A justified anger

The frustration ventilated by the doctors' apex body over poor safety of health workers is something to be reckoned with.

In a letter to the health minister on Saturday, Bangladesh Medical Association (BMA) held the ministry squarely responsible for the fast spreading infection from Covid-19 among doctors and nurses.

In its view, supply of low quality masks, hastily and technically defective intensive care units and inadequate training of doctors are responsible for the health workers getting infected.

Are the doctors justified in sending off such a strongly worded admonition to the minister himself? Let us look at a doctor's experience with the poorly managed and run coronavirus fighting attempts of the ministry  that would be illustrative of the current pandemic response of the authorities and rationalise the frustration of the BMA.

Three months ago when she was transferred to Kuwait Bangladesh Friendship Government Hospital in Dhaka – from a district hospital – she knew little about the location of her new workplace. Using the Google Maps she reached the hospital, which had already been dedicated for coronavirus patients.

When all of her family members confined themselves to home in Dhaka during the general holidays to mitigate the risk of being infected with Covid-19, she did not have the 'luxury' to stay indoors and be safe. She had to join her job. Her working hours lasted 10 to 12 hours at the hospital almost every day treating coronavirus patients.

In a conversation with her last month, I asked her if she had any misgivings about spending so much time up close with the Covid-19 patients. Her first concern was about her safety because of the low quality personal protective equipment and her reply was blunt. "I know I would be infected with the virus today or tomorrow. I may be spared only if I'm lucky."

No, luck does not come into the equation in such cases. She has now tested positive and is staying in isolation in a hotel, which the health authorities turned into a residence for doctors a few months ago.

She could not meet her two kids as she had been staying in her temporary residence for the last two months even before she tested positive.

Her story is not an exceptional one. Many doctors and nurses have similar stories.

Away from home and family members, they are taking care of Covid-19 patients to save their lives with their heroic efforts even if that means they have put their own lives at great risk.

They are now standing in the first line of defence in the battle against the pandemic virus. They are exposed to hazards that make them easy targets of infection.

These hazards include exposure to pathogens, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence.

Unfortunately, they were not given required personal protective equipment (PPE), such as masks, gloves, and gowns that would help keep them safe when they are treating patients with a highly infectious disease like Covid-19.

Two latest reports by Brac University's James P Grant School of Public Health and the Bangladesh Health Watch (BHW) reveal that 24 percent of healthcare workers are yet to receive PPE, and 44 percent of those who have PPE are not satisfied with its quality.

This means the situation remains almost the same as it was three months ago. A previous survey, conducted from March to April by Health Watch, had revealed that 25 percent doctors and nurses, and 60 percent support staff treating Covid-19 cases lacked PPE.

What did our health ministry do in the last three months when there was an outcry for quality PPE?

The findings of the latest reports expose the ministry's acute indifference towards the doctors' safety.

However, the ministry has done one thing efficiently. In April, it issued an instruction, gagging the doctors and nurses so that none of them can talk to the media about the shortage of PPE.

A medical officer of Noakhali 250-bed General Hospital was served with a show-cause notice by the hospital's superintendent for posting on Facebook about the short supplies of N95/KN95/FFP2 face masks and PPE.

The health minister himself issued a note of warning. On April 22, he directed officials not to talk to the media, saying that it goes against the government's policy.

What has his ministry achieved by gagging the doctors' voice? Only the minister and his ministry's high officials can answer that well.

But the reality looks bleak as the apex body of doctors, the BMA, said as many as 3,500 health workers, including 1,100 doctors, have been infected with Covid-19 in the country so far with 44 dead because of this.

No other Covid-19 affected countries, says the letter, reported such a number of deaths of doctors and health workers from the virus or infections, except Bangladesh. So it is a milestone we never wanted to reach.

The health minister and his ministry's high officials may have their own explanations to defend themselves. But mere words and lax action will not improve the situation.

Like every other citizen in the county every health worker – be it doctors or nurses or medical staff – has the right to life which cannot be jeopardised by any whimsical actions of any authorities.

According to WHO, health workers have the right to get PPE supply in sufficient quantities. They have the right to withdraw themselves from a work situation that they have reasonable justification to believe to be presenting an imminent and serious danger to their lives or health.

The authorities cannot require health workers to return to a work situation where there has been a serious danger to life or health until any necessary remedial action has been taken, says the WHO guideline published on March 19.

Aren't our health care-givers entitled to enjoying the rights stipulated in the WHO guideline?  

More than three months after the detection of the first Covid-19 cases in Bangladesh, we still do not know where we are now in the battle against the virus. We do not know how many more months we will have to fight the battle. Experts, however, forecast that we may have to live with the virus into the next year.

One thing has been certain that the virus is becoming strong gradually, killing more people and infecting several thousands every day.

Amidst such a time of uncertainty, death of a single health worker is an immense loss. Every death, every infection of the health workers weakens further our strength to fight the war which has now become much bigger than what it was three months ago.

Our health authorities should understand this. Denying reality using rhetorics will help none.