Health workers Pakistan
“Health workers are the frontline soldiers in the war against COVID-19. But we cannot fight this war without proper equipment,” Pakistani doctors say. Image Credit: Supplied

Islamabad: As Pakistan enters its third month fighting COVID-19, the virus has infected more than 35,000 and is now taking a heavy toll on the frontline soldiers risking their lives to protect people from the invisible enemy.

“As doctors, we are prepared to deal with the unprecedented pandemic. But the kind of numbers that we’re seeing every day at hospitals is really hard to explain,” says Dr Namra Asif, a Rawalpindi-based doctor on the frontlines of coronavirus outbreak for the past two months.

“It breaks my heart because so many of my friends who are doctors, nurses and healthcare workers are now exposed to the virus and some are getting affected,” she told Gulf News.

Dr Namra is one of the thousands of medical workers battling COVID-19 crisis in Pakistan, working extra shifts, struggling to save lives at hospitals and to avoid bringing the virus home to their families.

She says her two-year-old daughter rushes to hug her as soon as she steps inside the home. “We’re dealing with a lot in the hospital but one of my biggest fears is what if I infect my family?” she fears.

While her male colleagues can afford to self-isolate at home, it is simply not an option for most female doctors who have added duties as mothers, wives, daughters at home. “After completing the hospital duty, we also have to take care of our kids and parents. If we go into self-isolation, who will look after them?”

Getting infected but prepared to fight

Many medical workers, struggling under the physical and mental weight of the crisis amid lack of quantity and quality essential protective equipment, fear for their lives. “Everyone’s scared and exhausted. But we are fighting, we are pushing the limits. All we ask is that government and people understand that they can help us help them by staying at homes and providing us quality protective gear.”

Almost 450 healthcare providers in Pakistan have tested positive for COVID-19, including 216 doctors and 67 nurses, local media reported citing National Emergency Operation Centre. For every 10,000 people, Pakistan has only 9.8 physicians, five nurses and six hospital beds, according to a recent UNDP report. “When health workers are at risk, we are all at risk,” says World Health Organisation (WHO) chief Dr. Tedros Ghebreyesus.

Easing of lockdown could result in exponential rise

As the world slowly restarts economic activity with caution, Prime Minister Imran Khan too announced to relax the partial lockdown from May 9 to revive the stalled economy and support families that depend on daily wages. Health workers term it a “hasty and costly decision” at a time when Pakistan is witnessing an exponential rise in cases. On May 6, there were a total of 24,000 infections but the number surged past 30,000 in just four days, recording 2000+ cases in a single day. It took nearly a month to reach the first 1000 but the last 1000 cases took only few hours.

Challenges facing medical workers
- Lack of quality protective equipment
- Absence of measures to prevent the spread in hospitals
- Delayed recognition of COVID-19 symptoms in medical staff
- Lack of awareness among people that could expose large numbers

“The situation is becoming worse, capacity is overfull, suspected patients are asked to isolate at homes, we only have a few hundred ventilators, many of those filled. What will happen when the lockdown is eased at this critical time? What if it collapses the health system and leads to more deaths?” a frustrated doctor working at Rawalpindi’s public hospital who does not wish to be named told Gulf News.

He termed easing the lockdown “a long-term sacrifice for a short-term benefit.” At least 16 out of 32 doctors in a ward for coronavirus patients tested positive where he works an 8-hour shift.

The doctors recognize that global economies and health systems are reeling from the pandemic, he says. The focus should be on smart easing of lockdown, tougher measures to stop all non-essential activities.

Furthermore, the irresponsible behaviour of people is making things hard. “There should be a clear, consistent message from officials and strict implementation of issued guidelines.” Doctors urge the government to shift all non-emergency cases to online and call. “Out-patient departments (OPDs) that usually overcrowd hospitals are the potential site of virus transmission as anyone could be the carrier. If a doctor seeing hundreds of patients at OPDs is asymptomatic, just imagine the risk they pose to everyone they come into contact with.”

“We cannot fight COVID war with poor quality equipment”

Pakistani health workers seem dissatisfied with the quality of locally developed personal protective equipment (PPEs) and say, “It could be one of the reasons for increased infection among the medical staff”.

“Health workers are the frontline soldiers in the war against COVID-19. But we cannot fight this war without proper equipment,” stressed Dr. Rana Azeem, Young Doctors Association’s Rawalpindi President. Hospitals are still facing a shortage of N-95 masks. “I bought my own N-95 mask and I’m reusing it for three to four days but it increases the exposure the virus,” said Dr Namra adding that medical staff are also relying on donations from organisations such as Project Give Back Pakistan providing free-of-cost reusable PPEs.

When the young doctor Zain ul Hassan started his career in February, his first duty was in the corona ward in Ghurki Trust Teaching Hospital in Lahore. Now the hospital is developing PPE for its staff, but when there was an acute shortage he made his own PPE using parachute material.

Pakistan Dr Zain ul Hassan doctor
Dr Zain ul Hassan, who started his career as a doctor treating coronavirus affected patients at a Lahore hospital, made his own PPE amid the shortage. Image Credit: Supplied
How government can help doctors win the war against COVID?
1. Offer relief from burnout to the stressed health workers working long shifts without break
2. Offer on-the-job protection, quality personal protective equipment, up-to-date information.
3. Shift all non-emergency cases in OPDs to phone and online to reduce exposure.
4. Ensure health care for health workers with routine tests, counseling and other benefits.
5. Slow and smart easing of lockdown with a strong ‘stay at home’ message.
6. Stricter measures to halt all non-essential activities to contain the spread.
7. Provide food to daily wage workers and poor to restrict unnecessary movement.
8. Go tough to implement lockdown and enforce COVID rules.
9. Constantly communicate COVID guidelines to public such as hand washing, avoiding crowds, maintaining distance, wearing masks and warn about serious health risks.
10. Media campaigns to encourage online and phone services such as telemedicine, food delivery and home shopping.

Guidelines, protection and support

“In the beginning, I was scared. Some of the colleagues left jobs. My mother was worried I might catch the virus. But I told my parents that this is the time to serve and save lives. I must work,” he shared with Gulf News. Dr Zain’s biggest motivation was his connection and learning from Chinese doctors as he completed his MBBS degree from Capital Medical University Beijing. “I’m constantly in touch with my Chinese colleagues in Wuhan and Shanghai, learning about new development, treatments and best methods to diagnose the virus and sharing it with my Pakistani fellows.” He suggested that chest CT scans along with RT-PCR tests offers a more reliable diagnosis and urged the health officials to follow global standard procedures.

“When we take the Hippocratic Oath to become doctors, we pledge to care for patients. We are prepared to do all despite limited protection. But I just wish people could understand the severity of the pandemic and government offer us the training, support and protection we need to win the war.”