By Minahil Makhdoom
There was a sudden bombardment of messages in the Whatsapp group chat consisting of my batch from medical college, with more than 200 messages flooding it in over half an hour. They must be discussing some new developments in Covid-19 vaccines or treatment protocols, I assumed. But that was not the case for the sudden upsurge in messages. It all began when one of our batch mates in Canada told us that she, along with other members of the civil society, is volunteering to prepare face masks from home for a local hospital. This started a discussion among my batch mates, working as doctors in various parts of Pakistan, about the horrid situation they are currently experiencing: wilful discrimination, corruption and criminal neglect.
Dr A, a medical consultant working as the head of one of the clinics of a very renowned hospital in Pakistan, shared a photograph of her personal protective equipment (PPE) and other basic protective gear required for any health care practitioner (HCP). She, however, obtained the PPE just a day before the eventual semi-lockdown was initiated across the country; which is still acceptable considering what other doctors have had to go through
Dr M is a post graduate resident working in one of the most renowned emergency rooms (ERs) in the country. His supervisor would regularly appear on different television channels, and social media would be flooded with this individual’s messages promoting measures one should adhere to in order to prevent the spread of Covid-19. However, this supervisors’s claims reeked of hypocrisy since the doctors working under him were only provided with a pair of gloves and surgical masks each day. They themselves had to prepare or purchase other required gear including PPEs, overalls, goggles, skull caps etc. Mind you, these are the doctors that were on the front line receiving suspected Covid-19 patients, as most OPDs were already closed. Interestingly, initially, the soft, unofficial verbal message from the supervisor was to ‘not admit nor document’ any Covid-19 patients. Things, of course, were a little different for those patients who had political backing of some sort and needed a bed in isolation. Otherwise, the front line workers were made to divert the patients to other medical set-ups. Sadly, it seems like this was also the case in several other ERs across Pakistan.
DR N, a cardiologist, and his team who were deployed in the ER while working in a government set-up, were blatantly advised by their management personnel to divert cases to other private hospitals. They were also not provided with any noteworthy protective gear.
He told us how he had been repeatedly appealing to the medical superintendent (MS) of his hospital to provide the gear for the past few months. They recently requested again, just before the lock down, to be provided with essential masks and gloves at least. The latest unofficial response given to him by the relevant MS was that he wouldn’t need any PPEs since the doctors would not be admitting any Covid-19 patients anyway. Similarly, when the concerned paramedics of the same hospital requested to be provided with gloves and sanitisers for their own safety, they were told by the assistant medical superintendent (AMS) that they will not come in contact with any Covid-19 patients and, even if they did, to ‘not touch’ them. When the AMS was informed by the paramedics that touching patients is unavoidable, especially when they are moved for X-rays and other investigations, the AMS responded by saying: “Use a cardboard (gatta) to hold them†. Dr N remorsefully confided in me that apparently “enough†bleach spray is sprayed “once daily“ to rule out any chances of the spread of the virus from any suspected Covid-19 patients.
Yet another doctor, working as a gynaecologist in a number of hospitals, told us how there was one confirmed Covid-19 case in the pediatrics department of a second tier private hospital of the city where she is rendering her services. The management did not inform any of its staff and everyone kept going through that ward multiple times in a day. The hospital management did discharge all the babies and pediatric patients from the ward, and later the room was cleaned with bleach. The hospital management chose not to reveal the fact that they had attended to a confirmed Covid-19 patient since they feared it would ‘tarnish’ their reputation and decrease the usual patient inflow in other departments of the usually busy hospital. She, however, was happy narrating that this particular hospital, prior to this episode, prepared their own hand sanitiser and made it available for all those in the hospital premises.
Things were even more pathetic for Dr F, who is a postgraduate trainee for family medicine and was recently posted in the ER of a government hospital where she is completing her requirements. For days after the lockdown was enforced, she was not provided with any PPE or any protective material except for gloves. It was our medical college’s Whatsapp group members and her family who finally forced her to follow precautions and demand the same from her hospital administration.
My friend Dr Salman, currently working as an orthopaedic surgeon in Doha, Qatar, was the only one who allowed me to use his real name. He is currently posted in a quarantine centre facility in Doha and told us that the healthcare professionals there are given the right to refuse to treat suspected cases if they are not satisfied with the PPE provided to them. He was, however, very concerned for his talented friends who are “working without any protection†here in Pakistan.
Given just how dangerous Covid-19 can be in the country if it continues to spread, it is imperative that we don’t shrug off these shortcomings plaguing our healthcare institutes as things which are simply part and parcel of Pakistan’s medical facilities. It would be criminal to let doctors continue to operate under such conditions.
This is naturally part of a wider inability on part of the government to control the movement of people in the country. For instance, although pharmaceutical companies are allowed by the government to maintain a skeleton staff in order to continue the emergency medicine supply chain; some of these companies have bent this in their favour and are asking all their employees, whether essential or non-essential, to come to work, endangering their lives and that of their families. On the other hand, some police and traffic police personnel are now taking bribes to let housemaids go and work in the houses that are still calling them despite the lockdown.
While we all pray that this situation is not a ticking time bomb, it seems that we as a nation and those at the helm of affairs in Pakistan are leaving no stone unturned to make it into one. But, unfortunately, when I see images of doctors wearing plastic bags on their heads and hands in Mardan, or doctors wearing bike helmets as protective gear in the wards, I feel that they are still better off than some. Because, what we as doctors regularly come to know with respect to the workings of hospitals, managerial guidelines and mismanagement, this is not even the tip of the iceberg.
