At first, when the post-graduate doctors treating COVID-19 patients at Gandhi hospital decided to march out of the gate into the roads, the first reaction of the Hyderabad police was to resist the doctors, placing barricades in their path, pushing them back into the hospital premises. Later, however, the police gave up, letting through the protesting doctors onto the roads as their chants of “We want justice” started gaining momentum.
Telangana’s frontline warriors of COVID-19 were out in the streets on Wednesday in mutiny, accusing the state government of neglecting basic health care requirements at the hospital during a raging pandemic.
The state, as of Wednesday, has witnessed 3,920 total coronavirus cases, recording 148 deaths with 1,742 recoveries. Telangana has been reporting a rise in positive cases since the end of May and more instances of daily figures touching triple digits were noticed in June. At present, there are 499 positive patients, with 250 patients in the ICU at Gandhi hospital, the nodal hospital for treating COVID-19 patients in the state.
The doctors are expecting the cases to peak in the coming months and want the state to prepare in advance.
Many of the talking points raised by the doctors TNM spoke to were raised during protests in the pre-COVID era as well and the pandemic has brought these issues to the forefront again.
“You can’t fight a pandemic by just providing hospital equipment and beds, you need manpower. The doctor only treats a patient but gets blamed for the failure of every other aspect of the hospital,” said Dr Ritesh, a protesting PG doctor working in the COVID-19 ICU ward.
The demand by the doctors to the state for hiring more patient care workers is not new. At present, with cases rising, the hospital has just six patient care workers for the COVID-19 wards working both shifts. Doctors say they need 10 patient care workers for each shift of the day. The hospital superintendent had assured the doctors that more patient workers will be hired but did not say when they would do so.
The death of a 55-year-old patient at the hospital was a direct result of not having adequate patient care workers at the hospital, say the doctors. The patient, who should have been assisted by a patient care worker to meet his toilet needs, had to instead remove his own breathing mask to visit a toilet. The Acute Medical Care (AMC) ward with 65 beds occupied by coronavirus patients had just two ward boys, who were already overburdened at the time of the incident. The patient collapsed and died shortly after, and the doctor who went to inform the news of his death to the patient’s family was assaulted by two family members who alleged neglect by the doctors.
“The Telugu media also projected the whole issue as doctors’ fault, whereas the real accountability lies with the state government not hiring enough patient care workers, nurses and doctors. Why is there no recruitment happening?” asks Dr Naresh, another doctor at the protest.
Doctors at Gandhi Hospital had in the past highlighted the shortage of patient care workers and nurses; some of their protests even made news but the ground realities never changed.
Dr Ritesh had a week’s unshaven beard, dark circles under his eyes, and was still wearing his maroon overalls from the ICU ward, when he came out to protest along with 200 other doctors. He was on duty all night before joining the protest and hasn’t had a good night’s sleep in the past three months.
“We all have been doing grinding work without complaining to keep the morale up. Being inside a hazmat suit for 12 hours is not fun during the summer. Many doctors have fainted due to dehydration and some self-injected IV fluids to keep themselves hydrated. Does anyone care?” asks the tired doctor. Ritesh has not seen his family since December and doesn’t think he will be able to see them anytime soon.
“How can we go home? My parents are both old, it’s a huge risk,” says Dr Keerthi, who hasn’t been home since January this year. “We should be under quarantine after a fixed number of working days in the COVID-19 ward but here we are not being quarantined even after prolonged exposure to the virus, nor are we being tested. We get tested only when we show symptoms,” says the doctor.
The Resident Doctor Associations claim as many as 79 government doctors have tested positive while on duty in the state, the numbers include cases tested positive at Osmania and NIMS, both non-COVID-19 hospitals.
Shortly after several hospital staff tested positive, the Director of Medical Education issued a circular asking all hospital administrations under the Greater Hyderabad limits to divide the PG doctors, interns, paramedical and outsourced employees engaged in-patient care to be divided into two batches. The two batches were to work on a rotational basis and would be sent for a seven-day period quarantine after their duty is over. The batch on duty would also work in shifts and ensure that no patient suffers. However, this order that came on June 4 is yet to come into effect.
