India’s novel coronavirus case-load is now doubling once every five days, and the scary phase of the pandemic is almost upon us. As we gear up to face a wave of admissions to hospitals, the country’s lack of capacity and preparedness has become unmissably obvious – especially the shortage of skilled personnel. If only the National Medical Commission (NMC), which regulates medical education in India, took a few steps, many of these gaps can be filled.
It is no secret that India is grossly underprepared for the crisis facing us. The country has a projected 0.7 million ICU beds, against the potential demand for 1 million COVID-19 patients by the end of May, plus only 4,000 or so ventilators and abysmal doctor-patient and nurse-patient ratios. Most Indian hospitals also lack the quality controls necessary to prevent healthcare-acquired infections, so outpatient consultations have either been called off or shortened considerably, leaving even more people without access to medical care.
In this time, the NMC needs to proactively design re-skilling courses for doctors and allied health professionals who are out of clinical practice but will want to help deal with the COVID-19 case load – directly by enlisting with hospitals that are ready with COVID-19 wards and indirectly at locations away from the hospitals where they can consult with other patients or join a pool of counsellors, etc.
Students currently enrolled at medical colleges – all of which have called off their classes in view of the social-distancing requirement – should also consider participating in this repurposing exercise.
The NMC could create a temporary license to be issued to these individuals, with an assurance that in a post-pandemic India, they will receive a chance to upgrade their skills and become ‘preferred’ members of the national healthcare system.
Available human resource
There are many doctors with MBBS and postgraduate degrees who do not have clinical practices but would like to help as well. While their exact number is unknown, thanks to a defunct registry, they are likely to number in the tens of thousands.
There are also AYUSH professionals, dentists and foreign medical graduates, also numbering in the many thousands, who can be invited to re-skill themselves in exchange for future opportunities. ‘Bridge courses’ are a good idea: as I wrote in The Wire earlier, they are training courses designed to adapt “allied health science graduates” to participate or help with allopathic treatment in a “limited and regulated manner”. Perhaps this pandemic will leave us with important lessons about how we can increase our healthcare system’s human resource capacity.
Let’s also remember that while we scramble to respond to the COVID-19 pandemic, India’s burden of non-communicable diseases burden is not going away either. These diseases include cardiovascular disease, diabetes, cancers, respiratory and kidney disorders, and mental health issues. A little over 60% of all natural deaths in India, with 47% of them in rural India1 are of this type. Even as the markets have crashed and economic activity has ground to a near-standstill, non-communicable diseases pull back India’s GDP by about 1% every year, largely due to the constantly-increasing out of pocket expenses.
Patients of non-communicable diseases still need to consult doctors, have tests conducted and evaluations performed, and have their prescriptions refilled. This healthcare burden cannot be neglected or wished away. In this regard, the government should consider establishing temporary outpatient departments at multiple locations in districts, and away from the main hospitals where re-skilled personnel can be deployed. Alternatively, the Ministry of Health and Family Welfare recently issued guidelines for the practice of telemedicine, and some re-skilling courses can be designed to produce the corresponding ‘tele-doctors’ and ‘tele-consultants’ working within the prescribed safety standards.
New needs, new opportunities
Obviously short-term courses and even hands-on training cannot create an ICU interventionist – but India still needs personnel trained to handle ventilators and other devices and protocols to manage respiratory distress. The NITI Aayog did well to issue a call to doctors on March 26, asking them to volunteer their services. The government should also consider training and/or re-skilling, and widening the net to catch other healthcare professionals as well.
Doctors in Italy – one of the countries worst-affected by the COVID-19 pandemic – have reported that hospitals will need a significant number of doctors, nurses and other healthcare workers to attend to patients as community transmission of the virus begins: some to attend to patients, some to deal with patients’ relatives, some to attend to non-serious cases, some to manage affairs outside a ‘hot’ zone, and so forth. If India gets to where Italy is right now (69,176 confirmed cases and 6,820 deaths as of March 25), we will need more workers to handle the deluge of new cases as well as another lot to attend to non-COVID-19 cases.
India has thus far had a rigid medical education structure that has discouraged the formation of a second or a third line of professionals to fill the gap during emergencies (that every day is an emergent situation in Indian healthcare is another story). This pandemic has many lessons for India, the biggest ones perhaps in healthcare. Many are rising to the occasion, hope India’s medical education regulator rises too and helps create that second and third line.
Sambit Dash teaches in Melaka Manipal Medical College, Manipal Academy of Higher Education (MAHE), Manipal. He comments on public policy, healthcare, science and issues of social interest. He tweets at @sambit_dash.
Non-communicable diseases are incorrectly thought to be an urban phenomenon↩