In healthcare, there is no equivalency between a doctor and someone who isn’t one, as patient safety requires doctors to step in when a complex problem or uncertainty arises over the given treatment. But considering the current shortage of doctors (and nurses and paramedics and assistants and so on) amid a pandemic that is intruding into the hinterland, optimum usage of doctors and medical staff is the immediate prudent thing that can be done to try salvaging the situation. Setting up centres that somewhat look like primary health care centres is now a must in every unit of a district to triage the cases and provide preliminary care.
The everlasting shortage of healthcare professionals has had fatal consequences for Covid-19 patients, who are now dying gasping for air despite the presence of brand new ventilators lying in district hospitals, as there aren’t trained staff to operate the machines.
Primary care needs to be moving forth and towards small teams of healthcare workers with one supervising physician or even without one where there’s none. There are lots of things that require high skill and knowledge that only doctors can do, and there’re other things that nurses can manage and there’re still others that social workers /health coaches are adept at.
The pandemic demands acceleration of this restructuring of primary care, which has been gathering steam in recent decades. The higher prevalence of poorly controlled comorbidities in a population make the ageing population, and even the young more vulnerable to the effects of Covid-19 and most of such conditions can be controlled with a few blood tests, physical examinations, and medication adjustments.
The current situation demands quick identification of areas in clinical care that health workers with varied qualifications and experience would be able to perform with hands-on training what otherwise doctors do; we can’t create enough doctors in a span of a couple of weeks, months or even years. Nurse practitioners (and physician assistants) who graduate after four to six yrs of education, can be permitted to do or trained/ guided to triage the sick patients as Covid/ non-Covid cases, or as mild, moderate or severely sick Covid cases. They can give initial care/advice, inform authorities of the need for oxygen or doctor consultation or transport to hospitals. This will save a lot of time of the golden hour of treatment for the patient as well as reducing a lot of confusion and crowd in hospitals.
Hospitals in much of America are triaging Covid-19 patients because of a shortage of professionals, especially doctors trained in emergency care and anesthesiology. Another way to make available a good number of doctors for Covid care is by training doctors of other specialities (like dermatology, ophthalmology, plastic surgery, general surgeons, laparoscopic surgeons etc.) in critical care of the respiratory system in Covid patients who would be able to acquire the expertise in a small period.
Final year UG and PG students who are yet to complete degrees and acquire experience should be left untouched in their academic pursuits to acquire their skills. It is likely to be detrimental for future generations if the current doctors-in-the-making are disturbed. Authorities can on the other hand help organise examinations at the right time so that the batches trapped in the pandemic can complete the degrees in the stipulated time without delay.
Another solution model that I believe is worth considering is developing a telemedicine web model that is closely linked to the primary care centres under a public health system. Such telemedicine units can be manned by nurse practitioner’s/ physician assistants with or without a supervising doctor present physically. The telemedicine room can be installed in the pharmacy/ chemist stores in villages /small towns equipped with the right Telemedicine kits (like digital stethoscope, thermometer, BP machines, oximeter, glucometer, audiometer etc.) in addition to a good quality video screen and audio system under good internet connectivity. Telemedicine is mostly ideal for follow-up patients or management of chronically ill patient that a doctor on the screen has already once seen/examined physically. But from our current experiences we’ve seen that Telemedicine consultations/ supervisions work as good in emergency care also where a specialist doctor can guide and direct the nurse practitioner or even a general practitioner/medical officer; and it also works in first-time consultations and even management of a critical care unit in a smaller centre from a higher distant centre.
For first time consultations, besides the working doctors, it’s possible to hire from the pool of retired doctors with their wealth of experience, or even the newly licensed doctors after some training in Covid care. The fresh doctors can even avail support from technology-enabled clinical support systems that are now available in the healthcare digital sphere.
Covid-19 has accelerated retirements of ageing doctors as many such physicians who are at higher risk of dying from Covid have reduced or stopped seeing patients; we see that most of the aged doctors tend to practice with a reduced practice load which now is further cut down in size so much so that these are literally erased off the scene.