“Is there any hospital in the whole country where the doctors at a COVID-19 ward work for 24 hours straight? Even after completing our duty, when we get back to the hostel there is no food to eat at night,” says Dr Ashmitha, a PG doctor with the Gynaecology department.
“Once you finish work at a COVID-19 ward, we have to take a bath before we go to the mess, but most times there won’t be any food left. We never complain, we eat a fruit or cook instant noodles and try to catch some sleep,” she adds.
Another doctor, Dr Madhav, said the past three months have been an emotional rollercoaster for him. “With the disease being in the news, there is a stigma attached when a person tests positive. The emotional and mental state of the patient is low when they come to the ward. We have to cheer them up and keep the patient’s morale also high. It gets difficult at times, we have to cheer them up when we are not happy ourselves. It gets difficult when they ask when they can leave,” he adds.
The doctors at the wards do not decide when a patient should be discharged, the decision is taken by the District Medical Officer (DMO).
“We don’t understand the logic behind this, it’s we who treat the patient and know when they are cured but the decision to discharge them is taken by someone else. When the patient asks us, we don’t have an answer,” said Dr Rehan, another PG doctor who was at the protest.
When asked if any of them fear contracting the disease, all the PG doctors TNM spoke to said they are not afraid of the disease, they only fear missing out on their learning for the past three months.
Dr Nikhil, who is doing his post-graduation in surgery, says since assuming COVID-19 duties three months ago he has never entered an operation theatre.
“I am getting calls from patients who have follow-up surgeries. You don’t need a surgeon at the COVID-19 wards; the claims by the state government to the High Court, to the media and to the public is incorrect. Not all doctors are deployed to treat COVID-19 patients, what will a neurosurgeon or an orthopedist do when the need is for more anaesthetists and pulmonology doctors?” the doctor asks.
“I am doing my PG to become a surgeon and for three months I haven’t touched a scalpel. I am afraid of forgetting what I had learnt without any practice,” adds Nikhil.
For the past three months, gynaecologists like Dr Ashmitha and Dr Supriya have been shuttling between the gynaecology departments of both Osmania and Gandhi hospitals. The doctors attend to pregnant COVID-19 patients.
“When there is a shortage of staff at Osmania, we get called in but when we are understaffed, why don’t the authorities depute doctors from other hospitals to fill the gap at COVID-19 wards at Gandhi?” asks Supriya. “We are only bound to COVID-19 duties and missing out on the course. We are here to learn gynaecology but are taking care of COVID-19 patients. This is a crucial stage in our career, the course is only for two years and we have missed three months. This burden should be shared by all hospitals and not just doctors at Gandhi. We need to decentralise COVID-19 treatment,” she adds.
Telangana at present brings all COVID-19 positive, both symptomatic and asymptomatic, to the Gandhi hospital for treatment. The doctors, on the other hand, demand the state consider allowing patients to be treated at the district level itself. They want the state to open up treatment for the public at all departments but a section of the hospital to be converted to be dedicated to COVID-19 treatment.
The Gandhi Hospital Superintendent, during a lunch break, visited the protesting PG doctors, requesting them to move the protest to within the hospital premises. The senior doctor could be overheard telling them that the goals they wished to achieve were “not easy” but that their effort is “commendable”.
The doctors were defiant and standing their ground as Wednesday came to an end. The Telangana Health Minister who visited the protesting doctors made no assurances to the various suggestions made by the doctors, they say. The minister kept repeating that a final call on the demands will be made by the Telangana Chief Minister K Chandrashekar Rao, who had earlier taken a tough stand when TSRTC (Telangana State Road Transport Corporation) workers were protesting against their working conditions in 2019. The TSRTC protest saw the state government clamp down on protesters when political parties got involved.
The protesting doctors, however, do not care about politics.
“In a day, we get 2,000 outpatients at Gandhi hospital. With the outpatient facility closed at Gandhi and at Osmania, where are all these people going for treatment? What about their health? That is what we care about,” said Dr Manideep, a Gandhi Hospital doctor at the protest.
Doctors’ protests continue at #GandhiHospital in Secunderabad. pic.twitter.com/iCU8ymwwnv
— Sushil Rao (@sushilrTOI) June 10, 2020