the safety issues faced by health-care professionals, he told me, “Many internees and doctors at a Govt. Hospital weren’t given enough gears as the hospital bustled with suspected cases. The PPEs that the workers receive are of questionable quality. The quantity isn’t enough to arm the workforce. If we have six doctors in duty, only two to three get PPEs. Many have to buy their own aside from relying on donations. These gears were supposed to be given by the authorities, but instead, we have to fund for them ourselves and rely on donations.”
In the beginning, the supplies weren’t enough, but now the concerned authorities are stepping up. But that doesn’t echo a story of hope. The supplies are still very inadequate in proportion to the workforce and admission of patients, and the quality is questionable, says Dr. Mirza.
These individuals on the frontlines have to go through all the blood, sweat, and tears involved in their positions. They are required to be devoted to their services for hours on end clothed in PPEs.
The PPEs, coupled with the humidity, make things even more taxing.
“Even the doctors from the cold countries have trouble wearing such uniforms for so long. In a country like Bangladesh or India, working for ten to twelve hours wearing a PPE is very challenging,” he says. “Our bodies become slimy with sweat.”
Ideally, after undressing oneself from a PPE, one is not supposed to reuse it. But with the rising costs and the dearth of such gears, doctors are left with no option but reusing them.
“We are not expected to have meals or go to washrooms, since a PPE should not be reused. But we have no other option,” he says. “The costs are too high, and we can’t keep on buying them.”
Aside from PPEs, even using N-95 masks poses a big challenge for them.
“A mask can be used for at best 6 days. So we have to buy around 4 masks in roughly a month. And now they probably(altogether) would cost at least 4000BDT. When I bought them, each cost 500-550,” he says.
Those working at hospitals also face accommodation challenges. Dr. Mirza’s colleague’s apartment owner told him and some of his other colleagues not to come home since they fear infection. A doctor from delta hospital shared the same fate. His neighbors told him he couldn’t stay there as it was very risky to be in close proximity. Kuwait Maitree hospital designated a hotel for such doctors. The cook from that hotel fled in fear.
Those I interviewed expressed their concerns over the need of a safe accommodation for the doctors, since going back home to their family invites severe risks for the members.
“Doctors rent a mess in groups. They don’t have eating facilities. Many had to even leave their places since they are on duty. Homeowners don’t want to rent,” says Dr. Ronny*.
For Honorary Medical Officers like him, this situation is extraordinarily burdensome, given they are not paid and provide service voluntarily. Without HMOs, Dr. Shafiq tells me, the workforce would struggle more than it is now to stay afloat.
The nursing staff and the cleaners at hospitals also need proper guidance with regard to quarantining themselves so as not to infect their families. Dr. Maruf says, “It would be like a Domino effect, if the staff members are not guided properly, the risks of spreading contamination would run high.”
In light of the hostile behavior the health-care workers face from different people, Dr. Ronny says, “It’s very demoralizing; it dampens our spirit when people demonize us.”
*Name has been changed to protect anonymity.