In healthcare, there is no equivalency between a doctor and someone who isn’t one, as patient safety requires doctors to step in when a complex problem or uncertainty arises over the given treatment. But considering the current shortage of doctors (and nurses and paramedics and assistants and so on) amid a pandemic that is intruding into the hinterland, optimum usage of doctors and medical staff is the immediate prudent thing that can be done to try salvaging the situation. Setting up centres that somewhat look like primary health care centres is now a must in every unit of a district to triage the cases and provide preliminary care.

The everlasting shortage of healthcare professionals has had fatal consequences for Covid-19 patients, who are now dying gasping for air despite the presence of brand new ventilators lying in district hospitals, as there aren’t trained staff to operate the machines. 

Primary care needs to be moving forth and towards small teams of healthcare workers with one supervising physician or even without one where there’s none. There are lots of things that require high skill and knowledge that only doctors can do, and there’re other things that nurses can manage and there’re still others that social workers /health coaches are adept at.

The pandemic demands acceleration of this restructuring of primary care, which has been gathering steam in recent decades. The higher prevalence of poorly controlled comorbidities in a population make the ageing population, and even the young more vulnerable to the effects of Covid-19 and most of such conditions can be controlled with a few blood tests, physical examinations, and medication adjustments. 

The current situation demands quick identification of areas in clinical care that health workers with varied qualifications and experience would be able to perform with hands-on training what otherwise doctors do; we can’t create enough doctors in a span of a couple of weeks, months or even years. Nurse practitioners (and physician assistants) who graduate after four to six yrs of education, can be permitted to do or trained/ guided to triage the sick patients as Covid/ non-Covid cases, or as mild, moderate or severely sick Covid cases. They can give initial care/advice, inform authorities of the need for oxygen or doctor consultation or transport to hospitals. This will save a lot of time of the golden hour of treatment for the patient as well as reducing a lot of confusion and crowd in hospitals. 

Hospitals in much of America are triaging Covid-19 patients because of a shortage of professionals, especially doctors trained in emergency care and anesthesiology. Another way to make available a good number of doctors for Covid care is by training doctors of other specialities (like dermatology, ophthalmology, plastic surgery, general surgeons, laparoscopic surgeons etc.) in critical care of the respiratory system in Covid patients who would be able to acquire the expertise in a small period. 

Final year UG and PG students who are yet to complete degrees and acquire experience should be left untouched in their academic pursuits to acquire their skills. It is likely to be detrimental for future generations if the current doctors-in-the-making are disturbed. Authorities can on the other hand help organise examinations at the right time so that the batches trapped in the pandemic can complete the degrees in the stipulated time without delay.

Another solution model that I believe is worth considering is developing a telemedicine web model that is closely linked to the primary care centres under a public health system. Such telemedicine units can be manned by nurse practitioner’s/ physician assistants with or without a supervising doctor present physically. The telemedicine room can be installed in the pharmacy/ chemist stores in villages /small towns equipped with the right Telemedicine kits (like digital stethoscope, thermometer, BP machines, oximeter, glucometer, audiometer etc.) in addition to a good quality video screen and audio system under good internet connectivity. Telemedicine is mostly ideal for follow-up patients or management of chronically ill patient that a doctor on the screen has already once seen/examined physically. But from our current experiences we’ve seen that Telemedicine consultations/ supervisions work as good in emergency care also where a specialist doctor can guide and direct the nurse practitioner or even a general practitioner/medical officer; and it also works in first-time consultations and even management of a critical care unit in a smaller centre from a higher distant centre.

For first time consultations, besides the working doctors, it’s possible to hire from the pool of retired doctors with their wealth of experience, or even the newly licensed doctors after some training in Covid care. The fresh doctors can even avail support from technology-enabled clinical support systems that are now available in the healthcare digital sphere.

Covid-19 has accelerated retirements of ageing doctors as many such physicians who are at higher risk of dying from Covid have reduced or stopped seeing patients; we see that most of the aged doctors tend to practice with a reduced practice load which now is further cut down in size so much so that these are literally erased off the scene. 

