In times of adversities and global-scale challenges, there are always a few who stand up and exhibit superhuman abilities. The Corona pandemic exposed the unpreparedness of all countries for managing such a mammoth-scale challenge. In time, certain countries fared better than the others through better planning and execution of policies for saving their citizens.This was because of those common human beings from simple,even unprivileged backgrounds, who rose to the occasion and exhibited the resolve to make a difference. We started calling them the Corona Warriors. They stood as the front line of defence against the viral infection and its aftermath. These front-line workers didn’t care for their own safety; but worked tirelessly to alleviate the pain and suffering of all who needed help. However, as history has repeatedly demonstrated – once a title gets attached to such supreme beings, they cease to be perceived as mere humans. Their relations and relationships, physical and mental health, imperfections and infirmities are side-lined, even scoffed on, and they are granted a Superhero status.
One such section of the society that stepped up to the mantle is the doctors. The medical front line is managed by the Resident doctors who suit up in PPE kits and strive to help the patients cope and recover from the dreaded disease. Doctors have foreverheld a status parallel to God, as they save lives. Corona highlighted society’s dependence on these angels for survival.
It is important to see these faceless Corona Warriors for who they are– Humans. What are the challenges that the Resident doctors face every single day? How does it impact them psychologically?
Dr. Neha (name changed) is pursuing her 3-year specialisation DNB (Diploma of National Board) at one of the prestigious hospitals in Delhi that is catering to COVID patients exclusively. She explained that DNB students must excel in academics while working as Junior Resident (JR) for three years in an approved hospital. The rules are that they can work as JRs for not more than three years. The examinations for the new students aspiring to join this course and the final completion examinations of the third-year students have been postponed indefinitely by the government citing COVID crisis and their inability to conduct them safely as per the protocols. Elections, rallies, and religious programs have continued during the same period.
The tenure of the current final year batch has been autocratically extended by the government till the time a new batch joins. The postponement will be for at least six months before any examinations can be held and the passing students can be interviewed. Neha suspects that this is being done because the salary of a JR is much lower than that of an SR.Postponing the exams means that cheaper labour is available to work in the COVID wards. JR receives around 50k in a private setting in Delhi compared to 90k+ in a government hospital. In addition to this existing disparity, doctors like Neha are forced to continue for the same salary despite the completion of the three-years tenure.The completion of their mandatory three years of service as JR should have been recognized and they should have been rehired at a better pay and designation. Instead, with no immediate hope of their examinations to be held soon, their future looks gloomy and cloudy. An additional impact is that these students who would, typically, prepare for their examinations over a period of two to two-and-a-half years at least, will now be asked to give the examination with a study period of just a month or two.
They are working in shifts day and night, exposing themselves, and, now, even their families to infection – for no extra pay! Last year, when the first Corona wave had started (at least in Delhi), the doctors and medical staff were provided commuting facilities and accommodations with meals to prevent their families from getting infected. Flowers were showered, lamps were lit, thaalis were banged to raise the morale of the front-line workers.They were publicly applauded and appreciated for their sacrifices and selfless efforts.
This year, with the second wave, we’ve been caught off-guard despite having the time, warnings, worldwide examples, and scientific data. We are suffering more than ever. Yet today, these doctors are not provided any transport, accommodation, or meals. The use, rather abuse, continues, reaching higher proportions.Shockingly, the support has been reduced. Neha mentioned how they are offered 15k as allowance, which has to somehow cover the transportation. Just booking a cab can take up to an extra hour and a half despite the use of the taxi aggregator apps.Meals are not readily available, and much more expensive. But the worst part of the impact is the increased risk and exposure of their family members to the dreaded virus. As a married couple, both Neha and her husband risk infection as do the other family members living with them.
Dr. Vikas (name changed) is a JR in the second year of DNB working in another private hospital for COVID patients. He’s a bachelor, originally not from the city. He uses the metro to commute from his shared accommodation to the hospital. His flatmates are also doctors, working in different hospitals, in different six-hour shifts. Like Neha, Vikas is currently in the morning 8am – 2pm shift. There are three shifts: Morning (8am-2pm), Afternoon (2-8pm) and Night (8pm-8am). Both Neha and Vikas singled out the Morning shift as being the most hectic. They have to be in their PPE kits in the wards; two JRs responsible for 80-100 serious COVID patients. The kit stays on till the end of the shift. This means that they cannot eat, drink, or even use the washroom during the entire shift. Imagine the plight of the Night shift doctors who have to manage over 12 hours of continuous confinement without food, water, or bladder relief!
