The battle against Covid-19 is on. Will it cost us the public health war?
The onslaught of coronavirus has consumed a vast amount of resources and energies of health sector professionals at an unprecedented scale.
In Pakistan, as in many other countries, the government is striving desperately to improve the health facilities; strengthen the workforce available with it; set up new hospitals and quasi-hospital facilities to accommodate and treat coronavirus patients; and so on. Mindful of the huge challenges it foresees over the coming days and weeks, it is bracing itself for them. There have been reports about repairing the dysfunctional ventilators available within the country and procuring more from China. Some local designs have been submitted for approval, and production might start as soon as they get it.
Fighting the pandemic is and will likely remain the top priority of the government for some time. Given the extraordinary nature of the problem the question arises: how can the government adequately fight coronavirus without compromising the interests of patients suffering from other diseases and conditions who need regular or emergency care? Nobody expects the striking and maintaining the right balance in this regard to be easy. Fortunately, we can benefit from the experience of some other countries who have tried various policy models with varying degrees of success.
Dr Ashraf Nizami, a senior office bearer of Pakistan Medical Association (PMA), tells TNS that doctors are no longer as accessible to their patients as they used to be. He says there is a reason to it – “There is a general perception among doctors that they have to suspect every visiting patient of being a coronavirus carrier until proven otherwise. The fear is overwhelming, and in the absence of proper protective gear, they are reluctant to interact with patients lining up at the OPDs. The fact that a few doctors and paramedics too have been infected has made them extra cautious.”
Nizami says KP is the first province to have closed the outdoor patients departments (OPDs) of all government hospitals for 13 days, and treat serious patients at the emergency wards. He believes that other provinces will follow suit.
A recent development in this regard is that the Islamabad administration too has issued a similar order. The patients are being told that ‘routine’ medical cases can be discussed over phone and medical advice sought the same way.
Nizami points out that it is common for people to argue that their medical condition falls in the category of emergency but it is for the examining physician to decide whether it is indeed so — “People must realise what an emergency is, and not take matters like a headache, a shoulder pain or digestive issues as such”.
However, he adds, fractures, heart attacks, injuries sustained in road accidents must be treated at emergency wards – “Nowhere is such treatment being denied.”
He says that when he receives a call from one of his patients, it’s he who decides, after asking some questions, whether it is a matter of medical emergency or not. If it is, he meets the patient.
“Pakistan has over 100,000 thalassemia patients, each requiring 3 to 4 pints of fresh blood per month. Students are our primary donors but due to closure of educational institutions, we are no longer able to hold blood donation camps, resulting in severe shortages. Imagine how acute the crisis will get in case of a countrywide lockdown.”
As mentioned earlier, news of medical professionals and paramedics getting infected by coronavirus while handling patients has caused a stir. The fact that many coronavirus carriers can be asymptomatic has further aggravated their fears. As a result, many private medical practitioners have closed their clinics, leaving their contact numbers on entrance gates for their patients.
Ali Butt, who has a pharmacy in Lahore, says many doctors are prescribing medicines to their patients after talking to them over phone about their symptoms. In case of prescription drugs, he says, “leading pharmacies are asking the buyers to obtain images of the prescriptions written by their doctors on their letterheads using WhatsApp. The pharmacies then match the name written on the prescription with that of the patient”.
He says some people have resorted to panic buying, and are stockpiling anti-malarial drugs, sedatives, anti-depressants and medicines used to treat diabetes and hypertension. The anti-malarial drugs including chloroquine phosphate, he says, disappeared from the market after there were reports on both conventional and social media about their being an effective treatment for coronavirus. The other medicines became short in supply in the market over fears that their regular supply would be an issue during lockdowns and restrictions imposed on businesses.
Butt says the news that raw materials imported from China to manufacture medicines in Pakistan are not arriving due to mobility restrictions has made things worse. The government, he says, must take notice of such news and explain the factual situation to the masses so that they do not needlessly stock medicines. One can well imagine the plight of malaria patients who cannot find anti-malarial drugs despite visiting several medical stores, he adds.
Punjab Health Minister Dr Yasmin Rashid has expressed hope that chloroquine phosphate can be beneficial in treating coronavirus patients. Dr Zafar Mirza, the special assistant to prime minister on national health services, announced some time back that the government had imposed a ban on the export of this drug. There were reports that huge stocks of the drug were recovered from some warehouses where people had hoarded them for selling at a premium.
Salman Kazmi, the Young Doctors’ Association (YDA) Punjab secretary, tells TNS that OPDs are open in public hospitals in the province though certain hospitals have been designated coronavirus specialty hospitals. In Lahore, he says, Mayo, Services and Pakistan Kidney and Liver Institute (PKLI) have been designated coronavirus specialty hospitals. In addition to these, he says, “a 1,000-bed facility has been set up at Expo Centre to accommodate coronavirus patients so that there is no extra pressure on other hospitals where patients are visiting in small numbers due to the prevalent fear.
The situation is also disturbing for dialysis patients who are being turned away as well as thalassemia patients who are having difficulty in getting blood for transfusion. An appeal by Islamabad-based Jamila Sultana Foundation (JSF) highlights the situation on the ground. As per the statement: “Pakistan has over 100,000 thalassemia patients, each requiring 3 to 4 pints of fresh blood per month. Students are our primary donors but due to closure of educational institutions, we are no longer able to hold blood donation camps, resulting in severe shortages. Imagine how acute the crisis will get in case of a countrywide lockdown — there is no way we can ensure uninterrupted supply of blood.”
The organisation has requested potential donors to come forward and donate blood. It says during the lockdown it will collect the donations from the donors’ doorsteps.