In an interview to NPR, the American medical anthropologist Paul Farmer says, “A dread of responsibility lays heavy on the shoulders- the dread is what a lot of folks feel, if they are clinicians, caregivers. It’s kind of scary.”
One frontline yet to make headlines is the one staffed by allied health professionals – therapists of all kinds, technicians and other staff who literally hold the back of a health facility or a system as they perform tasks with patients, in the wards, in investigation areas, therapy rooms and the rest of the hospital. As key staff who are also grappling with service provision without adequate self-protection, it is important to highlight their stories, challenges and continued efforts during the new coronavirus’s outbreak.
Allied health professionals are a diverse group of people who play critical roles in therapy, rehabilitation, chronic care, ward-based care, investigation areas, day wards, waiting areas, short-stay wards and many other ‘smaller’ places that often form the larger backbone of a hospital, away from the floodlights that light up the emergency rooms and the critical care areas, and who are as much at risk as the doctors, nurses and the patients.
In many national contexts, including India’s, the traditional hierarchical systems in hospitals tend to save the best of gear, protective or otherwise, for key professionals and leave the staff lower down the order to manage with the remains of the paraphernalia. These divisions and inequities stand out in the face of uncertainties and crises. Most allied health professionals, particularly in government-run hospitals, make do with face-masks (that have often paid out of their pockets for).
Due to multiple logistical reasons, they almost never have access to gloves for use in routine therapeutic settings, and their hands as much as high-touch surfaces that are seldom cleaned or disinfected could become the source of new infections. Personal protective equipment (PPE) remains a privilege for these professionals. Their counterparts in the developed world, however, are typically much better equipped.
Additionally, therapy rooms are almost always overcrowded. Even in large, busy government facilities, doctors need to conduct multiple sessions in parallel, while therapists, patients and their relatives all breathe the same contained air, potentially with germs that could prove deadly. Equipment may not be properly cleaned between patients, since session time is limited and there is always an endless list of patients waiting.
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Many instances have come to light in recent times when these professionals are subjected to social pressures for ‘bringing home’ infections from the hospital; however, only the stories of doctors seemed to have reach the social media and the public eye. Other hospital staff are typically not seen as being integral to the care provision process and are often questioned about their capacity and status in the health system. They are the ones following the prescriptive orders, and spend more time with patients, helping them recuperate and reach their homes from the hospital.
Many therapists also administer services at homes and other settings outside hospitals. With the lockdown, these services have stopped putting patients in hardship and but the staff is in dire straits. These workers are paid much less, but work just as hard as many of their colleagues, miss meals, and perform their duties quietly in the background. They are threatened even more when people report to hospitals without disclosing their illness or even that they recently came in contacted with a person who tested positive for COVID-19.
The above real-life experiences of therapeutic professionals shed some light on what health systems can do to protect them as a community, and make their hospital spaces safer in the heat of this (predominantly) respiratory outbreak.
Hospitals and care-providers must allow PPE protocols and safety measures to be implemented as they would be in emergency or critical care areas. All staff who continue to provide essential services in therapy areas should be provided basic PPE. Equipment surfaces should be thoroughly cleaned between patients and as per the norms.
In patients with mild or moderate ailments, certain procedures could be done less frequently or even deferred for a short while. These could be re-scheduled for a later date, when the outbreak has been controlled and therapy spaces are safer to occupy.
Many services cannot be stopped, particularly for critical patients who may not be affected by COVID-19 but suffer from severe forms of other diseases. Even so, therapy rooms and wards should be managed with shifts. Disinfecting these spaces at regular intervals and maintaining spatial distancing by requesting attendants and relatives not required in therapy to wait outside will help reduce a significant number of infections.
Finally, the medical community and the wider society must allow space and voices for allied health professionals of all kinds to participate in awareness and advocacy efforts to bring their perspectives to the fore, for their own safety, the safety of their patients and to play their part in helping control this pandemic.
While it’s critical to prioritise care for those infected with COVID-19, the way forward is to also focus on other arenas of medical care and create a holistic plan that wards off the further spread of infections from vital (if not emergency and critical) hospital spaces. It is key to strengthen allied health services, ensure allied health professional safety and give these valued professionals a stage.
Shubha Nagesh is a medical doctor by training who works with children with developmental disabilities in the foothills of the Indian Himalaya. She tweets at @snagesh2. Stuti Chakraborty is an occupational therapy intern and advocates for young people, with a special focus on the rights of people with disabilities.
The views expressed here are the authors’ own.