Kashmir doctors on the front line: Here’s your colleague in England giving you some life-saving tips
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
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
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.
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
“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
“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
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.”
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
“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.
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
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.”
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
“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
“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
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
“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:
Dr Manzoor also suggested doctors and paramedics to avoid cross-covering
“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.”
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
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
“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
“If a doctor develops any symptoms of this virus, they should
immediately self-isolate to protect other doctors, patients and their own
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.”