Although India’s healthcare workers (HCWs) are at the forefront in the battle against COVID-19
pandemic, they are facing several challenges in delivering their duties.
The plights of HCW in India (and perhaps across the world) can be described in five factors:
1) Shortages of Personal Protective Equipments (PPEs): Most healthcare facilities in India are facing shortages of personal protective equipments (PPE), including face masks, gowns and respirators. Either the hospitals do not have these available in adequate numbers or they cannot afford to purchase the PPEs. In these extraordinary times, the healthcare providers must adapt and be flexible so that they continue to safeguard themselves, their colleagues, their families and their patients. As the virus spreads, the challenge for the HCWs and other members of their communities to keep themselves safe is increasing day by day. It is nearly impossible to tell who has been infected with COVID-19 until he or she is displaying symptoms.
2) Long working hours: It is becoming apparent from the reports from across the world that the long duty hours of the HCW is a major risk factor for them to contract infection and, hence, it is mandatory they work in shorter shifts, based on a strict rotation.
3) Violence against HCWs: It is highly disturbing and demoralising to see the HCWs on duty are facing anger and violence from some irresponsible public — within the hospitals and in the community surveillance work. Such public acts dampen the morale, motivation and the work of HCWs, thereby, ultimately, affecting the welfare and the treatment of the public to a large extent.
4) Increased risk of infection: There are reports from across the world that several HCWs are getting infected or dying due to COVID-19. In Spain, HCWs have accounted for at least 14 per cent of total Covid-19 cases. The hospitals and isolation centres are getting overloaded, essential medical equipments are scarce and the doctors and nursing staff are stretched thin. The high viral load in hospital settings may make healthcare workers particularly susceptible to the disease
(A). The implications of infection in HCWs are serious and many folds:
i) They can spread the infection to the colleagues, family members, friends and the patients.
ii) India already has a grave shortage of HCWs. An increase in number of cases seems inevitable. This will require all the available human resources, but if doctors and nurses get infected on a largescale, the opposite will happen. They will need to be quarantined and treated, depleting resources.
iii) There would be a direct blow to the morale of the medical fraternity. There are already reports of doctors and nurses contemplating mass resignations, which authorities are in no position to accept. While this may seem irresponsible, it is important to recognise that they are individuals, with anxieties and fears, families, and want to survive. India cannot afford its HCWs to be low on motivation at a time when it needs them at their best.
5) Social and Family impacts: Indeed, the medicine is a humanitarian profession, and the HCWs have a duty to care for the sick. By willingly entering into this profession, they have implicitly agreed to accept the risks involved in it. However, they need to balance their obligations as professionals with their duties to their
family members too. The risk to personal health from the coronavirus is alarming enough, but the risk of infecting their families because of exposure on the job is unjustified and not acceptable.
The HCWs have also been facing a sort of ‘ostracisation’ by the society. Several HCWs have been asked to vacate their rented accommodation on the presumption that they may carry and spread this disease from their place of work (hospitals) to the society.
It is becoming apparent that some HCWs have already started rebelling during this COVID-19 pandemic, due to the direct impact of the various factors mentioned above. If it becomes rampant, it would be a disaster, because people are in urgent need of care. Social order relies on reciprocity. Imposing outsize burdens on one group without sacrifice from others is unfair.
Doctors and nurses and other HCWs may be heroes in this pandemic, but we will not be martyrs. It is important for the public, health care administrator and politicians to realise that the HCW are the ones holding the line against Covid-19 and they need to be fully supported in this time of crisis. The Government of India has taken some commendable steps, like imposing severe punitive actions on people who are violent against the HCWs, by providing Rs 5 million insurance cover and asking the manufacturers in India to do mass production of the PPEs.
At this point of time, HCWs really need these equipments, which are in extreme short supply. There are reports that doctors are having to use with substandard PPEs, which some have compared to raincoats – akin to sending soldiers into war with misfiring guns.
If we are to win the battle against coronavirus, the country needs to support and provide resources for its doctors and other HCWs — just as it would support its soldiers in a war.
About the author:
Raju Vaishya is a Senior Consultant Orthopaedic and Joint Replacement Surgeon at Indraprastha Apollo Hospitals, New Delhi.