As a team that works with gynacs who strive to help women defeat cervical cancer, we couldn’t help but wonder: what happens to obstetrics work where an emergency can knock at the door any time, any day? We decided to speak to a few gynaecologists about how the COVID-19 has changed the world for them and their patients.
The last few weeks have been possibly the most testing of times for everyone not just in India, but around the world in view of the COVID-19 situation. While every Indian business is finding new ways to cope up with the reduced in-person interactions with their stakeholders, healthcare facilities in India are impacted in both ways – on the one hand, they have to gear up for emergencies related to the virus and on the other, they have to cut down on services such as routine medical checkups.
In this series, we will present to you, experiences shared by gynacs across India.
Dr. Veena Rahatgaonkar-Joshi, Senior Gynaecologist, Deenanath Mangeshkar Hospital and Research Centre, Pune
Working in a 100-bedded hospital with a continuous footfall of patients is not an easy task for any doctor to handle. Who knows this better than Dr. Veena Rahatgaonkar-Joshi, senior gynaecologist at Deenanath Mangeshkar Hospital and Research Centre, Pune. She has a booming OPD of 30-40 patients on any regular day. But in the wake of this pandemic, she has improvised to adapt to the new situation.
Speaking about how they are able to handle the patient flow in the hospital while ensuring the safety of everyone, Dr. Veena said “We are giving all the routine patients our reception numbers to coordinate efficiently. Whenever a patient calls in, the receptionist talks to the patients to get feedback about the condition and trimester of the patient. Depending on the complication or severity of the case, the patient is connected to me. Then I determine if the patient needs to come or not. If the patient is in the 9th month or in the 5th month in need of sonography or notices that there is no movement of a baby or notices any other unusual condition, then I call the patient to the OPD. For other patients where no physical examination is needed, we have started providing telephonic counselling including prescriptions.”
“In keeping with the need to minimize the movement of people, we are advising patients to bring only one attendant with them. For patients who can use their own vehicles, the police facilitate a drive-through. Where patients do not have their own vehicles, they use autorickshaws that have been provided with special permission from the police dept and are available on call; these rickshaws are used to ferry the patients to the clinic,” she said.
Since the lockdown that started in Pune around the 20th of March, Dr. Veena has handled 8-10 normal deliveries and a few C sections. However elective surgeries have been closed.
A special room has been opened in the ER area in Deenanath Hospital where a preliminary screening for COVID19 is performed for the patient and the attendant before sending the patient to the OPD. Positive suspects are sent directly to the isolation ward.
This system seems to be working well for the hospital as the period has been incident-free and Dr. Veena hopes that with correct precautions, it will remain that way till the COVID19 situation improves and normal life is resumed.
Dr. Shyamkant & Dr. Srilekha Bhosale - Geeta Nursing Home, Hyderabad
Dr. Shyamkant and Dr. Srilekha Bhosale run Geeta Nursing Home in a highly-populated area in Hyderabad, India. The nursing home is bustling with patients throughout the day and saw one delivery per day on an average prior to the lockdown. Now, they are admitting only patients whose expected date of delivery is nearby. “Since we have a record of all the patients, we are able to triage and see who will need help,” Dr. Shyamkant said.
“We are doing everything possible to keep the hospital sanitized. We have to take special care to maintain the distance between the staff and the patient. We have re-trained our staff on washing hands frequently, cleaning chairs, tabletops, every now and then. We, in fact, have to sanitize the doorknobs as soon as anyone comes inside the hospital. However, we may be running short of sanitizers soon as the user has increased drastically.” The hospital has provided disinfectant soaps for their staff individually and advised them not to share with others to ensure hygiene and sanitary conditions.
Dr. Shyamkant assured that medicines and other essentials for patients are available in plenty and they did not face any crunch so far.
“Some of our staff is trained to make cloth masks and hospital gowns for internal use. We would be happy to make these for others too should the need arise but will need the hospital-grade disposable material,” he said.
