'Govt allocation for health care must go up'

The entire nation has been witnessing chinks in the armour of our health care system as the hospitals are fighting the epidemic. In a freewheeling interview with The Hans India's Aksheev Thakur, Dr Jagadish Hiremath, CEO, Ace Suhas Hospital, talks on how the hospitals are treating patients when there is an acute shortage of medicines and medical staff. He also talks on how the huge death rate has impacted the doctors psychologically.

Doctors differ over the efficacy of plasma therapy and Remdesivir in treating Covid patients. Shouldn't there be a standard protocol for Covid treatment?

There is already a standard protocol for Covid treatment which most of us agree is the right way to treat the patients. The two large multi-centric trials conducted in association with WHO, have shown that Remdesivir is of no use or has questionable benefit. It doesn't make sense to use Remdesivir when it is proven to be having a questionable benefit. If Remdesivir is to be used it must be used within 7 or 9 days after the first symptoms are seen.

Plasma therapy has been found resoundingly useless. We are not sure of the long term effects of convalescent plasma infusion on patients. We have been against it and we do not use it. We recommend our patients not to fall prey to such advice given by any WhatsApp forwards or social media messages.

Apart from vaccines there is a huge shortage of other medicines required for treating Covid patients. What has been your experience?

There is a huge shortage of medicines since an unprecedented number of patients are getting admitted to hospitals. There is no hospital which is not full hence the consumption of medicines has skyrocketed. We are barely running on reserves and trickling supplies due to lockdown. Although lockdown is helping in stopping the chain of transmission and probably reducing the caseload, it is adversely affecting the movement of essential drugs and medical supplies. Our experience in this has been quite alarming. We are paying two times the cost for required medicines and consumables. There is a lingering fear that I may not get required medical supplies tomorrow. We are not getting adequate quantities of supplies that we ask for. For instance, if we order 100 numbers of something, we get 40 or 50. This makes us place multiple orders and also go in search of orders.

We are witnessing shortage of beds, more so, ventilators and ICU. There is a threat of a third wave as well. What should be the government's first priority to improve India's healthcare so that in future we are battle ready?

There has to be a systematic change. Corrections must be made base-up. Fundamental changes need to happen starting from prioritizing healthcare. We have to move from health coverage which the government talks about providing to people like in the case of Ayushman Bharath. Ayushman Bharath talks about health coverage. But we need fundamental change where we have to offer healthcare to people when in need. It is not about offering people health insurance cover. It is about giving actual treatment in far away distant places where they are needed. For this there has to be a rapid shift in the way the government thinks about healthcare delivery and in the way the government wants to spend on healthcare delivery. We need to increase the number of beds available in rural and semi-urban areas for early care of patients. Unless systemic change is done, we will continue facing waves after waves and keep blaming one another. Private blames the government and government blames private and both end up blaming the public. This must not happen. For this not to happen, the government's allocation for healthcare should go up. We see advertisements of the government offering MD physicians a salary of Rs 15,000 to Rs 30,000. This kind of unrealistic thinking of the government must stop. They must offer realistic on ground salaries which medical workers receive. There is a huge disparity between the salary government and private hospitals pay doctors. This gap needs to come down if the government needs to hire good doctors to work in rural and semi urban areas. Expenditure for healthcare must increase.

Proper planning and execution of primary, secondary and tertiary care for all the people in India. Starting AIIMS in multiple districts is a good idea. The same way the government must continue increasing the number of such tertiary and quaternary care centers. Along with the availability of primary and secondary care centers.

You have pointed out the shortage of nurses and othe medical staff regularly, something that is missed in the mainstream discussion on Covid. How this issue impacted the treatment of Covid patients?

In our hospital itself we are not able to use all the equipment available due to the shortage of staff. We have a shortage of doctors and nurses. This is not unique to our hospital as each is facing the same problem. We are managing as our doctors and nurses are working double shifts. It needs attention. This is the first time I could feel the deficit of doctors and nurses being so much alarmingly present.

It is not affecting patients much as they are given adequate care. Instead of running full strength, we run partial strength. If a hospital has 50 beds, the hospital would run 30 beds as there is no staff for the remaining 20 beds. In a situation like Covid, we can never relax.

The last one year has not only been traumatic for the general mass but also the doctors. Would you want to talk about the stress you all have been through and how it affected doctors psychologically, given that they have been working in a not so conducive environment?

This pandemic has severely affected doctors psychologically. It has been a very stressful period for the whole medical fraternity. Doctors are strained having to run the show under such a stressful situation. Young doctors have been affected even severely. Seeing people die every day has turned into a real worst stressor for young doctors. Seeing so many deaths has not been a good sign for any young doctor. Young doctors are psychologically scared looking at such a huge number of deaths. Everything that we see at the hospital is something that we never thought would happen real just a year ago. But now it has been a truth and something that we have to live with for quite a longer time as what we are observing.

Having been under severe stress, we are finding out ways to cope with it. Be it taking vacations when there is a lesser caseload or engaging our mind in spiritual activities to give it a rest and calm environment so that we can deal with severe stress while at work.