Many doctors had got training that only showed how to switch on a ventilator
MUMBAI: The day-to-day experience of a young doctor at a Covid care centre on the outskirts of Mumbai shows rapid upgradations in facilities have been a far from smooth process.
“I would see patients brought with 70% oxygen saturation and, even though I was trained to help them, there was nothing I could do,” the doctor told TOI on condition of anonymity.
The doctor’s centre had 25 ventilators donated by the central government and an equal number of high flow nasal cannulas, but none were put to use. “They had been rusting for months” because none of the medical personnel at the doctor’s centre knew how to use them.
“I had some basic training in critical care and knew how to intubate a patient and provide ventilator care,’’ he said. “But many of my senior colleagues trained in alternative therapies asked who would take care of the patient after my shift ended in eight hours,” he said. The practical solution thus was to keep the machines away.
In public hospitals of repute, the task of monitoring ventilator care is assigned to the seniormost nurses or resident doctors. But when Covid-19 struck, additional doctors were recruited to such facilities with barely five days of training. “Many had been through training that literally only told them how to switch on a ventilator,” he said. “Critical care is a specialty that a doctor learns for two to three years,” he said. While, on paper, senior consultants from the private sector were earmarked to help and monitor critical care, the arrangement rarely worked.
The elation that the Mumbai-based doctor felt initially at being assigned a facility closer to home than in the rural parts of the state soon turned into frustration. “Putting up beds and providing oxygen supply doesn’t make for an ICU,” he said.
While lakhs were spent on buying ventilators and high flow nasal cannulas, nothing was done to set up a 24×7 laboratory, which is at the heart of most ICU setups. “An arterial blood gas analyzer helps doctors monitor the blood gases at regular intervals. It is perhaps a fifth of the cost of a ventilator, but this centre didn’t have it. Our laboratory did only simple tests and too for two hours in the morning,” he said.
Thousands of medical students have been assigned Covid duty at such centres across the state as a part of their bond for availing of subsidised government education. Students who managed to get duty in Mumbai’s centres consider themselves lucky as there is a system in place. “Many of my friends are happy… but I am frustrated and upset at how little I could do to really help patients. And this barely a few kilometres away from Mumbai,” said the doctor.
The BMC spends over Rs 4,000 crore on public healthcare every year, but most corporations around it spend a fraction of the sum. “It is unfair if a person’s geographic location dictates the level of healthcare he gets,” said the young doctor.
One of the biggest problems in the planning of Covid care is that the rapid upgradation of smaller facilities has taken place without commensurate training for medical staff. “Overnight, a primary healthcare is designated as a referral centre for Covid. Now, it cannot refer a patient outside except for super specialty needs such as heart attacks. So, a patient brought in cannot be sent out even if he cannot be intubated here… one cannot admit that the centre is lacking on trained manpower,” said the doctor, who is now looking for assignments in Mumbai region to avoid the same degree of disillusionment.
“I have come across ambulances working without even pulse oximeters. The focus is on oxygen production but what about the plumbing system to supply it. There are so many issues of maintaining pressure that the patient doesn’t get continuous oxygen flow,’’ he said.
While medical personnel, be it an ayurveda doctor or nurse, worked hard, the atmosphere was tinged with a fear of reprisal. “They couldn’t use sophisticated equipment out of fear following fires in a few hospitals.” The blame game over mortality often sets off defensive practice. “Ill-equipped ICUs are filled with stable patients so that it can be said that there is no bed available for any new critical patient,” said the doctor. “One cannot claim that all doctors are warriors. That is the bitter truth.”