May 22, 2021

Why PM-CARES ventilators still lying unused and locked up despite hospitals needing them

By Shakir Alam Mazumder

The demand of  ICU beds has increased drastically in the second wave of Covid-19. But even the despite need of ventilators, they are either remain unused or locked up. Critical Covid-19 patients require ventilatory support. Hospitals are turning away patients not because they do not have it but due to lack of skilled staff.Ventilator, intricate machines that are required to help patients breathe, are found in a hospital’s intensive care unit (ICU). Often we see patients in serious conditions are admitted in ICU.  They are taken care by the specialists in critical care medicine, called intensivists. Anaesthetists, pulmonologists, and physicians with specialised training are also qualified to operate ventilators and ICUs.According to the recent data from the Indian Society of Critical Care Medicine (ISCCM), the largest non-profit association of critical care physicians-the number of qualified physicians in India is acutely insufficient for a country over a billion people. “Our association has 14,000 members and this comprises most of the critical care professionals in the country. Of these around 12,000 are fully qualified.” Dr Srinivas Samavedam president of ISCCM told.Talking to one of such physicians who has been working in ICU for years has said that the job requires one to think on his feet as it is a high intensity job. He further stressed that the job often involves irregular hours and emergency situations which is major reason that puts off many people. He added that critical care was only identified recently as a super specialty by the medical education  regulator and it does not offer enough seats contrasting to the rising demand in India. Poor infrastructure in rural areas has been another obstacle, he said.American College of Physicians (ACP), a professional organization of doctors specialising in internal medicine describes critical care as a specialty that “encompasses the diagnosis and treatment of a wide  variety  of clinical problems representing the extreme human disease”. According to it, intensivists who work in the ICU need to be “competent not only in a broad range of conditions common among all the ill patients but also with the technological procedures and devices used in the intensive care settings”. 

 In this prevailing situation of Covid-19, intensivists have to work in high risks. They must know how to intubate patients for mechanical ventilation that is when a tube is inserted into a throat to help air pass through. This must be done very carefully or can cause excessive aerosol spray, putting the intensivist at risk of infection. Whereas in India, a number of critical care doctors are anaesthesiologists because they know how to use ventilators from their operating room experience but ICU care requires more than just operating a ventilator. Critical care physicians have to make tough decisions at times and work in high pressure environment. It is because of these reasons a lot of medical professionals are not comfortable getting into this field.A study recent study in 2020 found that the country had about 95,000 ICU beds and 48,000 ventilators. These numbers are likely to have increased with hospitals setting up more beds and the PM CARES fund paying for 50,000 new ventilators. The study also found that in rural India where 80 percent of the population live, ICU care is poor is absent at the district level. The availability of critical care doctors are only limited to urban areas. The shortage is also partly blamed to Medical Council of India which recognised critical care as super specialty only in 2010. The National Board of Examinations which monitors the standard of post graduate medical education, had recognised it as a field a few years prior to this.“There are very few doctors graduating with specialization in critical care medicine, and there isn’t adequate infrastructure in rural areas, which is what causes the urban-rural divide,” Dr Deepak Govil, president of the ISCCM told ThePrint “There must be hardly 25 to 30 Doctorate of Medicine (DMs) seats, the National Board of Examinations must have around 200 seats for critical care all over India. With such small numbers, you can see where there would be a shortage,” he added. The ISCCM partnered with Indian Medical Association last year to train 40,000 doctors in small centres on how to use a ventilator. It also offers courses on critical care medicine. Though these are not formally recognised by the Government of India, they are accepted by several private hospitals. Dr. Srinivas while answering the solution to tackle the shortage said “In the short-term, telemedicine is the way to make up for the shortage in skilled staff. But in the long- term, what will help is  popularising  the speciality and giving  accreditation to the courses we offer, so that training is more widely accessed and recognised.”

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