Wednesday, 10 June 2020

On the Frontlines: The Strain on Healthcare Providers

By: Komal Qidwai

A Covid-19 Ward at Civil Hospital, Karachi. Photo Credit: Health and Population Welfare Department, Sindh
As Pakistan’s Covid-19 tally rises above 100,000, hospitals across the country are running out of capacity and the burden on frontline providers is growing. Through our interviews with experts and on-going tracking of news and social media content, we have identified some major areas of concern regarding the safety and rights of frontline healthcare providers.

Starting in May, a stream of violent attacks began against healthcare providers and facilities by angry relatives of patients. In two separate violent incidents in Karachi’s Jinnah Postgraduate Medical Centre (JPMC) and Civil Hospital, relatives of deceased coronavirus patients demanded the release of their dead bodies, with the mob in the latter facility denying that the deceased was Covid-19 positive. Both groups of attackers damaged the facilities, breaking the glass windows on counters and throwing around furniture. Family members of a deceased patient also stormed into the hospital’s isolation ward and hurled abuses at the staff before attacking and injuring a young doctor in JPMC. In Peshawar’s Lady Reading Hospital, relatives of a 50-year-old corona patient broke down the door to the Covid ward and brawled with the doctors when they were informed that she died.

One reason for people to attack healthcare facilities and demand the release of dead bodies is denial that the pandemic is real. Near the end of April, Gallup Pakistan reported that over 3 in 5 Pakistanis believe that the coronavirus threat is exaggerated.

As hospitals run out of beds, ventilators and other equipment, frontline healthcare providers report high levels of stress. Even providers not directly dealing with Covid-19 cases are under strain and report constant anxiety. “Patients are being very rude and aggressive these days. Before the pandemic, incidences of aggression or violence happened rarely, but now it’s become a daily occurrence”, says senior gynecologist and obstetrician Dr Azra Ahsan. Providers are at risk of contracting the virus, as well as violence from angry family members of patients.

Over 2200 healthcare providers—1240 of whom are doctors—have been infected with the coronavirus, and 24 providers have died, including 15 doctors. Frontline providers report that facilities are now short-staffed because so many doctors and staff members are falling ill.Doctors had warned that infection would spread fast in the healthcare community due to shortages of personal protective equipment as well as lack of guidelines on its use. They complained that corona wards in hospitals were not disinfected properly. Healthcare providers also reported that private facilities were not providing their staff with PPE, risking their safety and lives. Young doctors have had to turn to non-governmental organizations (NGOs) for protective equipment supplies.

Doctors in Sindh urged the government to enforce stricter lockdown measures; pleading that people should stay at home and explaining that the situation in healthcare facilities was dire.

But government response has been mixed at best. In Quetta, the authorities refused healthcare providers’ demands for the provisions of PPE, and medical staff’s protests were met with police baton-charge and arrests. In Sindh province, doctors protested to demand PPE provision for all providers as early as the end of March, but to no avail. In Peshawar, two doctors resigned from Lady Reading Hospital in protest, claiming that the facility was not adequately equipped to deal with Covid-19 cases and healthcare providers were at risk. In Lahore, doctors of the Grand Health Alliance held a sit-in despite police threatening to charge against protestors. Over two weeks later, the government finally agreed to negotiate with the protestors, who were demanding PPE, regular screening of healthcare providers, and a risk allowance.

Doctors report the increasing number of staff falling ill combined with a lack of sufficient resources will now impact the quality of care being provided in healthcare facilities. Despite the worsening situation of healthcare facilities, the rising number of cases, and pleas of healthcare providers, the federal government is not considering re-imposing the lockdown. During a recent press briefing before a meeting of the Covid-19 National Coordination Committee, the federal Minister for Planning and Development, Asad Umar, remarked that the government would only impose a lockdown when the healthcare system gets overwhelmed.

Healthcare providers believe the system is already overwhelmed when even a cannula is not available for the treatment of a doctor sick with Covid-19. Families and colleagues of doctors in Karachi, Lahore and Multan have claimed that their loved ones have died from Covid-19 due to negligence of healthcare facilities and staff. The Special Assistant to the Prime Minister on Health, Dr Zafar Mirza, still claims only 30 percent of hospital resources dedicated to Covid-19 are being used. While the government has decided to provide 1000 additional beds with oxygen facilities in light of the burden on hospitals, there is no mention of the shortage of staff to provide care.

The strain on the healthcare system is not only impacting Covid-19 wards and patients but all other departments, including maternity units. Even in early May, Peshawar’s Lady Reading Hospital and Islamabad’s Pakistan Institute of Medical Sciences (PIMS) had to close their maternity wards due to the high number of infections among staff. Dr Nusrat Shah, a senior gynecologist at Civil Hospital in Karachi, reported they regularly received pregnant patients seriously ill with Covid-19. Despite these warnings, the government started to ease the lockdown in early May.

As the situation worsens, we can expect reproductive healthcare services will become more severely affected due to the strain on healthcare providers.Pakistan’s curve shows no signs of flattening; the government and the families would do well to remember that healthcare providers are risking their lives to provide services to their patients.