Dr. Satya Dev Gupta
Many persons don’t know much about the anaesthesia specialty because the doctors concerned work behind the curtain, may it be operation theatre, intensive care or critical care units, and its other sub-branches. Anesthesia doctors (anaesthesiologists) have been doing very crucial and far-reaching endeavors for many decades but all went unacknowledged, unrewarded, and unappreciated till 2019 when the demon of Covid 19 nailed its icy death hands-on entire population of the world. Oxygen therapy, Ventilators, stability of vital parameters, resuscitation (bringing back to the life from the claws of death) became the modules of paramount importance. Piercing the curtains of smog and clouds one specialty of modern medicine that emerged into the limelight is anesthesiology. Now authorities and the general public are looking at the diligent and untiring health workers with rubbing their eyes and raised brows. Anaesthesiologists have been called to the frontlines of this COVID-19 war for a vital and dangerous job, may it be putting the lifeline tube (endotracheal tube) into the patient’s windpipe (trachea) by opening the mouth of a patient with an instrument called a laryngoscope, inhaling the aerosol mixed with dangerous killer Covid-19 virus for giving artificial respiration for resuscitation or shifting the Covid infected patient to a desirable place. When a patient finds difficulty in breathing even with the delivery of 100 percent oxygen, blood hemoglobin saturation continues to fall below the survival level, and when putting the patients on artificial respiration by the ventilators becomes mandatory, then nothing works except the venture of Anaesthesiology, the lesser-known doctors accept this challenging assignment at the risk of their health. Anesthesiology is a supporting speciality to other disciplines of medicine, usually doesn’t have OPD functionaries which make it concealed to the general public, but at the same time it is vital and the backbone of the medical institutions. The staff of this specialty always remains on the toes but behind the curtain and work as pilot of an airplane on whose shoulder the safety of passengers lies. The difficult, backbreaking, challenging, and heroic jobs are their routine. A proverbial phrase has been coined since the onset of pandemics from Wuhan “putting the tube into the trachea is to race against the death are anaesthesiologists”.
Routine Work Field
Anaesthesiologists have a vast skill asset that makes them valuable in emergency intubation, cardiopulmonary resuscitation, and intensive care management. However, the most valuable procedures they perform have made them the most vulnerable to the virus attack.
We have listened to a heart-touching song about “China Aggression in 1962”, “Jab desh mei the Diwali wo khel rahe the Holi.” So, at a time when the whole world was following the safety lines for keeping a suitable distance and sticking to homes, the anaesthesiologists are dealing with the ailing patients in close proximity, doing the required physical maneuvers with the sick patients, as modes of treatment demanded. Overburdened due to a surge in the number of critically ill patients, they had to face an increased risk of infection to themselves and their families. It is pertinent to mention here that anaesthesiologists are at maximum risk of acquiring infection themselves. Like all other frontline health care workers, these doctors have also to manage the toll of a mental health crisis. Long hours duties, unpredictable, changeable work schedule, sleep deprivation, chronic fatigue, and night shifts have a deteriorating effect on the mental capabilities of the frontline workers. In India, every year 4500 postgraduate of this specialty pass out from different medical institutions. Indian Society of Anaesthesiologists (ISA) records show the country has a dearth of 1.5 lakh while 55,000 are working at present. Even with this crunch with deficient workers, along with doing the other usual general duties assigned, the anaesthesiologists are performing their duties in Covid-19 wards in the best possible ways by paying the cost of their lives.
India’s Overall Corona Fighting Scenarios
The 2nd Covid-19 wave, starting with the onset of the month of April, is more dangerous, dreadful, contagious, attacking all the age groups with lesser incubation period the virus has got mutations in different strains i.e., British, Brazilian, Maharashtrian (India); and developed the abilities to escape RT-PCR (Reverse Transcriptase Polymerase Reaction), once considered to be a most trusted test for Covid-19. Now the graph of Corona positive persons is gaining steep bend with magnitude, crossing over 3 lakhs on a single day. About all the provinces of the country showed a tremulous escalation in the number of infected persons that is reflecting on the resources of the state and Central Government; Hospitals are overburdened, oxygen supply is deficient, corona warriors, who are already reeling under pressure, have also faced other undesired and unwanted challenges.
Scenarios In Jammu And Kashmir
The Government of the Union Territory of Jammu and Kashmir is super-active in fighting against the spread of 2nd wave of this dreadful disease. The entry points of the Union territory Lakhanpur, Railway station, Airport, etc. are scanned effectively. The Government is vigilant in monitoring the areas or localities of infected human beings and effectively converting them into mini or micro containment to prevent further spread. Hospitals are infused with the requisite resources e.g., oxygen, ventilators, and other necessary equipment. But still, there are some lacunae as most of the health projects are compiled and executed by the bureaucratic setup; technocrats are rarely consulted or counseled and their advice is negated. The donated ventilators by the Government of India have been virtually dumped in district and sub-district hospitals in the union territory of Jammu and Kashmir e.g., RS Pura, Bishnah, Samba, etc. near Jammu have 15 to 20 ventilators. It is pertinent to mention that ventilators are not machines like fans where you can switch it on and off. Anaesthesiologists along with other paraphernalia are needed for its working. As for anesthesia doctors are concerned, it seems the concerned authorities don’t have any idea of this specialty, which is reflected in further context.
Plight of Anaesthesia Speciality
The story dates back to 2007-8 when senior consultant’s posts were created in almost all the disciplines of medicine for district and sub-district hospitals of the Health Department by the Jammu and Kashmir Government, but Inadvertently the anesthesia specialty was not projected in the list. A representation was submitted to the concerned authorities for rectification of mistake by The Jammu Branch of the Indian Society of Anesthesiology (ISA), which was endorsed by Director Health Services and forwarded to higher-ups and followed up constantly. One after the other popular governments came but without any colorful results, the reasons for this fate of this fervent appeal are best known to the concerned authorities. The representation file was somehow lost in the heap of bundles of documents in the civil secretariat and couldn’t be traced further. A new representation had been submitted through the Directorate of Health Services Jammu and is lying in the health section of the civil secretariat for more than 3years (with reference to one of the correspondence letters: (No-HME/HRM/83/2019 dated IL. I2.2019,) (The Financial Commissioner to Government, Health & Medical Education Department, Civil Secretariat, J&K, Jammu.)
The file is still in the civil Secretariat catching dust. There are about 150 anaesthesiologists in health services of “Union Territory Jammu and Kashmir” as consultants but their further promotion is in doldrum, as there is no Senior Consultant post created by the Government for15 years. The present reign also seems apathetic towards this specialty. The representatives of the ISA Jammu Branch have sought an appointment with the concerned authorities and discussed the issue with them, the outcome is still awaited. Through this writing and context of words, the attention of higher-ups is invited to give the proper acknowledgment to this vital and important discipline of medicine to save the human lives, especially in Covid pandemics with an assurance that if the doctors of this specialty get their long-pending demand fulfilled; they shall work with the more dedicated endeavor.
The dreaded 2nd wave of Covid-19 wave may take another dangerous turn and nobody knows in which way the wind blows. The fight with this virulent virus may be fought at district or subdistrict levels, where the role of anaesthesiologists shall be of paramount importance. Therefore, it is mandatory if the higher-ups in the government take the initiative in the right direction and also gear up for the rectification of mistakes done by previous governments without any further delay.
(The author is Ex-Head of Intensive Care Unit & Department of Anaesthesia Government Medical College Jammu.)
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