A policy decision was taken to keep the elderly staff - senior citizen doctors and nurses - of the hospital away from the patients to reduce the risk of infections. Instead, they are now functioning in strictly supervisory roles and staff trained by them has taken over the deliveries and care of patients.
When asked if he does not miss the action, he said, “We realized that it’s not just us who feel good when we catch up with our friends and family in these days to be cheerful and lively; our patients could also use the same love and care from us, albeit remotely. We noticed that follow up calls to patients really cheered them up and made them feel cared for. We are only too glad to do this to avoid unnecessary movement of people from their homes. The sudden shutting off of social life can make people a little depressed; so we think a little cheer would do them good.”
“I think one of the best things we can do at this point is to constantly stay in touch with our patients, even if remotely, provide emotional support and reassurance and make them feel really upbeat,” Dr. Shyamkant said.
Dr. Indira Dhyanam – Kurnool Medical College, Andhra Pradesh
Dr. Indira is the Head of Department of Kurnool Medical College in Andhra Pradesh - possibly the busiest of the hospital in the whole of Kurnool that sees a turnout of 250-300 outpatient pregnant women every Monday.
“Since the last two weeks, we are seeing only 15-20 patients on Mondays. We have advised patients of up to 7 months to talk to us on the phone or meet the nearest medical point person, so they can feel reassured about good health. As of now, we are admitting only those with labour pains or those who are near term,” Dr. Indira said.
However as other gynaecologists has pointed out, all the hospitals whether private or public, are ensuring that only patients who are due for delivery, those who have conditions such as diabetes, hypertension, anaemia, and those with prior surgical history such as C-section are now admitted in the hospital rather than women between the first and seventh month of pregnancy.
“We are encouraging women between a first and seventh month to meet their auxiliary nurse midwives (ANMs) or regular physicians nearby from time to time, rather than coming to the hospital located miles away; but in case of any emergency, they have been advised to call 108 ambulance service and get to the hospital at the earliest. In fact, we also drop them back after the delivery so that the mother and child reach home safely,” she said.
She mentioned that awareness about COVID19, care practices, myths and facts are being spread by ASHA Workers who pass on the correct messages; so, people do not get unnecessarily worried or carry any misconceptions.
“We always take the contact details of the patients for our record, but since the COVID19 situation, we have additionally begun asking patients about their travel, visitors to their homes in the last few weeks as well as travel history to flag any possible care to be taken.
“Since the private nursing homes are closed, all those patients now come to the government hospitals; hence we are taking extra precautions to screen patients and sending them to the physicians in case of any doubts. We also do this for complicated cases on a regular basis, to ensure all required testing is done and patients are regularly monitored. The District Medical & Health Officer (DMHO) has a list of high-risk cases with contact details to ensure that any necessary help is arranged immediately. The hospital has tried to minimise attendants in the hospital to reduce risk of infection,” Dr. Indira said.
She has put in place an optimal plan so that every one of her staff gets to rest and refresh and be available in case of emergencies. So instead of having 5 batches of doctors throughout the day, the batch size has been cut down to 3 during the day and 2 at night as the number of patients to be seen is lower now. “We are ensuring this with our nursing and paramedical staff too; in this manner, we have constant availability of staff without overcrowding the facility.”
“I maintain my composure in these difficult times by meditating every day and by taking the correct safety measures to ensure the health of my staff and people in general. I ask people around me to do so too as that’s possibly the best way to deal with the high-pressure environment we work in and even more so now,” Dr. Indira said.
Talking about protective gear, she said: “We have been promised personal protective equipment (PPEs) such as N95 masks in adequate numbers. As and when they arrive, we would be able to handle any eventualities that will arise. We realise that the PPE equipment is expensive however the safety of personnel and patients is equally important; hence, till the time we get the PPEs, we have to follow the guidelines to limit the exposure. As of now, all the staff members are attending to patients with gloves and surgical face masks.”
Dr. Indira is happy that so far, all supplies have been ensured and the govt has even provided an extra supply of sanitizers to keep the hospital sanitized. “Our hope and service motto is for everyone to be safe, sound, and happy, and that is what we are following.”
