A derelict public-health system has exposed its frontline staff to untold risk
Medical professionals are the first and last line of defence against any viral outbreak, and the global battle against the Coronavirus has proved no exception. Doctors, nurses, health workers, laboratory technicians, paramedics and others in the profession, are risking their lives to protect the rest of the community. The threat they face is way beyond what an ordinary citizen might face, as they are constantly at risk of being exposed to the virus. Despite knowing the danger, they choose duty over personal safety. But do we realise that their survival is vital to ours, and are we doing enough to protect them?
Frontline health workers are assigned data-collection work in the most remote and inaccessible parts of the city, in outlying slums and villages comprised almost entirely of the uneducated and the poor. Fearful of the spreading infection but unable to comprehend or comply with the government’s demand for ‘social distancing’, they are turning their frustration on health workers.
From simply being unresponsive, to lying about health conditions of family members, to verbal threats to stay away, to accusing them of deliberately getting people ‘arrested’ by the police, health workers have to face all this and worse.
“The main problem we face is when we try to talk to local people to procure more information,” says Sadhana Dutta, health supervisor with West Bengal Health Services, whose team works in the Thakurpukur-Mahestala block of Kolkata. “Not only are they unresponsive but react angrily to any questions asked. They are not willing to talk to us about anything related to their health. They think we will call the police to take them away if we find out that they are having health issues.”
Every surveyor is assigned to report on the health conditions and symptoms they find in a given area. These reports are sent to their heads presiding over blocks and are the primary source to determine the number of those infected. But with little cooperation, if not open threats, they face tremendous difficulties in preparing these reports or just doing their job. In many cases, villagers who have health issues, especially colds, fever or cough, secretly visit hospitals seeking treatment but deny they face any problems to health workers. Some of them have subsequently tested positive for Covid19.
Health workers dread having to work in areas that have been identified as ‘hotspots’ by the government. Police and health workers are tasked with tracing the possible spread of virus if a case is detected. They have to visit the infected, the areas where they have been, and people they came in contact with. In most cases, the infected do not comply. People who have come in contact with the infected choose to remain silent, making the tracing process the most difficult part of the job. This makes the job more complicated and very dangerous.
“Locating suspected and potential cases are almost impossible for us from the kind of response we are receiving,” says Dutta. “But this is not the only problem. Being health workers, we have to constantly be aware of the health condition around the areas assigned to us. The main source of such information is the locals. If we are not informed about health problems in an area, we can’t prepare ourselves, ending up in a very risky situation. Public compliance is the only aspect that can keep us safe. We produce the first update about the virus,” she adds.
Local people are terrified of being quarantined. “My son said there is a serious shortage of food supplies in isolation,” says Rinkle Laskar, a 59-year-old fruit vendor whose son was taken to a quarantine facility after being suspected of contracting the virus. “They keep a lot of people, and the number of mouths to feed is way more than the amount of food supplied. Abdul has to go to bed hungry every night. They don’t even allow food from outside. I wouldn’t want anyone’s children to suffer like mine.”
If the state is unable to protect health workers from the hostility and abuse of the public, it fares no better in providing them with personal protective equipment (PPE), like face shields and masks, gloves and shoes, let alone advanced gear like Hazmat suits. There is a serious shortage of PPEs. In many states, health workers receive PPEs only when they have to take a patient to a clinic or a hospital. Given how contagious the virus is, to work without PPEs puts them at great risk. The shortage of PPE is, in fact, causing a huge obstacle to conducting wider field visits.
The World Health Organisation has set clear guidelines for the safety of health workers. They include providing adequate infection prevention control (IPC) and PPE supplies (masks, gloves, goggles, gowns, hand sanitizer, soap and water, cleaning supplies) in sufficient quantity to healthcare or other staff caring for suspected or confirmed COVID-19 patients, so that workers do not incur expenses for their occupational safety and health requirements. Government has to familiarize personnel with technical updates on COVID-19 and provide appropriate tools to assess, triage, test and treat patients and to share infection prevention and control information with patients and the public. And as needed, provide appropriate security measures for personal safety.
But the government doesn’t even provide transport to its health workers. Some of them have ordered health workers to stay in the areas they visit and continue their work, but they are unable to provide accommodation there.
The shortage of health workers in India has been a persistent problem. According to the World Health Organisation (WHO), “Vacancies in sanctioned posts showed 18% of primary health centres were without a doctor, about 38% were without a laboratory technician and 16% were without a pharmacist.” In the face of a possible pandemic, their duties have been increased drastically within just a few months without any additional compensation. Currently, a single health worker has to visit two extra areas upon completion of the report of their assigned area.
“If we have to work during such a crisis, we should be provided with some facilities,” says Afruja Begum, auxiliary nurse (midwifery), West Bengal Health Services.
“Arrangements for us to stay, travel, eat, etc, should be provided by the government. In this emergency, we don’t even have a schedule for work. Wherever a problem pops up, the worker nearest to the area has to rush despite being in the middle of the work assigned to them. There is no method to our work. We thought we would be able to handle the situation, but its slowly turning into a nightmare.”
“We had problems with procuring PPEs as there was a shortage of supplies,” admits Kamalika Mukherjee, block medical officer, Thakurpukur-Mahestala block. “Since a week, we are being supplied with adequate PPEs. The shortage is mainly because these PPEs are to be used once and discarded. Hence, a constant supply is needed. Another major problem we are working to resolve is the unavailability of transport. We had provided transport initially during the lockdown as we were able to find a few vehicles. But now, vehicles are not available at all. It’s quite difficult as drivers refuse to visit Corona-infected areas.”
In every battle, resources and reinforcements are the crucial factors that decide its outcome. Without a well-funded support system and a clear plan of action, health workers are being forced to put their lives on the line and pray they don’t get infected. Already, at least 90 of them, including doctors and nurses, have been infected with COVID-19 and several have died. Medical professionals, especially frontline health workers, are the ones holding the line against the contagion. Once they fall, every Indian is at grave risk.