Ensure continued supply of PPEs, N95 Mask to HCPs treating COVID19 patients

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PMA’s plea to the Federal and Provincial Governments
Ensure continued supply of PPEs, N95
Mask to HCPs treating COVID19 patients
Expresses concern at increasing cases of violence
against doctors working at hospitals
Over-worked, doing duty under stress the doctors are
asking themselves what is the use of their efforts to
save the patients while the public is determined to
commit suicide by not observing protective
measures of social distancing and using masks?

By Shaukat Ali Jawaid

LAHORE: Pakistan Medical Association (C) has called upon the federal as well as all provincial governments to ensure continued uninterrupted supply of Personal Protection Equipments (PPEs), N95 masks and other protective measures to the healthcare professionals treating COVID19 patients. They have also expressed concern at the increasing incidents of violence against doctors, nurses and paramedics on duty at hospitals where COVID19 patients are admitted and at Quarantine and Isolation centers. It is the government’s duty to provide the HCPs security and safe working environment otherwise the situation may take an ugly turn.

Healthcare professionals treating these patients are overworked, performing their duties under stress and highly difficult circumstances. They have also started questioning as to what is the use of saving the patients if the public is bent upon committing suicide by not observing protective measures like social distancing and use of masks. The number of infected cases are increasing with the every passing day despite the fact that the pace of tests being conducted all over the country has slowed down and the present figures do not represent the true picture of infected cases in the country. It is true that almost 80% of these cases remain asymptomatic and get cured but 10% develop some symptoms while the remaining 10% develop serious symptoms necessitating their hospitalization. Once they become serious, require Intensive Care Unit admission or require ventilator support, hardly any one of them comes back. Doctors treating these patients have also observed that once they become critically ill, they go down within few days and doctors cannot do much. The HCPs problems have been multiplied when neither the authorities nor the public are taking this deadly virus seriously. Many of them has started questioning is it worth to expose themselves and their families at serious risk. So far according to reports more than six hundred healthcare professionals including doctors, nurses, paramedics have got infected and over a dozen are also reported to have died sending alarm signals among the doctors community. Repeated requested by the representatives of PMA, PIMA, health administrators and other distinguished medical personalities are being continuous ignored not only by most of the Governments as well as public. Under pressure from the business community, the relaxation in lockdown which now it looks has almost been eliminated to a great extent, with mad rush in Bazaars, at shopping malls where vast majority of people are seen without masks, we might see a significant increase in serious cases during the month of June 2020 and the authorities might be once again forced to opt for a lockdown.

Pakistan is perhaps the only country in the world which has relaxed lockdown without having seen the peak of COVID19 cases what to talk of flattening the curve. If the situation deteriorated, many other patients needing immediate medical interventions might have to be turned away from these packed to capacity health care facilities. With due respect to the higher judiciary, its recent verdict has also encouraged the public not to take the virus threat seriously which may cost the country dearly.

