Protect me with PPE gears and I will protect the innocent lives
By Dr Zarin Tasnim
As of July 20, 2020, approximately 2,100 doctors, 1,500 nurses, and 2,247 health care professionals (Total 5898) are infected by COVID-19 and more than 76 doctors died till 20th July, 2020. The rate of infection among health care professionals is very high in Bangladesh compared to other countries and mortality is the highest! Why it is so?
Former Advisor of WHO, Muzaherul Huq, pointed to not using protective gears while coming into contact with the confirmed or suspected patients as the main cause of infection among the health care professionals. Many experts also mentioned lack of training of the health care professionals on the proper use of PPEs. BRAC JPGSPH conducted a study on the assessment of knowledge, perceptions, barriers and enablers, and lived experiences of the frontline health workers (FLWs) involved in COVID-19 epidemic management in Bangladesh. As a team member and interviewer, let me share some personal experiences with you.
Under the restricted mobility due to the COVID-19 pandemic, we resorted to short telephone interviews with the respondents to elicit our necessary information. We had to face a lot of challenges to convince the respondents for an interview as PPE was a sensitive issue, especially for the govt. employees. Another limitation was the telephone interview. They expected us to be physically present at their facility and conduct the interviews. Sometimes we were rejected even after communicating with them thrice! Sometimes we found the respondents’ contact numbers switched off or unresponded during the appointed time. While performing roster duty it was also difficult for them to manage time for an interview. The most challenging part was to communicate and convince the 3rd and 4th class employee for the interview as they were the most concerned and were afraid of risk of losing their jobs due to any hassles by the authority after the interview.
We discovered varieties of responses from the health care professionals. Some shared their experiences and opinions spontaneously without any fear or worry as they were angry and distressed at the sorry state of affairs while some were found to be anxious while sharing the information. Some of their higher authority was concerned about their security and protection against COVID-19, some were not even bothered.
The knowledge and perception regarding the use of PPE was worst among respondents of the facility like ward boy, cleaner, lab technologists, and field health workers etc. The condition of the facilities in Dhaka was relatively better than the hospitals in the periphery of Bangladesh. A lab technologist from a remote facility mentioned that they changed the PPE, took rest, and sometimes had their meal in the same room as they did not have any extra room for these! Only a few doctors received training on the proper use of PPE. However, the rest of the doctors who did not receive training learned the use of PPE from various online resources but the non-professional support staffs were not able to do so. As a result, they were not being able to protect themselves from the gulp of COVID-19.
Some of the respondents were found to go through extreme mental stress while serving the COVID patients specially those who had parents with different co-morbidities and young children. The couples both working as health care professionals were the worst sufferers. However, some were stress-free as well! The most heartbreaking and shocking part was to receive the death news of one of the front line workers whose interview was conducted by me just a few days ago!
The study was performed in two phases. In the first phase, most of the facilities had either no supply of PPE or inadequate PPE. In the second phase of the study, these lackings were somehow alleviated, either by the authority or by personal initiatives. But the shortage and unavailability of hands-on training was still prevailing. Though the doctors could somehow manage their protective equipment, the others could not adequately. Most of the interviewees were not satisfied with the quality of the PPE they were supplied with. They pointed out many health care professionals being affected even after using PPE supplied by the authority.
Let’s see how the front line workers are coping with the struggles of their personal life specially the health workers in remote areas of Bangladesh. A respondent was sharing his experience as a front line worker. His duty started in the morning and ended up at night every day, he had no vacation, no weekend as he was the only expert in the particular field at his facility. He did not have any time to cook for himself. No one ever offered him food in the locality as he was a front line worker in the hospital. All the food hotels were closed as the lockdown was going on. He lived in an isolated bungalow arranged by the local chairman. He was passing his days having dry foods! No one ever served him food in his facility as well! How many of you are going to survive in this condition? The most amazing part was, after all these, he was happy and content with his work and profession of serving the humanity during a national crisis. There are lots of incidents of non-cooperation from the neighbors, landlords, housemaids, drivers, etc. I am the witness of a plethora of stories and experiences of our front line workers, just shared one with you. Similar situation also ocurred when no other relatives were ready to support the COVID infected patients but our front line workers stood beside them till the end!
Let me share the attitude and reaction of the community people in the periphery. They wake up in the morning and then directly go to the facilities like Upazila Health Complexes while brushing their teeth to demand the medications like anti-ulcerants, paracetamol etc! This is the most common picture of the community people in the remote areas of Bangladesh. This is the level of their awareness! They were too much dissatisfied about the social distancing while seeing the patients in outdoor. The health care professionals were not content as well to see the patients keeping this long-distance, as there was no scope to examine the patients properly. But it was one of the major ways to survive, to stay protected against the deadly virus! The patients also tended to hide their traveling, contact, and exposure histories to the health care professionals though there were lots of reasons behind it. The health care professionals tried their utmost to counsel them, but they failed. They strongly recommended the local leaders and television and other media to help increasing awareness among the local people. Otherwise, all of their efforts will go in vain.
Last but not the least, some recommendations were strongly suggested including an adequate supply of quality PPE, limiting the outdoor services, training on the use and disposal of the PPE, following strict lockdown by the general people as much as possible, maintaining social distance in crowded areas, proper use of budget in the health sector, public-private partnership, equal distribution of the PPE all over the country, etc.
Despite all the sacrifices, the health care providers are doing, they don’t get the proper support when their close family members get into trouble being affected by COVID-19. They cannot manage an ICU for their near and dear ones in their extreme need. Though some organizations like BMA, BDF are working for the rights of the health care workers, the govt. and general people should be more supportive to them. Their demand is very simple. They just need a little appreciation and encouragement to boost up their confidence and mental strength rather than bullying and attacking them. What would they do with the incentives or risk allowance they are being offered, if their lives are at risk due to lack of their protective equipments? Are we supposed to let them fight without their weapons? Is the fight only of the health care professionals’?
Dr Zarin Tasnim is a Research Assistant at the Centre of Excellence for Health Systems and Universal Health Coverage (CoE-HS&UHC), BRAC James P Grant School of Public Health, BRAC University