Surat: At the New Civil Hospital of Surat, a government facility, Hiraben, 45, is seated on the lawns. Inside, her younger sister, aged 40, is being treated for Covid-19. Recalling the day they brought her to the hospital, which is Surat’s biggest Covid facility, Hiraben describes a hassle-free admission process.
“Two nights ago, my sister got breathless and suffered chest pain. She had tested positive (for Covid) the same day,” she said. “We decided to take her to hospital immediately but we couldn’t find an ambulance. We brought her here in our own vehicle. As soon as we arrived, they (hospital staff) checked her vitals and she was immediately given a bed.”
This wasn’t the case at the hospital until a few days ago, though.
Just earlier this month, with the city struck by a surge in Covid cases amid the second wave, the hospital was struggling to accommodate the hundreds of patients turning up daily.
On 9 April, the hospital found itself in the headlines as a queue of over 40 ambulances built up outside, each with a patient waiting for admission, many of them gasping as their oxygen level dropped.
Its state was no different from that of many other government hospitals around India that have found themselves overwhelmed by the pandemic.
The deluge of patients — and fears that the long wait may kill some of them — set doctors at New Civil Hospital Surat brainstorming about potential solutions.
What ensued from these deliberations was a seamless chain of medical assistance called ‘Ambulance OPD’ that begins at the ambulance and extends to three parts of the premises that together comprise 2,600 beds. Largely, the system involves examining each patient arriving in the government-run 108 ambulances while they are in the vehicles, and then shifting them to different sections of the hospital based on the severity of their symptoms.
Each of the ambulances is equipped with a triaging protocol, which allows the patients to be categorised on the basis of the nature of treatment required.
This model, say hospital administrators, has helped reduce admission time at the facility to 10-15 minutes from up to 5-6 hours earlier this month.
“Our systematic approach to solving the problem did the trick for us,” said Dr Parul Vadhgama, 40, the head of the hospital’s respiratory department who has been key in setting up the Ambulance OPD model. “I am getting calls from doctors in other cities asking for instructions on how to manage queuing ambulances.”
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‘Had to do something’
According to state government data, on 1 April, the Surat Municipal Corporation recorded 464 new cases of Covid. This number nearly doubled to 913 cases by 10 April. On 15 April, the city recorded 1,551 new cases of Covid. The daily tally was 1,472 on 26 April.
The New Civil Hospital (NCH) of Surat is divided into three main buildings, each of which is catering to Covid treatment. One of the buildings is a stem cell research facility that has been converted into a 1,000-bed Covid unit. The old NCH building has 800 beds, and so does the third building, the New Kidney Hospital.
Speaking to ThePrint, Dr Vadhgama described how the new system was devised. At one point, she said, the queue outside the hospital was so long that “we feared patients would die in the ambulances”.
“When we saw the condition of patients, we had to do something to address the situation immediately and effectively. Since we were short of facilities, we started checking vitals and conducting an immediate Rapid Antigen Test (RAT) on patients (in ambulances),” Vadhgama added. “If the oxygen saturation of the patient was stable, then they were sent to the stable ward. If not, they were sent to the triage ICU.
“Once a patient is stable in the triage ICU, they are sent to the semi-critical ICU if they have comorbidities, and to the Covid ward in the kidney building if they are stable,” she added.
The stem cell building, she said, houses the most critical patients.
On the desk outside the OPD building, four doctors and six nurses help patients get registered and check their vitals.
Within a week of this system being adopted, the hospital said, they were able to bring the situation under control.
Dr Ritambhara Mehta, the dean of the medical college in the hospital, said “the kidney hospital was set to be inaugurated as a super speciality hospital but was converted into a Covid facility keeping in mind the need of the hour”.
The stem cell building has an in-house testing lab that conducts an average of 2,500 RT-PCR tests a day, according to the hospital. In addition to this, about 100 Rapid Antigen Tests, on average, are conducted daily on the patients who come to the hospital in ambulances.
Every building has a reserve of 500 oxygen tanks that are refilled once used. The facility is equipped with an in-house oxygen plant operational since 20 April. The pressure swing adsorption (PSA) plant, with a capacity to churn out 2 kilo-litres of oxygen per minute, is the first of its kind in the state, with dozens of others sanctioned for hospitals around India.
Dr Vadhgama said the hospital is currently getting “an average of 350 patients daily”. “The highest patient inflow the hospital has seen so far is 587. That happened on 10 April, when the caseload was extremely high,” she added.
According to the doctors at the hospital, although the caseload has reduced by 30 per cent since the city first saw numbers surging earlier this month, the requirement for ventilators has increased by 20 per cent.
“Doctors are already being trained in using ventilators in anticipation of another increase in case load. Patients from nearby districts of Navsari, Valsad, Tapi and Nijhari come to this hospital for treatment,” said Vadhgama. “As the disease spreads in rural areas, there’s a possibility that serious patients will be diverted here.”
The hospital, she said, has written to the state government to increase the number of ventilators made available to them.
Dr Mehta said the hospital currently has around 1,200 Covid patients.
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Women lead charge
Staff at the Surat hospital includes 600 nurses, 236 faculty members, 430 residents, 60 senior residents, 152 interns and 147 final-year MBBS students.
Dr Mehta, a psychiatrist who set up the hospital’s department of psychiatry, said women at New Civil Hospital have stepped up and taken charge.
“About 60 per cent of our staff is female. Out of 236 faculty members, 124 are female doctors and about 90-95 per cent of our nursing staff is female as well,” she added.
“Most of the important positions, as far as Covid is concerned, are being headed by female doctors. We have Dr Ragini Verma, who is the medical superintendent of the Covid hospital and Dr Neeta Kawishwar, who runs the anesthesiology department,” she said.
(Edited by Sunanda Ranjan)
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There is some silver lining. Humanity will prevail…