As we know that the PPP (Public-Private Partnership) model has worked in all other industries/sectors in our country, the authorities should implement Telemedicine solutions through a viable PPP model reaching out to nooks and corners of the country enabling the right network connectivity, availability of medicines and patient transfer facilities whenever need be,
Other smaller wellness models may also work around the telehealth units where a patient can himself or with aid from a trained health worker, can upload data from his home blood pressure monitor, oximeter, glucometer and electronic scale, and he/she gets a visit/call from the local health coach/health worker to talk about his health data and required changes to lifestyle etc., or/and, get scheduled for a teleconsultation with a medical officer or a specialist when necessary. To help with mental health issues, one can schedule a virtual visit with a mental health worker or even a psychiatrist located in a nearby city/ hospital.
It’s common knowledge that in India health has been a completely neglected area in the public sector and the poor health infrastructure and incentives for professional/ financial growth under a pitiable GDP to the health sector is the bottleneck of our health system. I have known doctor couples joining government services and leaving the same for issues like lack of toilet facility, insecurity and disgraceful behaviour from raging attendants. These affect the female doctor more than the male doctor. Every year girls outnumber boys in securing medical seats and graduating from college, but this is only to disappear from the world of medicine or practice in a few years of practicing.
In India, girls have been constituting more than 55% of the students joining medical colleges for years together (as per NEET UG 2020, women cornered 427943 seats compared to 343556 men). However, there is a serious shortage of female doctors in India. According to a paper (Prof Mohan Rao, 2011) titled Human Resources for Health in India, published in The Lancet (Placeholder1), only 17% of all allopathic doctors and 6% of those in rural areas are women. This is less than one female allopathic doctor per 10,000 populations in rural areas (0.5), whereas the ratio is 6.5 in urban areas. According to a paper on women in medicine (Bhadra M., 2011) published in the journal Indian Anthropologist, the gender gap increases at the post-graduation and doctoral levels–the percentage of female doctors here is around one-third of male doctors.
Another paper on women in medicine by the psychiatry department AIIMS (Mamta Sood) in the Indian journal of gender studies, noted that medicine has been a male-dominated profession considering long demanding hours of service and inflexible work hours, and this is in addition to disproportionate wages against the demands of the services, make female doctors with young families decide against practising creating a dent in our health system. It’s time, government find out the missing lady doctors that will uncover a huge pool of qualified medical graduates ready to be trained for Covid care and critical care services in a short period.
The writer is a medical doctor (pathologist) and holds an MA in Creative Writing from the University of London. The views expressed are personal.
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RUSSIA WILL ACCEPT CONDITIONAL HANDOVER OF CYBER CRIMINALS TO US, SAYS PRESIDENT PUTIN
Three days before the US-Russia summit, Russian President Vladimir Putin on Sunday said that the two countries need to engage in a constructive dialogue and establish mechanisms for interaction as there are areas in which Moscow and Washington can cooperate.
“[We need] to restore our personal contacts, relations, establish a direct dialogue, create really functioning mechanisms of interaction,” Putin said in an interview broadcast by the Smotrim.ru media outlet. The President noted that the US side is well aware that there are a number of areas that are of mutual interest, such as strategic stability, regional conflicts, environmental protection measures, and climate. “There are areas in which we can really work effectively,” Putin added.
In the process, President Putin said that Russia would be ready to hand over cyber criminals to the United States if Washington did the same for Moscow and the two powers reached an agreement to that effect.
The Russian leader said he expected the Geneva meeting to help establish bilateral dialogue and revive personal contacts, adding that important issues for the two men included strategic stability, Libya and Syria, and the environment.
Putin also praised Biden for having shown “professionalism” when the United States and Russia agreed this year to extend the New START nuclear arms control treaty.
The White House has said Biden will bring up ransomware attacks emanating from Russia at the meeting. That issue is in the spotlight after a cyberattack disrupted the North American and Australian operations of meatpacker JBS USA.
A Russia-linked hacking group was behind that attack, a US source familiar with the matter said last week.
Asked if Russia would be prepared to find and prosecute cyber criminals, Putin said Russia’s behaviour here would depend on formal agreements being reached by Moscow and Washington.
Both sides would have to commit to the same obligations, he said.
