Thread by @docbhooshan

#Thread
#healthcare
"Private practitioners must step in..." says newspaper headline.
This kind of quote is usually by a govt official who sees difficulties on the ground; by NGO who find it difficult to recruit doctors for their ventures or by senior doctors who are

already working in their own clinics.

Let's look at what is happening on the ground.
Healthcare in India is 4 layered.
1. Family doctor/GP - single doctor clinic set up
2. Specialists - one or more doctors + paramedical staff - clinic set up
3. Hospitals - for admitting

patients for more care/ investigations/surgeries, etc. - small, medium or large sized. - Private or Govt set up.
4. Laboratories - for investigations of blood, urine, xray, monograph, scan, etc - small private set up and large corporates.

Government claims that all four layers are absent from healthcare services at present.

Most imp point to remember is - present govt strategy is to seal and quarantine a facility with staff where Covid positive person is found.

Let's look at this in some detail -

Layer 1 and Layer 4 - Family doctors and laboratories - small clinic like set up situated in the heart of the community they serve. Usually less than 2-3 km from residence. Patients may need transport to get there.

These are most crucial and most vulnerable components of healthcare. Simply because ~80% people use private services. These practitioners work on first come first serve queue based pattern.

People turn up anytime during clinic hours and wait for their turn.
Small clinics have no staff to manage queue, sanitation and social distancing. PPE should be available as FULL KIT for the doctor as they have no way of knowing who is positive but has no covid symptoms.

These asymptomatic positives are visiting clinic as patient companions or themselves for non covid issues.

Without FULL PPE doctor is exposed and vulnerable. Present guidelines say surgical mask + distancing is sufficient.

IS IT, REALLY? Then why are politicians and senior

officials wearing N95 masks?

Unless this issue is solved and harassment after finding covid positive patient is stopped, your family doctor CAN NOT function in community.

NGOs and GOVT need to focus on helping family doctors with PPE and providing volunteer assistance in clinics for social distance management. Assured freedom from harassment by various govt agencies empowered with coercive actions is desperately needed.

Layer 2 - specialists - situated far away from patients' residence, they see more sick patients. Patients can not visit a specialist without door to door transport and atleast one accompanying person. Specialists are presently doing most work online for follow up patients

and few new patients as well.
Telemedicine and active communication with Layer 1and 4 can take care of lot of work even in present conditions. Easing travel bans inside city is crucial for in person specialist work to happen. Police need to find a reliable and quick way for this.

Present procedure of police pass takes up to 48 hours. Police and technology need to make this happen. Doctors can register Geo location of their clinic and patient with enabled phone should get specific route pass from home to clinic in automated, instantaneous way.

Layer 3 - Hospitals of all sizes - provide all 4 layers of service at single location. They have staff to ensure social distancing and required sanitization - here problem is two fold - most staff travels to work by public transport or are dropped by relatives.

admitted patients need to travel long distance with relatives as well.
Fear of seal down , quarantine for staff and punitive action if Covid positive patient is treated here (inadvertently) keeps hospital owners on tenterhooks.

So as I see it, solution involves following components -
1. Full PPE and volunteer assistance to ALL family doctors, hospital doctors and nurses.
2. Instantaneous travel pass between two geolocation for patient and staff travel.
3. Some reasonable protection for good faith

actions of healthcare staff if covid positive patient is found.

Presently administration is trying to CREATE an entirely alternative system of covid/flu/fever clinics, non covid clinics , non covid hospitals, etc.
This WILL fail (already failing) as 80% are asymptomatic +ves.

Active assistance given to preexisting and well established system is best way to make sure that healthcare remains well and noncovid patients don't suffer.

Creation of alternate system on threats in the middle of a pandemic is NOT going to work.

It will cause more misery to ALL and MORE DEATHS.

Red Zones like Pune, Mumbai, Delhi, etc will need longterm measures. 3rd May is not some magical deadline for corona virus. Covid protection plan does not need to cause death of other patients.

Jai Hind.