Despite the best efforts of NDMA and its claims to providing PPEs to the healthcare professionals treating Covid19 patients and increased number of testing kits and equipment, there are constant complaints from the healthcare professionals related to non-supply of PPEs and N95 masks. Supreme Court of Pakistan has also expressed its dissatisfaction with the quality of service being provided by NDMA, the federal as well as provincial governments. Patients admitted at Isolation Center established at EXPO Center at Lahore recently came out protesting at the quality of care and other facilities. Quality of care seems to be the worst in Khyber PK which is being ruled by PTI Government for the last over seven years in general and at Lady Reading Hospital in particular where the healthcare professionals have repeatedly complained at the working conditions and facilities available in the hospitals. A detailed report appearing in Daily DAWN of May 5th was very revealing. The case fatality rate in Paksitan is 2.3% whereas case fatality rate in Khyber PK was 5.62 percent which is highest in any province of Pakistan. The virus is reported to be pandemic in most populous district of the province i.e. Peshawar, Mardan and Swat.” The 1750-Bed Lady Reading Hospital the report stated was heading towards closure owing to rapid spread of infections among its staff. The hospital had to close the Gynaecology ward to ensure safety of the staff and patients for two weeks.” Staff in the Gynae department has been sent into quarantine. The situation is no better at other two major hospitals at Peshawar i.e. Hayatabad Medical Complex and Khyber Teaching Hospital. High mortality among the admitted COVID19 patients is a serious cause for concern. Increasing cases of infection among the healthcare professionals are being reported from other hospitals in the province. Dr. Aisha Mufti a noted intensivist at Lady Reading Hospital has tendered her resignation citing the administration’s inability to draw plan for providing care to the COVID19 patients by deploying inexperienced and inadequate staff to treat critically ill patients as the reason. She was the first whistleblower against the Medical Teaching Institutions Reforms Act (MITRA) 2015. Being in charge of the Intensive Care Unit, she was being ordered by irrelevant people on medical matters about which they had no knowledge at all. A vast majority of the consultants in KPK believe that MITRA has ruined the healthcare system in the province and a large number of them have also resigned in the recent few months. The objectives are and must be ideal to improve service at the healthcare facilities and also ensure monitoring and accountability but the methodology being used to achieve these objectives was faulty. All MTIs in the province are reported to be pursuing their own protocols for treatment of COVID19 patients in the absence of any centralized protocol resulting in the loss of precious lives which is said to be one of the reasons for the high fatality rate in the province. When Dr. Aisha Mufti brought the deficiencies and inadequacies in treatment, instead of rectifying the situation and taking some remedial measures, she was issued show case notice. She is reported to have pointed out that Non-invasive ventilation (NIV) and high flow nasal Cannula are needed in High Dependency Unit, it went unheard. Her resignation letter is in fact a serious charge sheet against the administration. Till last week Dr. Aisha was reported to be being pressurized to withdraw her resignation. All this reflects the current state of affairs in major hospitals of Peshawar.

In Islamabad Pakistan Institute of Medical Sciences also had to seal its MCH Center and operation theatre after fifteen of the staffers tested positive for COVID19. The situation was also very bad at Nishtar Hospital Multan where a large number of healthcare professionals have tested positive. According to Young Doctors Association, over hundred doctors working at Lahore General Hospital have tested positive for COVID19 and the virus is spreading fast among doctors. If no effective measures are taken immediately the hospital might have to be closed. Repeated requests to the Punjab Government, they say, have failed to wake them up from deep slumber. LGH’s orthopedic unit is now reported to have been closed after sixteen doctors tested positive. After the two surgeons tested positive, cardiac surgery is reported to have almost stopped at Punjab Institute of Cardiology. Numerous healthcare professionals at other hospitals in the province are also being tested positive in various hospitals of Sindh and Punjab province as well. Professor and Head of the Dept. of Psychiatry at KEMU Lahore was the latest victim who after being tested positive is reported to have been admitted in Intensive Care Unit of Services Institute of Medical Sciences. The stories circulating on the Social Media of a Doctor Husband and his Wife who had to lock themselves in Mayo Hospital at night to save their lives from violent mob coming with a COVID19 patient by calling police for help does not help to ease the situation either. These are frightening stories which have put the family members of these healthcare professionals under tremendous stress and risk. Under these circumstances will these HCPs be able to serve with devotion and dedication remains a big question mark? The duty roaster being issued by the hospital administration all over the country is being criticized saying that the doctors were already overworked, under lot of stress hence their duty hours needs to be drastically reduced besides providing all those involved in treatment of COVID19 patients additional remuneration and facilities. Health Experts have time and again expressed their serious concerns at the strategy being employed by the Government to deal with this pandemic but all this appears to have fallen on deaf ears. This has now forced the PMA to write a letter to the Federal and all provincial governments to protect healthcare workers from corona virus by providing those PPEs on regular basis, protecting them from violent mobs in hospitals so that they can work in peaceful atmosphere with peace of mind. In his letter Dr. Qaisar Sajjad Secretary General of PMA has also called upon the government to give all these health workers working with CORONA19 positive patients two weeks leave after one week’s six hourly duty. Their other recommendations include establishing a centralized networking between corona designated hospitals, including Ambulance in this network to ensure the drivers take the patients to the hospital where these facilities are available. It has also recommended accelerating the daily tests besides providing the required comforts to the patients at quarantine and isolation centers.

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