“If we agree to extradite criminals, then of course Russia will do that, we will do that, but only if the other side, in this case the United States, agrees to the same and will extradite the criminals in question to the Russian Federation,” he said.
“The question of cyber security is one of the most important at the moment because turning all kinds of systems off can lead to really difficult consequences,” he said.
With agency inputs
12 killed, 138 injured in gas explosion in China
HUBEI: At least 12 people were killed and 138 were injured in a huge gas explosion in central China on Sunday, state media reported.
A gas pipe exploded in the Zhangwan district of Shiyan city, in Hubei province at about 6:30 am local time. The number of casualties is still being verified as the search and rescue operation is underway. According to the local authorities, 150 people have been pulled from the debris, and the injured are being treated at local hospitals.
Apparently, the explosion destroyed a wet market there and greatly affected nearby residents. “Hearing the loud bang, I immediately scrabbled beneath the table, thinking it was an earthquake,” a resident surnamed Liu, told the Global Times via phone.
Images are circulating on social media, which appeared to be from the scene, showed rescue workers in orange jumpsuits working through the wreckage of flattened houses.
The cause of the accident is under investigation, according to the city government, which informed on the Chinese microblogging platform Weibo.
Rescue operation is underway and more details are awaited. ANI
SAUDI ARABIA BARS FOREIGN PILGRIMS FROM HAJJ DUE TO COVID-19
Amid the raging Covid-19 pandemic, Saudi Arabia has once again barred foreigners to perform the Hajj, and set a limit of maximum of 60,000 pilgrims inside the Kingdom.
“Only 60,000 vaccinated residents and citizens living in the Kingdom will be allowed to perform this year’s Haj pilgrimage due to the ongoing coronavirus pandemic,” the Ministry of Haj and Umrah announced in a statement cited by Gulf News on Saturday. The Hajj is one of Islam’s five pillars. Every able-bodied Muslim who has affordability tries to visit it at least once in a lifetime.
“Against the backdrop of what the world is witnessing and due to the continuous developments of the coronavirus pandemic as well as the emergence of new mutations, Haj registration will be limited to residents and citizens from inside the Kingdom only,” the ministry also Twitted.
“Muslims between the ages of 18-65 and are fully vaccinated, or those who received their first dose at least 14 days prior, those who are vaccinated and have recovered from a Covid-19 infection are allowed to register,” the ministry added.
This is the second year in a row that Saudi Arabia limits the Haj pilgrimage to Muslims inside the Kingdom. However, only 10,000 Muslims were allowed to perform Hajj last year.
US AND JAPAN DEEPEN TIES WITH TAIWAN, DRAGON FINDS ITSELF IN TIGHT SPOT
The US and Japan have been deepening their engagement with Taiwan to help guard it against a growing threat from China. The move has out Beijing in tight spot.
J. Michael Cole, writing in The National Interest said that the regime in Beijing, which continues its effort to isolate Taiwan internationally, is now in the difficult position of having to express its discontent over coronavirus response while avoiding overreaction that could create the rationale for even closer relations between Taiwan and other countries. Taiwan has had a fairly positive past month in terms of its engagement with, and support by, regional partners.
Beijing’s setbacks began back in April, with the joint statement between US President Joe Biden and his Japanese counterpart, Prime Minister Yoshihide Suga, which “underscore[d] the importance of peace and stability across the Taiwan Strait and encourage the peaceful resolution of cross-Strait issues.”
Such direct reference to Taiwan by a Japanese prime minister had not been heard for more than half a century, reported The National Interest. This was followed the next month by a similar statement, this one by President Biden and South Korean President Moon Jae-in, which again “emphasise[d] the importance of preserving peace and stability in the Taiwan Strait”.
The unprecedented reference to Taiwan by a South Korean leader also signalled those countries within the region were becoming increasingly alarmed with China’s destabilising behaviour—particularly the high number of intrusions by aircraft from the People’s Liberation Army Air Force and Navy into Taiwan’s southern Air Defense Identification Zone (ADIZ), wrote Cole.
Four days before the Biden-Suga joint statement, a total of twenty-five PLA aircraft–14 J-16 multi-role fighters, four J-10 multi-role fighters, four H-6K bombers, 2 Y-8 anti-submarine planes, and one KJ-500 airborne early warning and control plane–entered Taiwan’s ADIZ, a new high since the PLA began intensifying its military activity in the region in 2020, reported The National Interest.
