Knee-deep in Covid-19, our hospitals need steady supplies of PPEs, sanitisers and adequate staff

At the moment, DUHS is diluting sanitisers to make them last longer.
Updated 02 Apr, 2020 01:17pm

"We don't want your salutes," says Dr Hamid Mehmood, consultant anesthesiologist at the Dow University of Health Sciences. "What we desperately need right now are the PPEs (personal protective equipment)."

"Walking out of my home at 7:30 in the morning, leaving the kids asleep, I ask myself every day — 'Do I really have to walk in that isolation ward of patients with Covid-19? Am I safe... the worst thought is am I bringing that virus to my home, to my kids, wife, and parents? What if I become a carrier?'".

The anesthesiologist adds: "My only survival in these desperate times is via the PPE because I cannot distance myself from my patients. My arsenal, scarce though, is my trustworthy PPE."

Helping Covid-19 patients in increasingly harrowing circumstances, Dr Mehmood says if healthcare workers get sick, then there isn't going to be anyone to treat the patients.

Also read: This Pakistan-made Covid-19 diagnostic kit would cost a fraction of the internationally purchased ones

Ensuring a smooth supply of the very basic PPEs, sanitisers, and bleach is taking up precious time of the Jinnah Postgraduate Medical Centre's executive director Dr Seemi Jamali in her battle with this virus.

"We have PPEs for now, but we will require a lot more," she says.

Dr Shobha Luxmi, who heads the isolation ward at the DUHS, says she has enough PPEs "at least for now", but what her hospital needs immediately and urgently are sanitisers. At the moment, they are rationing on PPEs and diluting sanitisers to make them last longer.

The ration has extended to the N95 masks as well.

"Our N95 masks are our lifesavers, but in short supply. We use them very carefully and after each use put them in brown bags marked with our names to be re-used, till these wilt away," says Dr Muneeba Ahsan Sayeed, infectious diseases physician at the DUHS.

"And can you please tell your readers, these masks are not for them, so do not cause shortage for us?" she asks, her voice filled with sadness. She says these masks are worn by healthcare workers so they can protect themselves while treating contagious patients.

Doctors in PPE carry out tests on a patient at a hospital in Muzaffargarh. — Photo courtesy: GoP.
Doctors in PPE carry out tests on a patient at a hospital in Muzaffargarh. — Photo courtesy: GoP.

At the Indus Hospital (IH), they have found a solution to make their PPEs last longer as well as to double their protection. "We wear another disposable gown on top of the one that comes with the PPE," says Dr Fivzia Farooq Herekar, consultant internist and infectious disease specialist at the IH.

At the DUHS, they wear another pair of lower quality gloves over their latex ones and shed it after seeing a patient.

Doctors getting sick, hospitals short-staffed

Already, it has been reported that six doctors, some very senior ones, in Karachi have contracted the virus.

"I think if doctors and paramedical staff elsewhere in the country are protesting and are hesitant to report to work, if not provided proper PPE, then it's justified," points out Dr Herekar. "Their panic is genuine."

"But the situation is going to get worse," anticipates Dr Mehmood. "We just don't have enough manpower even if we have the PPEs for them. Our janitorial staff, even our nurses are too scared to go near a Covid-19 patient for fear of catching the virus," he says.

More on this: Pakistan's dilapidated health system bent double with COVID-19 scare

Most hospitals, including private ones, had always been short of ancillary staff. "Some patients on ventilators who cannot move at all, need to be turned every couple of hours, some need to get their soiled pampers changed, or a patient's room needs clearing and cleaning, which involves moving his/her stuff."

At a minimum, Dr Mehmood says, a hospital taking care of 10 elderly patients infected with Covid-19 (and some on ventilators) needs 35 people for the duration of 24 hours — with each doing a six hour shift. "These include ward boys, sweepers, porters, phlebotomists, radiographers, on-floor duty doctors, nursing incharge, shift incharge, and the most important person, the consultant doing the rounds," counts the anesthetist.

With Pakistan sitting on a ticking "time bomb" of Covid-19 patients, Dr Mehmood anticipates the virus will hit the elderly whose health condition is already compromised, especially those who are diabetic and those who are suffering from hypertension.

"We will need assistance for taking them to the washroom, help them with eating, you know little chores that do not require any special medical skill," he says.

So what they will need, soon, says Dr Mehmood, is a brigade of young, energetic educated people who can, once provided a crash course in biosafety, quickly understand instructions on how to wear the PPE properly and store and doff it off carefully as well to avoid contamination.

Willing to volunteer, but not without proper SOPs

Twenty-five-year-old Mohammad Ismail, who founded a virtual group of science students, called Scientists Against Covid-19 Pakistan (SACP-19), and which today has over 3,500 young and eager Pakistanis from across the country, agrees with Dr Mehmood.

He says: "Even we would prefer that the most trained/most experienced people from among us go first as they are more likely to be careful compared to an eager undergrad who could make mistakes in their excitement."

Ismail adds that the only reason SACP-19 has not connected its young volunteers to the authorities so far has been the lack of availability of proper PPEs.

The SACP-19 is working to arm its members with a set of standard operating procedures (SOPs) in the Covid-19 context to ask of local authorities and hospitals as to whether these are being followed, before the group forwards its list of available volunteers.

The SOPs also require the availability of "isolated accommodation as it is not advisable for these volunteers to go back home for at least three weeks," points out Ismail.

What it's like to wear the PPE and the N95 mask

Not quite a hazmat suit, the basic personal protective equipment that healthcare workers in Pakistan are asking for includes a coverall made of an impermeable material, latex gloves, a face shield, goggles and masks (both N95 and the three-layered surgical mask).

