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Kashmir doctors on the front line: Here’s your colleague in England giving you some life-saving tips

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Srinagar, Mar 27: A Kashmiri doctor in England has provided some life saving tips to medicos in the valley on how to safeguard their lives while treating COVID-19 patients.

Dr Mushbiq Manzoor, who practices as internal medicine post-graduate doctor at Sheffield Teaching Hospitals NHS Foundation Trust, in Sheffield England, suggested doctors in the valley to ensure they keep themselves safe and efficiently use whatever resources are available to them.

 

“In my whole life I have never been so afraid going to work. We don’t know when one may catch this infection. Every morning I wake up and see the posts from Kashmir, I feel scared since I’ve worked in the valley and I know how things are on the ground there,” says the young doctor in UK, where, as per last reports, 578 people had died of coronavirus with 11,658 confirmed cases.

Alone in Sheffield, where Dr Manzoor is based at, as many as six people have died of the virus so far.

FOOD AND SLEEP FOR IMMUNITY

The doctor suggests his Kashmir-based colleagues to have a good breakfast to boost their immunity before beginning their day.

“Whenever you leave for work, have a good breakfast, eggs milk etc. It will help you boost your immunity and there is less chance that you will catch this virus,” says Dr Manzoor in a video post on his social media handle.

Besides food, he asks the doctors and other paramedical staff to ensure they get good sleep to be mentally prepared for treating patients.

“Once you are back from your shift, sleep well, it too will help your immunity,” he says.

He suggests Kashmir medicos to have different set of scrubs and clothes in the hospital and at homes to avoid spread of infections.

PPEs

The doctor says that while most in Kashmir complain of lack of facilities­–like masks, Personal Protective Equipment (PPEs)–they have to understand that most of the medical systems in the world are overburdened right now.

“Although hospitals here keep billions of pounds of budget for healthcare, we still have shortage of these things because nobody knew this pandemic is going to hit us. So now we need to efficiently manage whatever resources we have,” he says.

Dr Manzoor says it is a good step to designate hospitals for COVID-19 cases and suggests doctors and authorities to focus more on patient isolation and work-schedule.

“At any given time, we should expose least number of doctors to this virus. And the most important point to note is that 10 to 15 percent of patients across Europe, like in Spain and Italy, comprise of medical workforce. So we have to save ourselves,” he says.

The doctor adds that there are different types of PPEs for different circumstances.

For example, he says, if a doctor is attending a cardiac call for a COVID-19 patient, he or she will need a visor, a mask, double apron, and the hair should he covered too, to ensure there is minimum exposure.

“We can’t have all the PPEs all the time. We should know how to use these resources efficiently because we know the hospitals won’t turn five-star overnight. They are going to stay the same. Lamenting or blaming right now won’t help,” he says.

Dr Manzoor later told The Kashmir Monitor in a chat that it was “disaster” in UK and that he prays Kashmir stays safe.

He asks the doctors to follow all the basic infection control measures they have to practice on day-to-basis.

Basic practices like hand wash, precautions before taking blood samples or swabs, even when treating non-COVID patients is something doctors and other staff should always keep in mind, he adds.

“Remember, hospitals are the most favourable place for this virus to spread.”

HIGH-RISK PROCEDURES

Dr Manzoor forecasts that if the situation in Kashmir worsens, as it has in many parts of the world, several patients would require high risk procedures including intubation, bronchoscopy, and noninvasive ventilation (NIV).

“These procedures run with the risk of aerosolizing the virus thus exposing the entire staff. As such doctors and other medical staff should take maximum precautions,” he says.

SPLIT SCHEDULE

Dr Manzoor also lays emphasis on working in split shifts.

For instance, he says that if six people run a department or a ward, they should split in three groups.

One group should work, another remain on standby and the third one at rest.

He suggests that the three groups should not meet each other inside or outside of work.

“This is to ensure that if there an exposure, only two people at a given time will be exposed. I know doing so will increase the workload but right now we also know that the usual patient flow is lesser.”

DNACPR DECISION

In his video post, the doctor also speaks of the importance of doctors taking timely ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions?

DNACPR decision comes into picture when doctors judge what is the best action to take (or not take) should a person suffer cardiac arrest or die suddenly.

“I know in Kashmir we don’t have the habit of taking DNACPR decisions. But I think this is the right time to start introducing this practice. If you have a COVID-19 patient with multiple comorbidities, you have to take a call whether it is worth to intubate such patient. Would it help him or her? Can you save the patient?”

