0730 AM - A couple of three seat Auto Rickshaws draw up disgorging about 08 passengers each. Passengers comprise elderly, the middle aged and a couple of young kids. The older ones make a beeline to the laboratory - these are patients of Diabetes who have started coming in for their blood tests.
0800 AM - By this time a crowd of about 60 patients has collected, about 40 of them milling around the laboratory. The rest wait in front of the registration - jostling, shoving to be first in the queue. Being early means that the wait time to see the doctor is less and they can then get home.
The laboratory assistants arrive and set up equipment for the day.
One of the attendants collects the books/lab slips and lines them up.
An announcement is made
1. All those who have cough, breathing difficulty or fever step aside
2. All those who have returned from Kuwait (used generically for the middle east) in the last 2 weeks please step aside.
There are a fair number of people who work in the Mid East as labour, servants, cooks, drivers, goat herds etc.
The idea is to fast track these patients and get them home quickly.
About 10 patients put up their hands and are taken in first to the lab.
Fasting blood tests done they are asked to wait at a specified place in front of my room.
0830 AM:
The bus from Madanapalle draws up and about 40 patients get down - there is much pushing and shoving to get to the queue either to the lab or to the registration
The registration opens and the patients continue to jostle for that 1/2 inch gain in the line. No amount of entreaties work!!!
I come in along with Dr Anandhi and we take a look at the patients waiting for new registrations. The numbers in the lab are huge and there are large number of patients for review - probably around 120 - 130. Can we see all these patients? This is a call we have to take and one has to be very hard hearted to say NO to a patient who has come from far seeking succour.
Finally we give appointments to a few and the rest - about 20 of them are taken in.
0845 AM: pen down - and the first patient
1. A 60 yr old man, Diabetic, Chronic Obstructive Pulmonary Disease (COPD) - Coughing and wheezing. A quick assessment - no fever, no wet cough - OK Nebulise him, give him inhalers and off you go.
2. 20 year old woman - Cough, fever x 5 days. She works in Hyderabad - ah ha the warning bells go off. She has just come off the night bus and straight to the Health Centre. The poor thing looks so scared - she probably saw my expression change when she said Hyderabad! Anyway I examine her - Just a mild Upper Respiratory - reassurance, medications and send her off with a warning that in case it gets worse go to a Government facility.
The next few are old patients of Asthma or COPD - all a little nervous since the COVID message has been playing non stop on the cell phones - lots of reassurance and cheer do the trick.
Distancing? What is that in the context of such a large number of patients landing up in overcrowded Auto rickshaws and buses?
What about doctors? The length of a stethoscope is 45 cm - much less than the mandates 1 metre
Can these rules be followed in a country like ours, with such a large population and so many needing health care under even normal circumstances?
I don't have the answers but am wondering about the practicality of the repeated reminders on Social Distancing.
Hygiene? Its a daily battle to prevent patients from hawking, spitting bringing out phlegm and just letting loose - Cough and sneeze hygiene - forget it! Carrying a handkerchief - you must be joking!
In all the crowd there will be a couple of youngsters who wear a handkerchief around their nose and mouth.
Water is at a premium - particularly when one has to fetch it from a communal tap. Why waste water on washing? Use hot sand or better still don't wash!! That's an option many of us, who read this will not even understand. We are so used to our 24 hr water supply.
Job Losses: Towards the end of the day a smartly dressed young man accompanies his father to my room. The father is a Diabetic and has been so for many years. He has come to the RHC for treatment. After I finish my examination and spiel on diet etc, I spend time with the young man.
He had till about a week ago a flourishing single man hair cutting shop in Electronic city, Bengaluru. Ever since COVID hit, work from home has started. He has steadily lost clientele and income. He has now come back to his village to ride out the storm. His family is dependent on his income. What's going to happen?
What will happen to the parking attendants, sweepers, baggage cart handlers at Bengaluru Airport? many of them are migrant workers from near our area. They will be all out of jobs and their families will suffer.
School Closures: Yes great idea to mitigate crowding. But what will happen to the kids whose only source of nutritious food is the MID DAY MEAL. They will now be forced to stay at home and help out in the fields or household chores. Typically in rural communities both parents work - and they work long hours. How do these parents make time for their kids? So not only do these kids miss out on meals they also miss out on education.
Hospitalisation?: If someone from the village gets a Pneumonia and progresses to Respiratory Distress (ARDS in medical terms) - they have to travel 120 - 150 km to a tertiary care centre at Tirupati or Bengaluru. Many a time - even under normal circumstances, there are no ventilators available. Whatever can be done is done.
The call on how much to do is routinely taken by doctors. Many a time I have spent time with a seriously ill patient's relatives laying out the pros and cons of taking such patients to a higher centre. Some of them choose to stay at home and we provide palliative medications to the extent possible and also teach them the basics of home care.
Others choose to go - some pull through and the others pass on.
Afterword: Yes COVID is a frightening reality. It is sweeping through the world. I shudder to think what will happen if it takes root in a community. The already stretched medical system will possibly break under the burden of disease. I read that hospitals are closing down since doctors got infected. Yes we doctors need to protect ourselves but then what about the people who depend upon us. Its like saying that the Armed Forces will cease to fight because a few soldiers got killed!!!
The GOI has done a tremendous job of keeping tabs on the epidemic. Village level volunteers have gone house to house checking on foreign returnees. These get a call from the Primary Health Centre checking on their status. More labs are being roped in to do tests. Here's hoping that the COVID involutes upon itself. Till then we continue to do what we are trained to do - PROVIDE HEALTH CARE TO THE SICK & NEEDY
Jai Hind
Kartik
One can see the staring eyes and expressionless facies of possible Parkinsons
