Dr Satya Dev Gupta
Since the onset of the new year, 2020 Corona viral disease insidiously entered in our country. At that time China, from where the virus shred, ballooned with the high-profile record. The western world with whom the Red country had higher trade relations were very first to get entangled into the claws of this viral pandemics. The people of these countries embraced the Chinese victims of this disease with great affection and enthusiasm, and unknowingly got the fruit of this sweet-smelling poison. Italy, Germany, and France were the worst hit in the initial stages. In late February and the beginning of March, people enjoying the spring were in a notion that being a hot country the viral pandemics in India wouldn’t be so virulent as in the European and other western countries.It is also beyond any suspect and doubts that India being a developing country lacks basic facilities in the health care; so our government had chosen the other ways to combat the disease by imposing lock-down hence discouraging person to person contact and therefore was effective in preventing the mass spread of this epidemic in the early period until possibilities of introduction of vaccination is sort. Being a highly populated country the COVID-19 pandemic has spread its wings on masses to hunt but still 79,722 deaths against 4,846,427 till date 14th September, infected cases less than 1.64 percent mortality rate is remarkably better in comparison to world figures.
Jammu and Kashmir
The Union Territory of Jammu and Kashmir has a very good record of fighting against COVID 19. However, since the onset of September month, there is a tremendous increase in the number of COVID patients in our state. This bump continues to remain throughout the country and our state didn’t remain aloof from this hike. The Government of India has infused sufficient funds in the state to fight against this dreadful disease. The persons at the helm of affairs are also putting a lot of efforts to combat the morbidly and mortality. But still, the fundamental problems are yet to be solved. The general public who happens to become the victim of this disease narrates horrifying experience in the hospital wards. The wards are dirty, overcrowded, improper sanitation, lack of staff and medical facilities, insufficient toiletry, cleanliness, and above all the pathetic atmosphere. Public questions when a lot of money is bestowed by the Government then why there are such problems. People also complain of insufficient and improper Medicare. The government authorities must set up a medical audit, which could be a watchdog to curb the proper utilization of the funds.
The Government advisory board should also look into the non-emergency but genuine cases who are moving pillar to post for getting the treatment. The private hospitals and nursing homes are providing the medical facilities to such patients while government hospitals are not taking such patients. Why is it so?
It is learned that the central government has infused a lot of “Ventilators”, the artificial respiration equipment, made by DRDO in the state for respiratory care of very sick patients. Although it reflects the government’s attitude for the welfare of the state people however it is also astonishing to note that tehsil level hospitals like R.S Pura, Bishnah, Ramgarh, and other places are flooded with the supplies of these machines without knowing their utility and methods of working. On the first impression it looks good to have plenty of life-saving machines in our hospitals in the district and sub-district level, but what about the accessories and staff required to run such sophisticated machines.
Ventilators and Respirators
Ventilators are a complex respiratory support system for the patients who are otherwise not able to maintain their respiratory requirements needed for the life. During Novel Coronavirus19, many people developed a fake idea that Ventilators are the essential commodities without which the survival of a person suffering from this dreadful disease is impossible. It is pertinent to mention that the artificial respiratory support machine i.e. Ventilator is rarely required in most of the patients, but is only required when other measures fail. As there are certain requirements for using any sophisticated equipment, similarly installation of a Ventilator also needs accessories and paraphernalia. (1) There must be an uninterrupted power supply, (2) Constant high-pressure Oxygen feeding line,(3) Associated machines like (a)suction machine (b) drug delivery pumps (c) arterial blood gas analyzer (d) multiple emergency drugs with delivery systems (e) lot of disposable equipment and whatnot. As for as human resources are concerned (4) the expert doctors are particularly trained in Intensive care units, the intensivists, anesthesiologists, multimodal specialized medical experts, and highly qualified and trained nursing staff.
Although the Government intentions are very clear to provide the best Medicare at district, subdistrict, and rural levels, but it is only possible if all the working parameters are looked in advance and a proper plan is executed. To implement good health care to the grassroots level it is suggested that during this pandemic period good emergency centers and hospitals should have been built at district and if possible, at subdistrict standards where under one roof all the facilities could be provided. Loading the tehsil and districts with Ventilators without any further thought will prove futile and mere wastage of money and exchequer.
There was a time in the last 10 or 15 years when all the time the requests and requisitions were sent to the Government for the purchase of Ventilators and other necessary paraphernalia for the patients care in Intensive care units but due to financial constraints, it was not possible for the authorities to concede the demands. But now in GMCH 33 Ventilators are in function and 76 high-end Ventilators are yet to be installed. 156 Ventilators were provided by the Government of India (48 in the month of March and 109 in April). It is pertinent to mention here to provide respiratory care to seriously sick patients we need sufficient Oxygen supply. The GMCH Oxygen supply fell short as required in this overburden hospital, as the hospital Oxygen plant has capacity to provide 1200 LPM flow at high pressure and demand swelled up to 6000 LPM then how is it possible to fulfill it?
Henceforth it is suggested to the Government to make a comprehensive and detailed plan to fight out the pandemic COVID 19 in a big way, and in a systematic manner when we are enough funds and equipment at our disposal. It should also be ensured the supplies of Ventilators even at the district and sub-district level may not catch dust and become unusable in course of time.
(The author is Ex-Head of Intensive Care Unit & Department of Anesthesia Government Medical College Jammu. )
Dr Satya Dev Gupta