Dr. Nandakumar Jairam, Advisor, Manipal Hospitals
Speaks about physical and mental exercising to manage stress & sheds light on practical solutions to assist the current frontline workforce with additional manpower
The video is a detailed account of a conversation with him. Below is an excerpt…
What does the future hold for the Indian healthcare system, in terms of the pandemic?
The coming months demand that we continue the fight at an individual level: protect yourself to the maximum by practicing social distancing, get the vaccination and any future booster dose that is recommended and promote vaccinations in your social circles. We may also be headed for a 3rd wave. But the rapidity with which frontline warriors have administered vaccines till now, means that future waves will be less intense in comparison to the recent one.
The next priority for the foreseeable future is protecting the vulnerable groups that cannot be vaccinated, like children. Developing vaccines that are safe for children will be a major milestone.
Frontline warriors experience a continuous build-up of stress with each wave. What are some easy coping strategies?
Stress has been skyrocketing among healthcare professionals. The first necessity is physical exercise. Activities like yoga, weight training are compatible with current lifestyles and do not require excessive space or time. Physical activity also leads to better sleep, which is crucial, as sleep pattern disruption is common in current times. Secondly, prioritise social interaction where you can share your feelings with friends. Virtual meetings can allow you to do this with greater convenience.
Eating healthy should be a major priority, as stress can cause issues like vicious cycles of binge eating, which can be detrimental to both mental and physical wellbeing. Medication for stress is only required when faced with serious emotional imbalances. Lastly, dedicating some time to prayer or music as per your own liking, can have a calming impact.
What is the possibility of bringing in additional human resources and capacity in the system, so that fatigued frontline warriors can get a break?
Additional human resource creation is a challenging issue. We can only use existing manpower to expand the number of healthcare warriors to share the load. Existing possibility to create warriors is from final year medical students, who have not passed, but can come to the frontline when required. Nurses who have not completed nursing school but are in the final year of training, can also be involved.
Some non-COVID diseases are a grave threat to life. How can the Indian healthcare system deal with a bulk of COVID and non-COVID patients?
Capacity building involving final year medical students, with rigorous training, can be beneficial. These students can be divided into two distinct groups: one focusing on providing COVID related care and a second group that tackles non-COVID cases. Those allotted to the second group must have strong knowledge of the standard of care in the management of chronic non-communicable diseases (NCDs). Most NCDs have fairly clear-cut ways in which they should be handled. This can be managed at a primary care level by these workers either in person or with the use of simple telemedicine apparatus.
Secondly, all people with NCDs should become adept at self-management of their diseases. Basic tasks like checking one’s own blood pressure, using a glucometer is knowledge that should be imparted with simple pictures and descriptions on mobile apps that governments can develop.
What innovations can we apply to fortify rural frontlines?
In urban centres, services like COVID care centres, hospitals, ICUs are easier to access. In rural areas, a village is likely to have a Primary Health Centre or a clinic. Milder cases can be treated at the village level, while complicated ones should be transferred to centres with better equipment. Transportation to transfer patients is also an area of concern. Directing vaccination to the rural sector at a better rate than now, is important.
Use of technology is central to these times. Governments can empower people who know the basics of medicine even if they aren’t doctors, like midwives. They can be trained to use technology to communicate with professionals at a higher level.
What are the lessons for future disaster preparedness that we can take forward with us?
An emergent priority is investing in research. COVID-19 is a zoonotic condition that got transferred from animals to human beings. With further environmental destruction, more zoonotic epidemics could follow. As disease pandemics are a deadly, unknown enemy, investing in research at a global level and co-operating with agencies like the WHO, is a lesson to learn.
There are three areas where improvements should be made:
- Infrastructure: Due to the globalized networks, no country is safe, if there is a transmittable disaster in another country. There has to be uniform improvement in healthcare infrastructure globally
- Building manpower: Skilled, knowledgeable workforce is an essential investment for all governments. This becomes a reserve force that can play a vital role when needed during a critical emergency
- PPEs & medicines: The effectiveness of a variety of drugs and protective equipment needs to be analyzed to a greater extent. Vital drugs and equipment should also be produced beforehand
What are the key lessons to take away from the last 14 months, from a primary healthcare perspective?
Primary care in the country is not structured and lacks in many regards. There are PHCs in rural and urban areas, but their functionality needs to be examined. There are clinics led by doctors, but they overwhelmingly concentrate on reactive cures, not primary preventative measures. There has to be rethinking and reevaluation on how we can deliver preventive care at a primary level.
A community centered model is one such innovation. This involves a healthcare centre, which is responsible for one community where common people regularly interact with professionals. Such a system will demand high levels of accountability from the healthcare professionals in rural areas, which is necessary.
Where can NATHEALTH as an organization focus its energies, both, during and after the pandemic?
NATHEALTH has done considerable work in the last several years, and there is scope for more contributions. The federation can engage in formal discussions with the Government to form a core team and work on the creation of a healthcare system for India, which clearly defines the roles of the private and public sector. We need to change the way in which the public accesses healthcare, even at the most primary level. Insurers need to work with this team. Over a period of a year, such a team can create a blueprint that radically changes the nation’s healthcare policy. Primary care for every Indian in a structured manner, with evidence-based practice needs to be made possible.