Besides it, Dr Manzoor says, doctors in Kashmir should prepare a proper escalation plan for such a patient right from the day he or she is brought into their care.

The doctors, he says, have to decide the escalation plan beforehand.

“If the doctors are ready with the plan knowing that a particular case with multiple comorbidities will eventually slip into the critical phase, it will save them from a lot of unnecessary medial intervention which will prevent exposure in the end.”

There should be a checklist of actions for a COVID-19 positive or even a suspect patient, he says.

“In high-risk patients, especially the elderly, the doctors can be frank with the family members and tell them that intubation or any such procedure may not prove helpful, and can be more stressful for the patient. One should explain it to the patient and the family. We doctors in Kashmir never discuss these issues openly with those attending the patient.”

DON’T FORGET OTHER ILLNESSES

While treating a COVID-19 suspect, the doctors should also consider that the patient may have other viral infections with similar symptoms.

“I have seen patients who were COVID-19 suspects and turned out to be H1N1 positive and died. So we need to take care of it. They can have bacterial infections as well. Proper escalation of antibiotics is also necessary.”

DOFFING AND DONNING

Doffing and donning involves the proper way of putting on and removing of PPE and other safety equipment including masks, gloves, gowns, and visors. As per Dr Manzoor, there is a proper sequence of doffing and donning and it is very important to follow the same when treating a patient infected with coronavirus.

“There is a proper procedure how to doff and don. I would recommend all of you to should go through it online because it might be the difference between having you the infection or not.”

“If a COVID-19 patient is in a cubicle, there has to be a sub-clean area outside the cubicle or a room where a doctor or a nurse can dof and don. Otherwise it won’t make any sense doffing or donning inside the cubicle or totally outside it.”

While browsing for the doffing and donning procedure, The Kashmir Monitor found several credible resources informing about it. Here are few links that may prove helpful:

https://www.infectioncontroltoday.com/personal-protective-equipment/donning-and-removing-ppe-infection-prevention

https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf

Dr Manzoor also suggested doctors and paramedics to avoid cross-covering areas.

“Doctors treating people in one ward should remain in the same ward and not roam in the entire hospital. The flow should break otherwise it can spread infection everywhere. Staff must limit its movement. Nursing staff shouldn’t move a lot. They shouldn’t engage in chats with other colleagues in other wards. Rather they should leave for home directly once their shift ends.”

HYDROXYCHLOROQUINE?

About taking hydroxychloroquine, the drug many are dubbing is effective against the virus, Dr Manzoor said there was no clinical evidence proving the same.

“I know a lot of people are using it and various doctors are taking it. But so far there has been no clinical evidence, there is a big RCT (randomized controlled trial) going on in China. I think, the results will be available in a few days and would be a good thing to read.”

CAMARADERIE AND CONFIDENTIALITY

The doctor says it is criminal and highly unethical the way patient information is being shared in Kashmir on social media platforms as the same leads to stigmatization.  

“As a result the patients won’t come forward. Look at these photos you are sharing on social media. This is not acceptable at all. You can report to authorities but one cannot put such sensitive details on social media,” he says.

In fact, when this reporter asked Dr Manzoor to share the number of COVID-19 patients his hospital had attended so far, he said he could not share the same given the hospital policy.

Dr Manzoor also called for strengthening the camaraderie among doctors.

“We are soldiers in this war. If some doctor is anxious, we can counsel him. If someone is symptomatic, we can help them to report or suggest them to self-isolate. We doctors have this thing that we believe diseases won’t touch us and that’s why we see so many of us being infected by this virus,” he said.

“If a doctor develops any symptoms of this virus, they should immediately self-isolate to protect other doctors, patients and their own families.”

EDUCATE OTHERS

Dr Manzoor stressed on the need of informing others how dangerous this virus can be as it has brought some of the best medical systems in the world to their knees.

“If what is happening in Europe happens in Kashmir, people should know what devastation it will cause. Doctors need to put across this point to their families and neighbours. Kashmiris should know that after 5:30 or 6 pm they cannot leave there homes to roam around.”

“God forbid if it spreads in Kashmir, it will create havoc. I cannot explain the miserable state patients go into once this virus attacks. Besides, if a patient passes away, then we have all our social customs that can turn into a disaster infecting even more people.”