SMCH will turn upside down if air and railway movement is not restricted, District Hospitals don’t support

In JK Rowling’s Harry Potter, Hermione Granger had a bag with endless resources. She could simply store anything and everything in that bag and at pull out whatever she needed in crucial times. However, Silchar Medical College and Hospital is not Hogwarts and the doctors don’t have Hermione’s bag with endless resources.

There are currently more than 200 patients admitted to the Hospital’s Covid Ward. The rate of admission is high as it is the only hospital for Barak Valley that houses more than 40 lakh people. In fact, not only Barak Valley, patients from North Tripura are also being stretchered into the Hospital in critical condition. Today morning, one from Tripura even expired.

The hospital’s management has sacrificed the Gynecology, Surgery, Psychiatry ward to admit Covid patients. If the influx of patients continues, next Ophthalmology department will also be devoted to curing Covid patients. Gynaecology Department has been shifted to the Mother and Child Care building while Psychiatric patients are now treated in the Medicine department. From the ward boy to the Principal, they all know only one thing, “The situation is not good.”

The second wave, in Barak Valley which is considered to be from April 1, is more fatal. It gives less time to the doctors and spares none. Silchar Medical College and Hospital’s in charge of RT-PCR tests, Debdatta Dhar Chandra who has been at the helm of the lab that tested tens of thousands of samples, is admitted to the hospital infected by Covid 19.

Lack of resources has not hit the Hospital yet in its fight against Covid. Lack of awareness has. 

The Biggest Challenge 

Those who know Silchar Medical College and Hospital, understand it well that this is no AIIMS or GMCH. It is a Hospital that needed a pandemic to awaken the government from its slumber and pay some attention. “Thank God we have a 100-bedded ICU ready or else it would have been a massacre,” says a senior doctor. Out of the 100 beds in what we now know as COVID-ICU, 40 were inaugurated in September 2020, and the remaining 60 earlier this week. The Hospital does not have Cath Lab, a facility to perform angioplasty or neurosurgery… and the list is long. However, lack of resources has not hit the Hospital yet in its fight against Covid. Lack of awareness has.

By the time most patients reach Silchar Medical College and Hospital, they are already in a critical condition. Patients continue to hide symptoms, delay tests, and even after testing, delay their visit to the hospital. “Forget doctors, even God will fail to save the patient if he or she is arriving with an oxygen saturation level of 30%, 35%,” says a professor at SMCH involved in covid management and treatment.

SMCH is only admitting patients who are critical and need oxygen support. There are oxygen concentrators in the Covid ward and the 60-bedded newly inaugurated ICU is being used as Oxygen beds. If needed the ventilators in those beds can be switched on to assist patients. However, it’s nothing. According to medical experts’ assessment, the Hospital needs at least 400 oxygen beds immediately. “All the patients admitted to the hospital are ICU patients. But because of the lack of resources at our disposal we are applying various permutations and combinations,” informs a medical officer.

“The work is going on on war footing and the financial liabilities are being taken care of by the Deputy Commissioner’s office. This is a big help from the Deputy Commissioner of Cachar and this timely help can turn out to be a life saviour”

Deep Dive Into SMCH

Apart from the 100 ICU beds, there are 100 beds in the Covid ward which takes the capacity to 200. By roping in Psychiatry, Surgery, and Ophthalmology wards for COVID purposes that is by sacrificing them for non-Covid patients, SMCH will be able to add around 200 more beds taking the capacity to 400. Going by the infection rate in Guwahati and Kamrup district, the experts in SMCH feel there can be 400 patients at the Covid ward in the next seven to fifteen days.

Once the number of patients crosses 400, the government will have to declare the SMCH as Covid Hospital and only then the management can add 200 more beds to take the capacity up to 600 Covid patients. “At 600 we give up” says the top brass of SMCH.

Meanwhile, these are just beds and not oxygen beds. Doctors at SMCH assert that more than medicines and expert opinion, this disease needs a constant supply of oxygen. “If you don’t have oxygen beds, liquid oxygen cylinders are the only alternative option. These cylinders impose huge logistical issues as a patient can consume one cylinder in just a couple of hours. So, you need to immediately replace them with refilled ones. This needs huge deployment of workforce which is not a viable option,” says a medical expert associated with the SMCH’s Covid management.

So, the management has shifted focus on having connected oxygen beds. These are beds located next to walls with oxygen pipelines. These pipes are connected to the plant which is connected to the oxygen generator. By doing this, it can be ensured that there is a constant supply of oxygen the demand surpasses the supply of the generator. The surgery department has got connected with oxygen pipes and the Eye department will also get connected within a week. This will add another 115 oxygen beds. The district administration is playing a key role in getting beds connected with oxygen pipelines.

“The work is going on in war footing and the financial liabilities are being taken care of by the Deputy Commissioner’s office. This is a big help from the Deputy Commissioner of Cachar and this timely help can turn out to be a life saviour,” asserts a top officer at SMCH.

But Covid is not the only disease that forces patients to ICU. As more and more resources get devoted to Covid cure, it adds to the woes of the non-Covid patients. Currently, there are 13 ICU beds for non-Covid patients at the central ICU and around 8 at the Medicine department ICU.

In terms of oxygen and drugs, it is so far so good. There are more than 500 doses of antiviral drug Remdesivir available in SMCH and the supply is reaching from Guwahati every third day. However, the patients are charged at a government announced rate. Each patient needs to pay for all six doses before the first dose is administered. If the patient expires before consuming all the doses, the medical college management will reimburse the unused doses.

