Need for healthcare reboot to pass the Covid ‘test’

From having initial success in handling the pandemic to reporting the world’s largest single-day tally of covid cases, India witnessed unprecedented change in the situation within a span of few months during the second wave. 

As the second wave peaked, it felt that the whole healthcare system was in shambles when we saw patients waiting outside hospitals for want of beds. Even if someone got a bed, they struggled next to get oxygen support and the required medicines. Some people luckily got them but the remaining suffered and lost their lives in the struggle. But the struggle did not end even after their death. Dead bodies had to get in the queue for a slot in the crematorium. 

On the other hand, Healthcare professionals worked tirelessly, sometimes with minimal resources like PPE kits and essential medicines. After all the effort they put in, often the health workers have to face physical and verbal violence at the workplace. All these factors have led to a feeling of vulnerability among health workers and caused severe burnout. 

At present, the focus is primarily on alleviating the impact of coronavirus. There has been an interruption in treatment for other high-mortality diseases due to the delegation of a significant workforce for Covid duty. 

We discussed the above-mentioned issues with Dr Vayugundla Venkata Suryasai (MBBS). Following are some of the excerpts from the interview:

What explains the sudden increase in cases in India?

The reluctance to follow COVID-appropriate behaviour at all levels (individual, family, societal and leadership) is one of the major causes of increased cases. Some events of mass gatherings like election rallies, Kumbh Mela and grand weddings were also catalysts. The culture of masks started declining among the masses who were relaxed due to the slowing down of cases in the first wave. People need the right messaging in the right forms. But unfortunately, faster than the authentic information, misinformation reached a majority of the people leading to an Infodemic in a pandemic. All these factors contributed hugely towards the heavy damage suffered during the second wave.

Overburdening of hospitals and solution

The capacity constraint issues have been happening in the metros and the capital cities just because of the healthcare failure in the rural areas. When patients in rural areas fail to get services locally, they go to the upper reaches of the pyramid. For example, when certain regions of NCR have no proper health facilities, they rush towards Delhi. Thus, Delhi’s health system gets overburdened. The real problem is not in Delhi but the surrounding areas. So, we need to build up the rural healthcare system. 

Primary Health Centres (PHC) and Community Health Centres (CHCs) should be started and maintained everywhere so that people do not rush to Tertiary Health Centres for normal ailments which can be controlled locally. People need to know when actually they need to approach a doctor or when they need to approach a hospital. In some of the cases, not all doctors are well informed about the recent developments and changes, except in tier-1 cities. Continuation of medical education plays a very important role there. 

The problem has its own roots deep down, we need to address every problem. As we’ve created in over 70 years, the health scenario in India just can’t break the shackles overnight. 

Reducing the burden of doctors

We need to start initiatives where qualified nurses can treat people on normal home quarantine through videoconferencing and teleconferencing. Training Asha workers to do the basic primary things would be very good. So, now a hospital may not see a patient with normal fever or normal diarrhoea. All these can be treated by Asha workers and the first line of treatment can be given by them. The Asha workers can check into the symptoms and upload those reports to a doctor who can check them. Many people have done their paramedical courses and are waiting for opportunities. The government can just help such people to set up their labs in a public-private partnership. So starting from medical education to policy, a lot of things need to be changed. We just can’t increase medical colleges without actually increasing the facilities. 

Interruptions in treatment for some high-mortality diseases

As we felt impacted by COVID-19, most hospitals were turned into COVID hospitals, and many usual surgeries were postponed. Demarcation of hospitals as Covid-only hospitals is important but at the same time, it is important to mark hospitals that are marked for non-covid treatments so that emergency surgeries are not impacted.

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