Covid-19 Frontline Voices: India

We return to Duncan Hospital for the latest in our 'frontline voices' series and we hear from Dr Prabhu Joseph, surgeon and managing director.

I am Prabhu L Joseph, the Managing Director of the Duncan Hospital, Raxaul, India. I am an Orthopedic and spine surgeon, and I first came to The Duncan Hospital in 2003 as a fresh graduate. My wife Blessy is the paediatrician here, and we have a daughter, Sthuthi (8) and a son Stephen (5).

The Duncan hospital is a 200 bedded multi-speciality hospital which is over 80 years old. We provide Obstetric, Surgical, Orthopedic, Medical, Paediatrics, Psychiatric, Dental and Rehabilitative services.

Each day here begins with 30 minutes of devotions from 8 to 8.30 am followed by a small meeting with the medical team. We then start with ward rounds, followed by the outpatient department (OPD). The OPDs ends by lunchtime, and after a 30-60-minute lunch break, we see review patients. We finish at 5.30 pm and then complete the evening ward rounds. The emergency department and the labour rooms, however, run 24/7.

In the current scenario with the lockdown, the OPD patient numbers have dropped to 25%. However, emergency services have continued as usual. Deliveries have dropped by about 50%, and we wonder where the mothers are delivering. In all probability, they are giving birth at home with the help of traditional dais or with the help of local doctors and small clinics. The effects of the COVID pandemic may only be known much later. I would hazard a guess that, at least for now, people affected indirectly by the virus would far outnumber those directly affected.

COVID so far has only affected us indirectly with fear and panic. As a hospital, we can’t complain as we have the basic comforts anyone would need. The local region, which is predominantly agrarian and small business oriented, has been severely affected. Crop harvesting, transport and sales have been affected. With the decreased movement of people, small businesses have been hit. A large number of people here who are daily wage earners working as rickshaw pullers, cleaners, drivers, mechanics, etc. have all lost jobs. Manual labourers working far away from home are stuck away from families. Some areas far in the interiors of our state would be more affected than those easily accessible.

The Duncan hospital is not geared to handle a massive COVID pandemic because we have only one physician and one anesthesiologist. We have one critical technician and about 12 medical officers. We have about 120 nurses and some paramedical staff. We have sectioned a part of the hospital as an isolation area to treat suspects or confirmed (we don`t have test kits) In case the numbers increase we will have to open up the older wards or convert larger parts of the hospital for isolation. We would have to balance this as people will continue to have babies and come with broken limbs or a ruptured appendix, and these will also need care. We are procuring PPE and other essentials to help us. We have a few ventilators and equipment. However, in the event of an overwhelming number of cases, there is not much that we can do.

The main challenge I face is the massive drop in income of about 60% as a result of the lockdown. These funds are essential for paying staff salaries and for procuring goods and material for the running of the hospital. The other challenge is the sense of inadequacy in the case of a massive overwhelming crisis. We’re no strangers to disasters. In the past, bad floods shut us down for days, and we have been through cash crunches in the past, the only thing that has seen us through is faith in God and a close interdependence with each other. The Duncan family support each other no matter what and I hope God would take us through this.

As a hospital we have decided to be compassionate to all affected. We have kept the hospital running. We have tried to provide food for those unable to buy or prepare it. We have actively tried to support patients who can’t pay for their bills due to various reasons.

I worry about every staff member and their families, hoping they would not be affected. I worry about our kids and the older people on the campus. I fear that our region and state may not be able to bear the effects of this virus if it is as bad as it has been in the US, Italy and Spain. I worry if we would recover from this economic crisis. However, to worry also belittles our God who is capable of resolving this crisis and more and at this time, I can only look to Him as a solution. I believe we are here because God brought us here, and He will be the one to lead us through. We need each other and we need Him to hold us together as we battle this out.

I thank God for keeping us alive. I thank him for giving me life, a good family, an excellent hospital team to work with, people who care for us and an amazing calling to be there for people in need. I can only be thankful to be alive while many have not seen another day. I also realize how frail humanity is. While we marvel at what we have achieved, we are here battling a strand of nucleic acid that threatens to bring us down. Bringing us to our knees looking to God is probably the best outcome of this pandemic, reminding us of how insignificant we are yet how precious we are in Gods eyes if we call out to Him.

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