The deaths inside the Covid ward are taking a toll on the mental health of doctors and nurses.

Humans and not machines

Doctors, nurses, paramedics, ward boys, cleaners, they are all witnessing a catastrophe unfold infront of their eyes. Something so dangerous and at this scale is not even there in the gigantic books the doctors study to become professionals to be entrusted with the responsibility of human lives. “The deaths inside the Covid ward are taking a toll on the mental health of doctors (most of whom are freshers) and nurses. Someone showing signs of recovery collapses within moment infront of their eyes. We get goosebumps reading and narrating these stories, but they are living them every day,” says a professor who, according to him is investing most of his energies in keeping the doctors motivated.

After the death of Dr. Jayati Chakraborty, professor of Women’s College, the female doctor who was treating her since day one had a mental breakdown. “Her breakdown was infront of everyone. Many doctors like her cry and cringe behind the PPE every moment and none of us realise,” adds the professor. At times it is the pep talk that motivates the doctor while in other times it is just the statement, “you will have to do it.”

While there are enough doctors at SMCH for now, Principal cum Chief Superintendent, Dr. Babul Bezbaruah, Superintendent Dr. Abhijit Swami are staring at a scarcity of skilled nurses. Even if nursing gets managed by putting extra hours at work, the shortage of grade III grade IV staff, technicians, radiologists fuelled by the rebelling contractual workers who have opted out from Covid duty, is a nightmare keeping the top officials awake at night.

It takes 30 to 45 minutes for the ward boys to stretcher in a patient three floors up to the Covid ward. The ward boys are few and the number of patients is high. This causes delays in transferring patients to the respective ward and at times, the delay claims lives. Because it is Covid-duty, unless the Government via district administration allows, the SMCH cannot accept help from volunteers or NGOs willing to put in a shift. The risk associated with it is huge as it demands coming in direct contact with the patient carrying infection caused by Covid 19.

“Even if they got infected by the virus, the ones vaccinated have recovered soon and it has not turned fatal for them,” Dr. Babul Bezbaruah

According to sources, two Radiologists working on a contractual basis volunteered to join Covid duties. They were detained by the association of the Contractual workers and weren’t allowed to work. Their demand is to make them permanent. While the demand has its legitimacy, pushing it during a Health emergency violates DDMA norms. For now, Covid is being managed by the staff employed by SMCH – exhausted and fatigued but not giving up.

“Experts we spoke with feel the immediate necessity is to impose restrictions on air and railway traffic”

The Immediate Necessity 

All top doctors and medical experts believe though the situation is grim, it is still not out of control. But it will soon turn the SMCH upside down. Experts we spoke with feel the immediate necessity is to impose restrictions on air and railway traffic. Those coming from outside Barak Valley, despite passing through the testing and screening points, can be carriers of the infection. With the number of cases growing in Guwahati, the next stop could be Silchar.

Also, the experts feel, it is time the administrations across Barak Valley impose strict restrictions in the movement of people. The crowded streets and markets can act as hubs spreading the virus. The medical setup needs a break to address the loopholes and search for alternatives.

The principal of Silchar Medical College and Hospital, Dr. Babul Bezbaruah, Padma Shri, Dr. Ravi Kannan, all believe that vaccination is the only way to tackle the virus. Dr. Bezbaruah says, so far, the patients vaccinated have shown good signs of recovery. “Even if they got infected by the virus, the ones vaccinated have recovered soon and it has not turned fatal for them.”

“To withstand the wave, a collective effort is necessary, or else the already in shambles medical infrastructure will crumble like a house of cards.”

One hospital for 40 lakh is not enough 

While Kamalakhya Dey Purkayastha, MLA elect from North Karimganj, and Zakir Hussain, AIUDF legislator elected from Hailakandi have met the Commissioner &. Secretary, Ministry of Health and Family Welfare and submitted a memorandum to install the ventilators at district hospitals in the respective districts, it remains unknown why were they silent on the issue and for so long. From the ‘PM Cares’ fund, 20 ventilators were shipped to Hailakandi and Karimganj in August 2020. Those 40 are kept packed decaying uselessly.

Oxygen beds in District Hospitals are the need of the hour. Not only that, in hospitals in Hailakandi and Karimganj, Xray, requisite tests to understand the level of infection needs to be performed feel experts. The district hospitals in Hailakandi and Karimganj are nice buildings but that’s about it. Inside they are nothing but incapable chambers of no secrets. The number of symptomatic patients is more in the second wave and therefore the medical experts feel tests and investigations need to be performed before the patients are transferred to SMCH.

In Cachar District too the Civil Hospital and the Primary Health Care Centres need to play a larger role. As the number of Covid patients grows in SMCH, Civil hospital can start sharing the load of non-covid patients, treat general patients and admit some who needs to be under observation for medicinal treatment.

Last year, before the Pandemic broke in Assam, Health Minister Himanta Biswa Sarma had signed a memorandum of understanding with the private nursing homes to offer non-covid treatment at the government’s cost. That could not work as 90% of the nursing homes in Silchar survive on doctors of SMCH. The government won’t allow doctors enrolled with the SMCH to ensure there is adequate medical attention available for the patients in the hospital.

Overall, the wave that has run havoc in Delhi, Mumbai, Bangalore – known for advanced healthcare in the whole country is fast approaching Barak Valley. These waves hit like Tsunami and destroy families in moments. To withstand the wave, a collective effort is necessary, or else the already in shambles medical infrastructure will crumble like a house of cards. Harry’s magic wand doesn’t exist in reality that could fix it with spells. Nor does Hermione’s magical bag which could expand capacity.