As we know that the PPP (Public-Private Partnership) model has worked in all other industries/sectors in our country, the authorities should implement Telemedicine solutions through a viable PPP model reaching out to nooks and corners of the country enabling the right network connectivity, availability of medicines and patient transfer facilities whenever need be,

Other smaller wellness models may also work around the telehealth units where a patient can himself or with aid from a trained health worker, can upload data from his home blood pressure monitor, oximeter, glucometer and electronic scale, and he/she gets a visit/call from the local health coach/health worker to talk about his health data and required changes to lifestyle etc., or/and, get scheduled for a teleconsultation with a medical officer or a specialist when necessary. To help with mental health issues, one can schedule a virtual visit with a mental health worker or even a psychiatrist located in a nearby city/ hospital. 

It’s common knowledge that in India health has been a completely neglected area in the public sector and the poor health infrastructure and incentives for professional/ financial growth under a pitiable GDP to the health sector is the bottleneck of our health system. I have known doctor couples joining government services and leaving the same for issues like lack of toilet facility, insecurity and disgraceful behaviour from raging attendants. These affect the female doctor more than the male doctor. Every year girls outnumber boys in securing medical seats and graduating from college, but this is only to disappear from the world of medicine or practice in a few years of practicing. 

In India, girls have been constituting more than 55% of the students joining medical colleges for years together (as per NEET UG 2020, women cornered 427943 seats compared to 343556 men). However, there is a serious shortage of female doctors in India. According to a paper (Prof Mohan Rao, 2011) titled Human Resources for Health in India, published in The Lancet (Placeholder1), only 17% of all allopathic doctors and 6% of those in rural areas are women. This is less than one female allopathic doctor per 10,000 populations in rural areas (0.5), whereas the ratio is 6.5 in urban areas. According to a paper on women in medicine (Bhadra M., 2011) published in the journal Indian Anthropologist, the gender gap increases at the post-graduation and doctoral levels–the percentage of female doctors here is around one-third of male doctors.  

Another paper on women in medicine by the psychiatry department AIIMS (Mamta Sood) in the Indian journal of gender studies, noted that medicine has been a male-dominated profession considering long demanding hours of service and inflexible work hours, and this is in addition to disproportionate wages against the demands of the services, make female doctors with young families decide against practising creating a dent in our health system. It’s time, government find out the missing lady doctors that will uncover a huge pool of qualified medical graduates ready to be trained for Covid care and critical care services in a short period.

The writer is a medical doctor (pathologist) and holds an MA in Creative Writing from the University of London. The views expressed are personal.

NEW DELHI: Three persons have been arrested in Delhi for allegedly black marketing Remdesivir injections and six vials of the drug being used in the treatment of Covid-19 patients have also been recovered from them, the police said on Monday.

According to the Delhi police, the accused have been identified as Anshul Aggarwal, Sunil Kumar and Rahul Paul. “Kumar works as a nursing assistant at NKS Hospital in Delhi’s Gulabi Bagh area, while Paul works as a nursing assistant at Gayatri Hospital in Gaziabad,” the police informed.

The police further informed that they acted on a tip received.

“The team used a decoy to finalise the deal. Accused Anshul confirmed the availability of the vials at Rs 32,000. He was apprehended when he came to deliver the promised order. On his lead other two accused were also arrested,” the police added.

A case has been registered under the various sections of the Indian Penal Code (IPC), Epidemic Act and the Disaster Management Act.

With ANI inputs

The Youth Bar Association of India (YBAI) has moved the Supreme Court seeking directions for appropriate measures to be taken for the provision of door-to-door Covid-19 vaccination of all Indian citizens, particularly the elderly, differently-abled, less privileged, weaker sections, and those who are unable to register online for their vaccination.

The YBAI, a group of young and vigilant lawyers, has filed the Public Interest Litigation (PIL) before the Supreme Court, through lawyers Sanpreet Singh, Ajmani, Kuldeep Rai, Manju Jetley (Advocate for the Petitioner) and Bably Singh. “Direct the respondent to consider the necessity for providing door-to-door Covid-19 vaccination of all the citizens residing in India, particularly those who are elderly, differently-abled, less privileged, weaker sections and those who are not capable to do their online registration for approaching the vaccination centre,” the petition filed by YBAI said.

The petitioner, YBAI sought the issuance of guidelines or formulation of a Standard Operating Procedure (SoPs) to give immediate effect to the functioning of door-to-door vaccination to incapable people free of cost.

The petitioner also sought direction to the respondents to have a 24/7 toll-free portal through which the incapable and underprivileged people may register themselves and which may resolve their queries and doubt in their regional language.

