Doctors, nurses and the staff at hospitals around the country are putting themselves at risk while trying to identify and treat those infected with Covid-19, and to stop the virus from spreading further.
However, exposure and a significant lack of protective gear are now fuelling concerns for the safety of these healthcare personnel in Bangladesh — where 20 coronavirus cases and one death have so far been confirmed.
Health workers say their fear of getting exposed is increasing as they do not have adequate personal protective equipment (PPE) — like masks, gloves, and gowns — and infected patients could walk into the hospital at any moment.
The public hospitals in Dhaka and other parts of the country are yet to take any foolproof preventative measures. There are not many hospitals that are checking temperatures of people at the entrance, and only a few public hospitals have mandatory hand-washing or sanitizing facilities.
Four doctors of Dhaka Medical College Hospital (DMCH) are already in home quarantine on suspicion of being infected with Covid-19, a new coronavirus strain that has so far infected 255,000 people and killed over 10,400 globally.
When the virus spread into many countries around the world, worsening the situation, hospitals in Bangladesh were ordered to open isolation or quarantine units in preparation thereof. But the bigger problem the caregivers are facing right now is with PPEs.
Requesting anonymity, a junior doctor at DMCH told Dhaka Tribune that they are not getting enough PPE against the number of junior doctors who work at their department every day.
“At least 30 people work in one shift in my department, but only five PPE sets are provided every day. Because of this, I personally buy mine at Tk230 from an online shop every working day,” said the doctor.
DMCH Director Brig Gen AKM Nasiruddin said they have provided full PPE to doctors and nurses in the medicine, paediatric, outdoor, and emergency departments as they require more protection.
A health worker collects sample at an Isolation Ward in Dhaka Medical College Hospital outdoor | Mahmud Hossain Opu/Dhaka Tribune“We are using 300 full PPE every day for our doctors and nurses in these departments. But, if the situation gets worse, we will need approximately 2,000 of those PPEs per day,” he said.
According to the junior doctor, their problems do not end with the PPE. “Most of the patients are not at all conscious about maintaining respiratory hygiene.
“Forget about masks, patients cough and sneeze literally on our faces at this hospital,” the doctor said, adding that their risk of getting infected by a patient is beyond measure.
With the number of Covid-19 patients rising in Bangladesh, healthcare professionals fear they are compromising their health in absence of proper and enough PPE compared to the developed nations.
Doctors opine that they do not want to run from their duty, but demand adequate, and if possible, additional protective gears.
Different media reports have also shown similar remarks from doctors and nurses from hospitals in different districts, including Chittagong, Jhenaidah, Rajshahi, Comilla, and Barisal.
The Directorate General of Health Services (DGHS), however, said that they are bringing in one million PPE to ensure safety of the healthcare personnel around the country.
More challenges
“Of course, we want to stick to our oath [to treat all patients] during such a crisis, but we are also human,” said Dr Farzana Sharmin Shuvra, assistant professor of gynaecology and obstetrics department at Bangabandhu Sheikh Mujib Medical University.
She also maintained that doctors are at high risk of getting infected through their patients. “But, to avoid that, our hospital has instructed us to wear disposable gowns, gloves, masks, and caps. But we don’t have goggles.”
Dr Farhad Manjur, of Dr MR Khan Shishu hospital and Institute of Child Health, also said: “Every doctor has a family. If they get infected from a patient, they will surely carry the deadly virus to the vulnerable members in their families.”
Dr Farzana said they are also dealing with another challenge. “Some patients, who came from abroad, hide their travel history. We cannot take extra precautions if they do not disclose their travel history.”
Doctors of emergency, outdoor and medicine departments in hospitals are more concerned as they are the ones who mostly tend to people with fever and cough — two of the common signs of Covid-19 infection.
DMCH Director Nasiruddin told Dhaka Tribune that people here have some misconceptions about PPE, as they see pictures of health workers in different countries online.