But now, China is in a tight spot as Taiwan is receiving more attention from allies. One strategic mistake Beijing may have committed earlier this year was its refusal to reduce its military activity around the Taiwan Strait during the transition period in Washington, wrote Cole.
WHO chief asks China to cooperate with probe into Covid-19 origins
World Health Organization (WHO) chief Tedros Ghebreyesus has called on China to cooperate with the ongoing investigation into the origins of the Covid-19 amid renewed call to further probe the virus.
Dr Tedros made these remarks after taking part in the Group of Seven (G7) summit by video conference on Saturday, The Wall Street Journal (WSJ) reported.
The WHO Director-General hoped there would be better cooperation and transparency when the next phase of the probe into the virus’s origin is underway. “As you know we will need cooperation from the Chinese side,” he said. “We need transparency to understand or know or find the origin of this virus…after the report was released there were difficulties in the data sharing, especially in the raw data.”
He further said that the preparations for the probe’s next steps were underway and that the issue of the origin of the virus was discussed by G7 leaders on Saturday, WSJ reported.
Earlier this week, the US and the UK had extended support to a “timely, transparent and evidence-based independent process” for the next phase of the WHO-convened study of Covid-19 origins. “We will also support a timely, transparent and evidence-based independent process for the next phase of the WHO-convened COVID-19 origins study, including in China, and for investigating outbreaks of unknown origin in the future,” a joint statement said after US President Joe Biden met British Prime Minister Boris Johnson on Thursday.
This comes amid growing calls for a timely, transparent, and evidence-based independent process for the next phase of the WHO-convened origin study.
Recently, the calls to investigate further the origins of the virus have intensified. President Biden has also ordered a fresh US intelligence inquiry into the origins of the pandemic.
The origin of novel coronavirus that caused havoc around the world has remained a mystery even after 1.5 years the first case of infection was reported in the Chinese city of Wuhan.
Now, scientists and world leaders are calling for further investigations to figure out whether the virus originated naturally or leaked from the Wuhan Institute of Virology.
G7 NATIONS CALL OUT CHINA OVER XINJIANG, HONG KONG AND TAIWAN
In a veiled criticism of the Dragon, Group of Seven (G&) leaders called on China to respect human rights in its Xinjiang region, allow Hong Kong a high degree of autonomy, and refrain from any unilateral action that could destabilise the East and South China Seas, Reuters reported quoted a draft version of the G7 summit communique.
“We will promote our values, including by calling on China to respect human rights and fundamental freedoms, especially in relation to Xinjiang and those rights, freedoms and high degree of autonomy for Hong Kong enshrined in the Sino-British Joint Declaration,” the G7 said in a communique that was almost finalised.
Before the G7 criticism emerged, China cautioned G7 leaders that the days when “small” groups of countries decided the fate of the world were long gone.
The G7 also said they underscored “the importance of peace and stability across the Taiwan Strait, and encourage the peaceful resolution of cross-Strait issues”.
“We remain seriously concerned about the situation in the East and South China Seas and strongly oppose any unilateral attempts to change the status quo and increase tensions.”
“We also call for a timely, transparent, expert-led, and science-based WHO-convened Phase 2 Covid-19 origins study including, as recommended by the experts’ report, in China,” the communique, which is almost finalised, said.
“The days when global decisions were dictated by a small group of countries are long gone,” a spokesman for the Chinese embassy in London said.
“We always believe that countries, big or small, strong or weak, poor or rich, are equals, and that world affairs should be handled through consultation by all countries.”
Beijing has repeatedly hit back against what it perceives as attempts by Western powers to contain China, and says many major powers are still gripped by an outdated imperial mindset after years of humiliating China.
UN experts and rights groups estimate over a million people, mainly Uyghurs and other Muslim minorities, have been detained in recent years in a vast system of camps in Xinjiang.
China denies all accusations of forced labour or abuse. It initially denied the camps existed, but has since said they are vocational centres and are designed to combat extremism. In late 2019, China said all people in the camps had “graduated”.
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