New Delhi: Doctors across India have been witnessing both Covid and non-Covid patients go through ’emotional breakdown’, loneliness and other difficulties more frequently now due to lack of attendants in hospitals.
While many patients are deliberately not bringing their family members to hospitals, in some cases hospitals are not allowing attendants fearing spread of Covid infections.
From attending chemotherapy sessions to collecting medical reports or going for regular check-ups — most non-Covid patients have been doing all these alone.
Attendants are usually close family members, who accompany patients to hospitals for check-ups, report collections etc. They are even allowed to stay at hospitals once patients are admitted to help them with their personal hygiene tasks, delivering meals to them, among others.
Doctors say attendants act like an “emotional support” to patients, and help keep them active and motivated as patients can easily “get depressed in a hospital setting”.
Bengaluru-based Dr Vivek Belathur, senior consultant for oncology at Fortis Hospital, said he had to call a psychologist to counsel one of his patients, who broke down after learning about his late-stage cancer.
“I recently informed a patient about an advanced stage cancer he was suffering from. This job has always been difficult but this instance was terrible. My patient broke down to an extent that I had to call our psychologist to consult and motivate him,” Belathur said.
Despite hospitals in several states allowing attendants in non-Covid wards now, patients are still visiting hospitals alone for check-ups or admissions to prevent family members from getting exposed to infectious hospital ambience.
“While this has happened in pre-Covid days as well, but the attendants would take over after we finished announcing our diagnosis or we would only inform the attendant. However, it is more clear now that the role of attendant is very powerful. They act like emotional support for those who are already struggling with a life threatening, powerful disease,” Belathur said, while adding that he has been seeing several of such patients coming for chemotherapy sessions alone.
Attendants for both Covid & non-Covid patients
Presence of attendants becomes absolutely necessary specially for elderly patients, who feel more distressed as they’re mostly unable to connect with their family members due to their inability to access smartphones and technology.
Dr Manish Sontakke, a consultant orthopedic surgeon at Fortis Hospital at Vashi, Mumbai, was attending to an 88-year-old woman admitted in the Covid isolation ward in the early days of the pandemic.
“Her entire 10 day stay at the ward was uneventful and she was recovering well. But on the last day of her stay, just prior to discharge, she slipped and fell, sustained a fracture,” Sontakke said, adding that “unfortunately, she developed complications from her fracture and passed away. She could have managed better if there was someone around her to motivate her and talk.”
According to Sontakke, elderly patients are probably the ones in greatest crisis due to lack of attendants at hospitals.
“They are lonely, distraught especially if they are not comfortable with using mobile phones as that is the only means of communication with the outside world,” he added.
“Her son, who just hours before was ecstatic about seeing his mother, sobbed in despair. He never got to meet her.”
In regular check-ups as well, doctors are seeing elderly patients coming to hospitals without attendants.
Dr M. Shafi Kuchay, senior consultant, endocrinology and diabetes at Medanta Hospital in Delhi, has been regularly seeing elderly patients visiting him alone.
“One of my patients, who was in the late 70s, visited alone for diabetes management (earlier this month). He had uncontrolled diabetes and kidney abnormality.”
“I had to put him on multiple insulin shots. However, I couldn’t teach him the injection technique. He was not able to understand it. I asked him who he had come with. He replied, ‘no one’,” he said, while adding that in this case, family members were afraid of coming with patients to hospitals or clinics fearing infection.
Otherwise, limited attendants are allowed in non-Covid areas at Medanta, he clarified.
Also read: CCTVs in wards, one attendant for patients — Delhi issues new guidelines for Covid hospitals
‘There should be better laws for attendants’
Dr Kamna Kakkar, senior resident, Department of Pulmonary and Critical Care Medicine at PGIMS, Rohtak, who has been treating Covid-19 patients, said in some of the instances, it’s legal and ethical to separate the caretaker from the patient, “but if you look at the bigger picture, it is utterly inhumane to do so”.
“A 90-year-old bed-ridden man who was dependent on his family for feeding him, for taking him to the bathroom, for changing his clothes, had tested positive. Now he was admitted to an isolation ward,” she explained, while asking further, “would a single nurse for 200 people be able to provide him the help and attention he deserves?”
“He can’t be discharged for home isolation because he needs oxygen for survival. What to do?” she asked.
Kakkar further asked how a team of nurses would manage in hospitals if a three-year-old child tests positive but his whole family tests negative.
“Would you isolate the little child alone? Would you isolate a parent with the child and put the parent at risk? This subject needs attention and there should be better laws for attendants with Covid patients,” she said.
While the central government in July had written to the states directing them to make space for attendants in Covid wards, only a few states such as Goa have done it.
Some states such as Odisha and Andhra Pradesh have set up help desks to give out real-time updates to family members.
Contact with family essential for patients
Health experts believe that the government and hospitals should explore ways to establish contact between patients and family members through video calls, text messages and other technologies.
“The move to allow patient attendants in Covid-19 hospitals can help in providing support to patients, especially emotional, and provide comfort,” said Anant Bhan, adjunct professor and researcher in bioethics at Mangaluru’s Yenepoya University.
However, he added: “This needs caution and also adequate attention to reduce the chances of acquiring infection for the attendants through provision of adequate PPE when visiting wards.”
“The possibility of alternatives should also be explored, which allow for updated information and access to communication with patients being available to loved ones through mechanisms such as video calls, regular calls, WhatsApp messages, supported through help-desks and other such steps where required.”
Also read: Only one attendant, no sightseeing, no shopping — how India could reopen medical tourism
Why are attendants important?
According to Dr Kakkar from PGIMS, Rohtak: “Family members such as parents, spouses or children provide psychological support and help in keeping patients active and more open to treatment options.”
Apart from encouraging patients and giving them hope of recovering, there are several other roles that caretakers fulfil.
“From taking care of their food, clothes to handling the complicated treatment, the role of attendant is important. Patients can easily get upset and depressed in a hospital setting,” Belathur from Fortis said.
“We reach out to attendants in case of emergency situations such as understanding the allergies, past infections and reactions to certain medical treatments,” he added.
According to a report in July, a hospital in Jerusalem became “the first in the world to send recovered Covid-19 sufferers into virus wards to relieve patients’ loneliness”.
“It lights up patients’ eyes when they see a visitor,” said Moshe Tauber, quoted by The Times of Israel, who was infected with Covid in July.
“People were so excited the first time I walked in,” he said, adding that “they were excited because people there don’t see anyone apart from staff, sometimes for weeks”.
Also read: 40 lakh households, 10 days, much confusion — inside Delhi’s mammoth Covid screening drive