“Not all health workers are using full protective gears in other countries. Health workers who are directly treating Covid-19 patients are the only ones using heavy protective gears,” he said.
He, however, admitted that hospitals outside Dhaka are getting less PPE compared to the capital city’s hospitals.
Responding to a question, he said DMCH is trying to minimize the risk of losing more doctors to home quarantine protocols.
Same issue, different outbreaks
The scenario is not too dissimilar in other countries around the world.
Thousands of health workers have either tested positive for Covid-19 or have been quarantined in different countries, mostly at the outbreak’s epicentre in China’s Hubei province, since the pandemic started in late December last year.
In many cases, the victims alleged that they were infected either after coming into contact with infected patients unknowingly or by treating Covid-19 patients without proper protective equipment.
That, however, is all the more reason for the Bangladesh government to step up its game and ensure all-out support for the health workers.
Statistics is also in favour of the importance of dealing meticulously with the contagious disease in medical facilities.
During widespread outbreaks of infectious diseases, healthcare workers are almost always hit hard in nearly every affected country.
During the 2002-04 SARS coronavirus outbreak, H1N1 pandemic in 2009, the 2014-16 Ebola outbreak, and the early stages of Covid-19 pandemic in China, the caregivers were more likely, compared to other groups, to get infected. Many had either become severely ill or even died.
According to a recent research in the Journal of the American Medical Association, 41% of all Covid-19 cases in China were tied to hospital transmissions, and healthcare workers are at increased risk of contracting the disease.
A health desk is set up to screen people for signs of the coronavirus | Mahmud Hossain Opu/Dhaka TribuneDuring the SARS outbreak, which infected over 8,000 people and killed nearly 800 worldwide, healthcare workers were also at high risk and accounted for one-fifth of all the cases.
A 2015 World Health Organization report also said that health workers were between 21 and 32 times more likely to be infected with Ebola than people in the general population during the outbreak, which infected more than 28,000 people and killed over 11,000.
1 million PPEs on the way
On Thursday, intern doctors at Rajshahi Medical College Hospital abstained from work for several hours, demanding adequate protective gear for their safety in light of the coronavirus outbreak.
Doctors and nurses at Comilla Medical College Hospital, which has two isolation units, on Friday also made similar demands. They said they have not been trained and provided with protective gears to treat Covid-19 patients.
However, addressing a press briefing in Dhaka on Thursday, DGHS Director General Dr Abul Kalam Azad said they were gathering 100,000 testing kits to detect infected patients, and one million PPEs for the healthcare personnel around the country.
Once these equipments arrive, there will be no shortage of PPEs at any hospitals, he said.
But he said that DGHS would not be able to provide the supplies for three months at once. “All equipment will be supplied on a weekly basis.”
The Central Medical Stores Depot also collected 10,000 PPEs on Thursday and they were being distributed among hospitals, Azad added.
There are 102,927 registered doctors and 56,734 registered nurses, respectively, across the country, according to the Bangladesh Medical and Dental Council and the Bangladesh Nursing and Midwifery Council.
Apart from them, every hospital has ward boys, security personnel, administrative officials and employees at other departments — the total number of whom is unavailable.
Dr Abdun Noor Tushar, adviser to Foundation for Doctors’ Safety and Rights, also told Dhaka Tribune that healthcare workers from different parts of the country have been sharing their fear of contracting the disease with them.
“There are around 90,000 doctors in Bangladesh and 5.1 million PPEs are needed for them.
“A personal protective equipment set is not that expensive. It costs between $20 and $30. Also, a health worker does not have to dispose of all the equipment after a single use. Some of the equipment, like the goggles, can be reused,” he said.
Iqbal Hosen Sabuj, secretary general of Swadhinata Nurses Parishad, said nurses do not have to tend to all patients with full protective gear. However, they are provided with PPE whenever necessary.
Tanjir Rahman contributed to this report