The ratio of 2 JRs for 80-100 patients is itself skewed. But when these are COVID patients, most of them quite serious with complications, it is critical for the doctors on the shift to be sharp and ensure that they check all details. But this is nearly impossible when the time that they can afford to spend with each patient is not more than 3.5-4.5 minutes to read up on the patient’s history, check the line of treatment and medication, and decide if any subsequent changes are needed. They can hardly find the time to talk to the patient, but are expected to speak with the patient’s family because COVID patients are not allowed even an attendant.
They want to spend more time with each patient, boost their morale and explain to the family members what is happening. But they are crumbling under the unmanageable number of patients. Their challenge is further increased because most senior doctors and consultants only visit the wards in case of a VIP patient. VIP patients also increase everyone’s workload on the shift.The nursing staff are also stretched beyond their limits, struggling to cope.
Manpower is the biggest problem. Most of the hiring is on locum basis, i.e. part-time basis anything from 300-700 rupees/hour to 50k/month based on their experience. These locum doctors have initial teething issues, while trying to understand the hospital and how it functions. This also increases their workload and reduces the time that they can give to each patient. This, obviously, leads to dissatisfaction, for the patients as well as for the doctors. The pressure of the patient load while wearing the PPE kit only exacerbates the mental load. Not being able to do their work, as best as they’d want to, leads to frustration and mental burnout.
Last year, the doctors used to work for 14 days followed by 14 days of quarantine, not only to reduce the viral load (infection) but to also provide laydown time to recover both mentally and physically. The challenges are bigger with the second wave — the doctors are on a cycle of 14 days on COVID duty either followed by 14 days of isolation and 14 days non-COVID duty or 7 days isolation. The guidelines keep changing but it’s difficult to determine if these changes have a scientific basis or are purely based on administrative limitations.
So, the primary challenges are Manpower and Workload. The two are interlinked, and enhanced by the non-cooperative approach of the hospital management, which is primarily interested in profits, through reduced cost and inflated pricing. The doctors and the staff work overtime to help the patients and the hospital,obviously, with no incentives. They are also burdened with huge amounts of paperwork and writing of daily notes, which could be easily reduced by providing lighter hand-held devices that are used in the rest of the world. In contrast, most Indian hospitals have bulky machines (if any) to be lugged around on patient rounds,having connectivity and charging issues .
To add to this already heavy load is the VIP culture. VIPs get private beds, superior facilities,often jumping the queue,and demanding exclusive attention. Never mind that these would often be mild cases,occupying ICU beds. This special treatment takes away precious time that could have been otherwise given to the ones with real needs. The limitation of the actual bedside time and attention that the doctor can give to each patient means that they develop a mind map for which patient to see first and for how long.
Both Dr. Vikas and Dr. Neha spoke about the dissatisfaction that they feel at the end of their shifts each time, in addition to being extremely tired, cranky, and sweaty. Having to choose between patients daily heightens this dissatisfaction. Dr. Vikas mentioned that the second wave has critically infected comparatively younger people.At times, a younger patient is prioritized over an older one. It makes him wonder how his parents would be treated if they needed hospitalization. Had there been more doctors and staff available, these choices wouldn’t have to be made. The doctors can’t even go and attend to the needs of their immediate and extended families, irrespective if it is for a family celebration, or mourning over the loss of a loved one. All this while, the same doctors don’t get any special treatment when they fall prey to the virus. They have to go through the same queues for admission and treatment. Although, if a doctor loses his/her life during COVID duty,a cheque of one crore rupees (ten million rupees) is promised to their family as compensation from the Delhi state government. Is that enough? Wonder if the families of these lost lives would agree.
Both Dr. Neha and Dr. Vikas described the condition of the nursing staff as pitiful. They are the ones doing the actual work: taking care of the patient, handling more than 10-15 patients each, when no attendants are allowed. The nursing staff is also hired on contract basis and the shortfall is appalling. The demand for cheap labour is met by pushing in students who don’t have the requisite training and expertise to handle the current challenges.
The doctors and nursing staff are dedicated and want to work to their fullest capabilities. But these challenges are beyond their human abilities, and even after putting in so much effort there is little satisfaction, definitely, not monetary. Mental stress has peaked because they have been working tirelessly and continuously for over a year now.The hospital management remains aloof of their conditions, and offers no counselling support.
Lack of medicines, staff support, and infrastructure are visibly obvious. What is conveniently ignored is the overwhelming mental strain, caused by the deluge of death and despair that is torturing these young doctors and nursing staff, many of whom are still students. From the outside, we can never realize how dealing with deaths on a daily basis numbs the doctors after a point in time. They are still expected to continuously deliver high performance, while delivering the painful news of their patients’ deaths to the impacted families.