“The vaccination shall continue as before in Government of India vaccination centres, provided free cost to the eligible population as defined earlier i.e. Health Care Workers (HCWs), Front line workers (FLWs) and all above 45 years of age,” the petition said.

“All vaccination (through Government of India and Other than Government of India channel) would be part of National Vaccination Programme, and mandate to follow all protocol such as being captured on CoWIN platform and all the prescribed norms. Stocks and prices per vaccination applicable in all vaccination centres will have to be reported real-time,” the plea further said.

“The second mutant of Covid-19 infection is turning more infectious and widely communicable infecting almost more than 50% of the population and chances of it reaching its peak is in the mid to end of this month of May,” the petition filed by YBAI, before the Top Court said.

“The ray of hope emerged in people when the first dose of Covid-19 vaccine was injected to frontline workers on January 16, wherein the government ensured free vaccination to front line workers and citizens above the age of 65 years which later included citizens who are above the age of 45 years,” the PIL filed by YBAI said.

The plea further stated that however with the passage of almost months hardly 30% of around 40 crores of persons above the age of 65 years have been administered with the first dose of the vaccine and roughly around 1.8% of the total population have completed the second dose.

With ANI inputs

BHUBANESHWAR: Under the supervision of Odisha police, 516 tankers/containers carrying 9465.596 metric tonnes (MT) medical oxygen have been dispatched so far from Rourkela, Jajpur, Dhenkanal and Angul districts of Odisha to 11 states in the country facing oxygen shortage due to surging Covid-19 cases.

As per an official statement, as many as 21 tankers were dispatched from Angul with 852.642 MT, 132 from Dhenkanal with 2091.5 MT, 123 from Jajpur with 2543.192 MT and 210 from Rourkela with 3978.262 MT in the last 18 days. A total of 156 tankers with 3106.784 MT of oxygen have been sent so far to Andhra Pradesh, and 133 tankers with 2268.209 MT of oxygen to Telangana. Tamil Nadu has received 10 tankers filled with 202.04 MT of medical oxygen. Similarly, Haryana has received 76 tankers filled with 1385.422 MT of oxygen.

22 tankers with 388.68 MT of oxygen have been sent so far to Maharashtra, while 305.541 MT of oxygen filled in 20 tankers has been dispatched to Chhattisgarh. As many as 37 tankers have carried around 696.3 MT of oxygen to Uttar Pradesh and 45 tankers with 785.87 MT of oxygen have been sent to Madhya Pradesh to date.

13 tankers with 237.24 MT of oxygen have been sent so far to Delhi, 2 tankers with 58.22 MT sent to Punjab and 2 tankers with 31.29 MT sent to Bihar in the last 18 days.

More oxygen tankers from Odisha will be dispatched today.

Based on the directive of the Chief Minister, a special cell was formed under Y K Jethwa, ADG (L&O) as the Nodal Officer for coordinated action for loading and transportation of medical oxygen by Odisha to states facing deficit amid the ongoing Covid-19 pandemic.

With ANI inputs

Democracy is a system of governance in which the supreme power is vested in the people and is exercised by them directly or indirectly through free and fair elections held periodically. It is also a system where each one gets the right to express his/her views and participate in all desired activities provided these are peaceful. Contrast this with the recent spell of political violence in West Bengal immediately after the election results, allegedly perpetrated by the ‘karyakartas’ (workers) of Trinamool Congress (TMC). 

Surprisingly, and it has been alleged, the state government, run by the winning party TMC and the police, have been silent spectators to such violence! These attacks, heinous and inhuman, are in defiance of the very pillars of democracy and secularism. As the state, press, police, and politicians remain silent spectators, social media must be applauded for displaying the ground reality with the visuals of the political violence. Considering that the recent political violence is a deviation from established democratic ethos, will the state leadership be successful in addressing the issue impartially? Will it be able to protect the democratic space?

West Bengal history is replete with instances of political violence. Not long ago, the Left Front government in West Bengal committed the mistake to remain silent, and in some cases participated, in political violence which ultimately led to its downfall in the State Assembly elections and the rise of TMC. As the popular support of the Left Front was on its wane in West Bengal, it did not hesitate to use police force to suppress any form of resistance. As a result, criminalisation and politicisation became the order of the day in the governance of West Bengal. Today, TMC and its party workers seem to be replicating the Left strategy by overlooking the post-poll violence.