It takes about 10 minutes to get into scrubs, wash up and wear the PPE. "Do not rush to wear the PPE as it needs to be donned on properly," advises Dr Herekar.

But it is not the most comfortable of equipment everyone agrees and "adhering to the PPE protocols is quite a challenge" says Dr Sayeed.

Read further: ‘N95 masks and personal protective equipment kits are not meant for general public’

"You sweat profusely," she says, adding that one cannot remain in it for more than four to six hours. That is probably because DUHS is not air conditioned.

However, most doctors prefer and feel safer to not be in an air-conditioned isolation room which may not have a negative pressure when a hepa filter is used, increasing manifold the chances of catching an infection.

"The infection is air-borne and without a hepa filter that controls the spread of particulate matter through ducts, those inside the wards can catch the disease," says Dr Mehmood.

In addition, Dr Sayeed says: "You cannot drink, eat, go to the washroom," once you've donned it. But the IH has a room next to the isolation ward where doctors can go sip some water if they need to.

An N95 mask. — Reuters
An N95 mask. — Reuters

But more than the coverall, it is the N95 mask that is terrifying.

"Breathing in and out takes a huge effort and your communication is impaired, and you need to speak louder to be heard," says Dr Sayeed. "It saps my energy."

"It needs getting acclimatised to," agrees Dr Herekar, adding: "For those not used to it, or wearing it for the first time, it can cause dizziness."

"And what a relief it is when you doff it," she says, adding that "it does take both a physical and mental strain on you".

A person wearing a PPE and working for 6-8 hours is the same as a doctor completing a duty that lasted 36 hours, she says.


Author Image

Zofeen T. Ebrahim is an independent journalist based in Karachi.

She tweets at @zofeen28.

The views expressed by this writer and commenters below do not necessarily reflect the views and policies of the Dawn Media Group.

Comments (21) Closed

Mar 29, 2020 06:53pm
100% right. This current shortage can cause expanding he virus instead of reducing it. and these politicians already claiming victory. This is just the start, long way to go. First protection is for front end people.
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magbool basha
Mar 29, 2020 07:00pm
Difficult times, appreciate the services of medical fraternity. The government should gather all its resources and provide steady supplies to the hospitals.
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Mar 29, 2020 07:37pm
So many similar stories coming from India as well. At least Pakistan supply has reached. Modi planned poorly, endangered Indians lives.
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Mar 29, 2020 07:38pm
Should have pictures inside the hospitals of Pakistan, how the covid19 patients are being treated. How many patients are waiting in the lobby. Seen pictures of Italy & Spain.
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Mar 29, 2020 07:45pm
All said and done, Pakistan handling of crisis has been sensible. The PPEs must continue coming.
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Mar 29, 2020 07:47pm
Whatever the conditions I must still salute the efforts of these doctors. Every facility and safety equipment must be available throughout the country in sufficient quantities to all doctors, paramedical and other hospital personnel, as well as to any volunteers .
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Mar 29, 2020 07:56pm
I don't understand. There are about 1559 cases. Let us say 1600 till now. Each patient maybe handled by 3 medical personnel. That is 4800 highly protective gear like those suits and not I repeat not rain coats and boots. Then masks and overalls. This is the least a nation and government can provide.
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Dr. Salaria, Aamir Ahmad
Mar 29, 2020 08:07pm
Same is true for almost all hospitals, clinics and healthcare centers in the world including the ones in U.S., Germany, France, Canada, Italy, Spain, Portugal, England etc.
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Mar 29, 2020 08:49pm
@Indian, Modi is handling the crisis better than any country.
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Mar 29, 2020 08:51pm
@Indian, If you dont follow the lockdown, and the rules, dont blame Modi. You are responsible for your own actions.
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Mar 29, 2020 09:04pm
WHO said earlier today that, the infection is not airborne.
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Mar 29, 2020 09:48pm
Sharifs gift of Metro buses, orange lines and underpasses instead of a robust worldclass healthcare system. He should be dragged into these public hospitals..
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Mar 29, 2020 10:44pm
@Rahul-B, wish you were a doctor
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Mar 29, 2020 11:12pm
Situation in Indian hospitals is much much better as compared to Pakistan. Imran Khan must order complete lockout before it's too late.
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Mar 29, 2020 11:39pm
There are only 1500 cases in Pakistan as per official figures and hospitals and doctors are overwhelmed ?. This points that actual China Virus patients reaching hospitals is much higher than what we are we being told
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Ali Khan
Mar 30, 2020 03:43am
@Rahul-B, good for you.
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abdul Quadir
Mar 30, 2020 04:15am
All medical equipment and other items required to fight Coronavirus can be procured from China as part of CPEC.
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Mar 30, 2020 09:02am
IT should be mandatory for all Healthcare workers from Doctors to the Sanitary person, Law enforcement presonal, Volunteers to wear any kind of glasses to cover their eyes as much as possible, while they are in the field.
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Mar 30, 2020 09:23am
Thank you for sharing, please keep us up to date.
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Mar 30, 2020 10:28am
Those ruthless egoistic lawyers who beat up the doctors in Lahore, should get on their knees and ask for forgiveness. They should raise funds for protective gear for the doctors. Those lawyers are absolutely useless and worthless to the nation, and they still have not been tried for murder. Doctors give their lives to save the common man.
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Apr 03, 2020 07:13am
Urban areas of densely populated and hence chances of infecting other people is great. In certain areas many people live in small quarters and create havoc if one of them is infected.
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