Dr. Ramani Anishetty - Gynaecologist Kamineni Hospital, Narketpally Telangana
Kamineni Hospital is a corporate health facility based in Narketpally on the outskirts of Hyderabad. This hospital provides free service to low socio-economic families and is attached to a medical college in Telangana.
“Prior to lockdown, I used to look after 40 patients per day. Now that we have restricted the services to include only emergencies and not all obstetric cases, due to the lockdown, lack of transport and social distancing the number of patients I see is only about 5 to 6 per day. For follow-ups, women who are not in the first 1st to 7th month of pregnancy are accessing local nurses, Rural Medical Practitioners (RMPs), or anganwadis to get their weight and BP checked,” Dr. Ramani said.
She confirmed that many of the patients use their own transport due to lack of transportation services these days. However, some request hospital ambulances or the 108 ambulance service run by the government within 4-5 km.
“Our hospital is not equipped for COVID testing yet and we do not have PPE sets available at this time, though I think efforts are being made to procure some. Since all the PPEs are discarded after use, demand for them would be quite high. The PPE comes with a protocol of donning and doffing which by itself is a process and ensuring this each time, every time can be very taxing, especially when a patient is in urgent need of attendance,” Dr. Ramani said.
“We anyway counsel expecting mothers to look out for complications/danger signs such as irregular foetal moments, spotting, a sudden drop in blood pressure etc., and to reach out in case of any need. If the families are unable to come to the hospital but need to see a doctor urgently, they are provided referral letters to the Nalgonda govt hospital with a complete history of the patient so that it is easy for the other doctors to manage and treat in case of need. The police have been helpful in enabling the women to travel in case of emergencies and the hospital is doing its best to ensure social distancing in keeping with the requirement and the urgent need,” Dr. Ramani said.
“Staff has been assigned to work in shifts hence the workload since the past two weeks has been considerably less. Like others, I am also worried about the patients who are in the incubation period with symptoms not showing up till a later date. However, the situation will improve soon when test kits become available in larger numbers so that we can screen our patients before admitting them to the facility,” Dr. Ramani said.
When asked if she sees any home deliveries, she said, “No, I do not foresee any home deliveries as most of the emergency cases are referred to a hospital that is closer in our case, the Nalgonda Govt hospital.” she said.
“The patients in the hospitals, staff, and attendants are provided food. Although there is limited availability of vegetables, fruit, and groceries, the situation has been under control in our facilities so far.” Dr. Ramani confirmed.
“I have a 5-year-old child at home so the risk to my family is high but as a healthcare professional, it is my prime duty to attend to the cases and do everything within my power to ensure that the safety of my patients comes first. We at the hospital work as a close-knit team to do that.”
Dr. Usha N Reddy, Gynaecologist & Obstetrician - Chaderghat Hospital, Hyderabad
Dr. P. Usha Reddy has a nursing home in the old city of Hyderabad. It was a busy hospital until recently. Since the last two weeks, she has moved to manage her patients remotely, providing support on phone, and referring emergency cases to bigger private hospitals that are open as they are in a position to take care of the patients better. She mentioned that her regular clients do miss her services due to the rapport they shared with her and the assurance they had in visiting her on any day.
“Much as I would like to attend to them, I am unable to as I have never had to stock PPE. Given the current situation, it will be difficult for me to ensure the safety of my staff or of the patients.
“For the first time in 27 years of practice, I am not engaged 24/7! I have decided to utilise the time available in engaging myself in fruitful activities such as training younger gynacs remotely, creating content for patient education (Have spare time on hand and wish to give back to the society? Contact us today! http://periwinkletech.com/index.php/contactus), reading good articles on new technologies, etc all of which can be done online,” she said.
As the Indian medical fraternity and healthcare systems battle the pandemic bravely with the help of the police and government authority, we – the citizens of India – cannot thank them enough for taking care of us even in these difficult times!
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