Dr Avinash Gawande took charge as the superintendent of government medical college and hospital (GMCH) over a year ago, just when the world was about to the face its worst-ever pandemic in Covid-19. Hailing from a rural background in Yavatmal and specializing in community health and academics, Dr Gawande was initially a bit reluctant to take up his new role. Prodded by GMCH dean Dr Sajal Mitra and seniors, Dr Gawande eventually took the plunge, dealing with infrastructural issues like shortage of beds, outcry of asymptomatic patients, staff grievances and the need to keep students in the loop. A year down the line, Dr Gawande spoke to TOI about the challenges GMCH faced and its preparation ahead of a possible second wave.
Excerpts from the
interview...
Q. The beginning of your term and Covid ran parallel. How tough was it?
A. When I took over on November 7, 2019, a lot of people, organizations, NGOs came to felicitate me. As soon as Covid-19 reached the city, the people who honoured me started blaming me for it (laughs). Initially, I was focusing on staff punctuality and overall patient care. This being a medical college and hospital, I had to work as per the needs of students, institutional development and good infrastructure for patients. I did not avail of any leave or weekly Sunday off since March 12 till the completion of my first year in office. After gathering information about the functioning of GMCH, I realized that I could do a lot more for the institution. One of my initiatives was getting erring students and staff to do social work or help out a needy patient.
Q. What are the lessons that you learnt from Covid19?
A. It was decided to start 600 Covid beds at GMCH. We never thought that all of them would be fully occupied. Yet, there was a time when we had no beds. Every day, we would think there won’t be any new problem but each day came with a new challenge. I’m thankful to GMCH and the society. I learnt a lot during this phase.
Q. How were the Covid admissions initially?
A. As per the prevailing policy, asymptomatic patients were admitted. They mostly don’t have any health complains. Hence, it was not easy to keep a normal person at one place in a hall for a period stretching over two weeks or more. For them, it was unnecessary confinement. We analyzed the situation and came to the conclusion that food was the main factor which would keep them content. We got two donors who provided food for patients, nurses, attendants and doctors engaged in Covid duties. Over 70,000 to 80000 meals were served free of charge with the support of donors. We are thankful to them. We ensured that the asymptomatic patients celebrated festivals during their hospital stay. We also made several modifications and exceptions for the well to do and some foreigners who couldn’t adjust to the general wards. Two large TVs were installed for their entertainment. Despite our sincere efforts, miscreants shot videos and made them viral to malign GMCH.
Q. What was the scene like when critical patients started getting admitted?
A. The oxygen requirement shot up. The demand in August and September was more than GMCH has ever consumed in its lifetime. We had set up a security team to ensure that there was no problem in oxygen supply, no leakage and pressure fall. We made a daily checklist of oxygen, water, sanitation, diet and serious patient analysis from each ward.
Q. What measures did you take to ensure better morgue management?
A. Just once, a relative was misinformed about a deceased because both the patients came at the same time and their files got mixed. Relatives are shown the body before it is taken out. Now we have a tag system. It can’t be removed. So even if files are mixed the tag will remain. We ideally try to foresee challenges but being a big institute, the scope for improvement remains.
Q. In what way are you prepared for the second wave if at all it comes?
A. We have got a contractual staff from the divisional commissioner, collector’s offices and public health department for the additional 400 beds. One ward needs 4-6 doctors for clinical and non-clinical works depending on HDU or ICU beds. Third and fourth-year students from our nursing college have been trained and kept ready for the next wave. The class IV staff has been outsourced by the collector’s office. Now, we have 1,000 Covid beds, including 250 for the ICU.
Q. Why do patients prefer GMCH over IGGMCH?
A. Patients, who come from all over, especially far off places, prefer GMCH because it has one of the largest medical facilities in the country. We never stop providing services like routine surgeries, super specialities and interventional radiology.
Q. How did you cope with the intense pressure?
A. The focus is always on patient care and better communication with relatives. You have to keep your cool and carry on with your work. However, the way patients are increasing now, the situation is likely to turn chaotic again. The positive point is that the antibody titre in urban and rural population is good. By December 15, cases may peak. Compared to the first wave, we are better prepared now. We didn't’ rest in the last six weeks even though the number of cases came down significantly. We strengthened our infrastructure during this break. We are prepared even for a bigger challenge. Help desks for patients and relatives have been set up.
Q. Any new measure to manage patients better?
A. Both the medical colleges have started using a remote sensing application called Dozee. It helps in monitoring a patient’s heart rate, respiration, SPo2 and other activity. The medical superintendent, dean and treating doctor can track the patient’s health. The application was put to use towards the later stage of the first wave. It will prove handy in the future as well. Stopping the progress from mild to moderate, moderate to severe, early diagnosis and management before the patient turns serious is the key. Also, we are constantly training and counselling Class III and IV staff to help them overcome fear and occupational anxiety.