The number of cases has dropped over the last month and the caseload is beginning to reduce. Now, the contractual staff are worried if they will be fired and left to fend for themselves. Notwithstanding the Black Fungus situation, the number of emergency cases has decreased. But the pandemic is far from over. States are still grappling with vaccine shortage. It will be a considerably long time before we will be able to remove our masks and go about our lives as before.
The truth is that the government, hospital managements, and the general public have neither understood the sacrifices, nor appreciated the unstinting service that the frontline doctors and medical staff have provided during the COVID years. The medical frontline is hit by the onslaught of pressure from all sides: patient needs, communication with the patient’s or deceased’s families, own health and financial challenges, hospital rules, government guidelines, and the list goes on and on.
The recent incidents also highlight challenges faced by the resident doctors today.
Doctors have been attacked by the families of the patients who could not be saved.
26 people were arrested in Assam’s Hojai district in connection with an attack on the Covid Care Centre, which left several injured, including a doctor and nurse who needed to be hospitalised. The attack, which came to light after a video was shared on social media, was allegedly carried out by relatives of patient Giyaz Uddin, who died of Covid-related complications on June 01.
Dr. Seuj Senapati and Nurse Lalita Bharali are currently admitted in Guwahati Medical College for treatment. Dr Senapati had just completed his internship from Tezpur Medical College and is on a one-year rural duty.
As the medical fraternity demands safety protocols, the doctors and nursing staff continue to remain at risk despite striving to provide the best medical help to the patients.
Who is to take care of the safety of the Corona Warriors?
Low pay scales are being maintained forcing the doctors and medical staff to go on a strike for justified increases in stipends and salaries.
Over 3,000 doctors went on strike on May 31 primarily demanding a hike in their stipends and reserved Covid-19 beds for them and their family members for a Covid-19 emergency. On June 04, almost 3000 doctors resigned from their respective duties after the MP High Court directed the protesters to resume their duties and called the agitation “illegal.” Following this, the state government also sent eviction notices on June 05, asking them to vacate their hostels.
Doctors from AIIMS and Safdarjung hospitals, New Delhi on June 06 took to the streets at around 7pm and marched towards Aurobindo Marg, holding a candlelight vigil.
“Our healthcare system is anyways in shambles and any further reduction in manpower will affect it adversely,” quoted representatives of the Federation of Resident Doctors Association (FORDA) in a statement. “The resident doctors are protesting for their rightful demands which were denied outrightly and the outraged administration is headed to spoil the careers of thousands of trainee doctors,” they added.
The doctors ended their strike on June 07 and returned to their posts after the state Health Minister VK Sarang met with them and agreed to their demands.
Should the doctors during this pandemic that calls for exceptional commitment, be forced to go on strikes for basic rights of proper increments in stipends and clinical support for them and their families?
After a welcome drop in the Covid numbers, ironically, the future of the contractual hires is in jeopardy. Once deemed critically necessary, they are now extraneous and superfluous.
The Covid related hospitalisation numbers are coming down daily as the daily positivity rate has finally started to dip. Many Covid-specific facilities have started to shut down. Most of the staff, nurses, and doctors are neither being shifted nor retained because their contracts were temporary.
How will we plan for future pandemic waves?Who will take care of the medical staff now left to fend for themselves? What is the long-term plan when our doctor and nurse proportion to the population remains abysmally low?
Can we blame our Corona warriors for feeling alone in the battle?
The doctors feel financially and psychologicallyunder (un) appreciated, understaffed, physically and mentallyoverworked, and unsure about their academic and professional future. NEET and DNB are some of the toughest examinations in our country, and need absolutely undivided dedicated attention.
The challenge of coping with the COVID situation is aggravating:
Without proper support and infrastructure – manpower, medicines
Constantly changing technical guidelines for investigations and treatment
Absence of proper scientifically based guidelines announced top-down by the administration and implemented consciously and diligently.All that our Corona warriors want is consideration and understanding to help them cope with the devastation of COVID and their exhausting workload. We need to reciprocate the support they have given us.They deserve better working conditions, better pay, a formal hiring process instead of an ad hoc or temporary basis of enrolment, better infrastructure, and an empathetic recognition of their dedication.
The Corona warriors are undoubtedly superhumans because of their service to humanity. Let’s try to remember that they are humans first, with simple expectations, fears, ties and attachments, and desires. The least we can do is acknowledge their needs and equip them accordingly. They have earned our respect. Now, it is our job to pay them back – in kind and with an open heart.
Aakshat Sinha (Artist, Writer, Founder MindAtEase – a mental health awareness initiative)