What is worse is the lackadaisical attitude of a few national and international media that have failed to report the gross violation of human rights on account of the recent political violence. Such an attitude can be dangerous for democracy in general and humanity in particular since it demonstrates blatant biases based on ideology and political leanings. The media should realise that they are the ‘third space’ between the government and the citizens in a democratic setup.

Some facts and figures are germane to substantiate that such violence has been on the rise under the TMC pre and post-elections. As per reports in the media, in the run-up to the state assembly elections, more than 130 BJP workers had been killed by the TMC’s ‘goons’ for joining the BJP. Even before West Bengal entered the first phase of the state assembly elections, confrontations were visible between many politicians, including Central Minister Arjun Munda’s Prachar Yatra and the TMC karyakartas. In the post-election phase, their party offices across West Bengal have been vandalised and set ablaze. 

Similarly, in the pre-election period, and according to a 2019 report by National Crime Record Bureau (NCRB), West Bengal had reported the maximum number of political murders in the country under the TMC rule. Interestingly, and as stated in the NCRB’s report “the number is likely to increase after the state submits the revised numbers”. The above facts and figures testify to the criminalisation of the public domain under the patronage of the state and partisan police force.

The process of criminalisation in the public domain has diminished the scope for dissent and differences. It should be remembered that voice of dissent and respecting differences of views and opinions, irrespective of ideologies, are core principles on which democracy survives and thrives. More importantly, it is also necessary to understand that expressing dissent and differences is as much a right as a duty. Implied, while democracy provides everyone with the right to dissent and express differences to bring forth their grievances, it also enjoins the citizens’ duty to ensure that any actions to exercise these rights are peaceful. Contrarily and if the voice of differences is expressed through violent means, be it the party in power or opposition, then it is the duty of the government in power to prevent the violent acts with all possible measures to protect the very edifice of democracy. 

While we rejoice over the fact that India is the largest democracy in the world, it is also important at the same time that we appreciate and accommodate multiple perspectives and ideological moorings! It is also the responsibility of the leadership, both central and state, to understand that the true spirit of democracy is: first, embedded in the right to freely elect the government and to vote it out of power in a legitimate manner by holding free and fair elections based on their performance; and second, to recognise that any form of violent public actions over election results, including inflicted by the karyakartas of the ruling party, is constitutionally illegitimate. Failure to do so will result in the emergence of undemocratic elements in a democratic space! With the conclusion of the swearing-in ceremony, it will now be interesting to see whether and how Chief Minister Mamta Banerjee endeavours to protect the democratic space!

The writer is Senior Researcher, Public Policy Research Centre (PPRC), New Delhi. The views expressed are personal.

If the voice of differences is expressed through violent means, be it the party in power or opposition, then it is the duty of the government in power to prevent the violent acts with all possible measures to protect the very edifice of democracy.

The United Arab Emirates (UAE) said it will bar entry of travellers from Bangladesh, Pakistan, Nepal and Sri Lanka from May 12 amid a sudden surge in COVID-19 infections in these countries.

“Flights between the four countries will continue to allow the transport of passengers from the UAE to Bangladesh, Pakistan, Nepal and Sri Lanka,” the UAE’s National Emergency Crisis and Disasters Management Austroity said. “This decision also includes extending the suspension of entry for travellers who were in these four countries in the 14-day period prior to arrival in the UAE,” it added.

The UAE citizens, diplomatic missions accredited by the four countries, official delegations, those travelling on business planes, and golden residence holders are exempted from the ban, Dawn reported. However, they will be subjected to precautionary measures that include a 10-day quarantine and PCR testing at the airport and on the fourth and eighth days after entering the country.

The country has also reduced the PCR testing period from 72 to 48 hours before travel.

Many South Asian countries are reeling under a new wave of COVID-19 infections.

In Pakistan, cases and deaths have also risen sharply, leading to fears about the strain on the health service.

Pakistan on Monday reported 3,447 new cases and 78 deaths, taking the country’s tally of infections to 861,473 and the death toll to 18,993.

Nepal is witnessing an explosion of COVID-19 cases.

Bangladesh too is witnessing coronavirus cases rising from early March, which forced the country’s authorities to impose a national lockdown.