New Delhi: A viral video circulating on many WhatsApp groups showing Dr Devi Shetty, cardiac surgeon and Chairman and Founder, Narayana Health, suggesting that the government enlist final year medical and nursing students in the fight against Covid second wave, has generated a debate among India’s medical community. As several helpless doctors have used social media to share posts claiming how stretched they are, the spectre of a massive looming shortage is now an urgent topic of debate among many public health experts.
Speaking recently at the SYMHEALTH 2021, a two-day virtual event organised by the Symbiosis School for Open and Distance Learning (SSODL) and Symbiosis International, Dr Shetty said final year medical students can help fill the upcoming shortage of nearly 5 lakh additional ICU beds, 2 lakh more nurses and 1.5 lakh doctors to cope with the rising tide of the Covid second wave.
But not everybody considers this a practical solution that can be implemented quickly.
Dr J.A. Jayalal, the national president of Indian Medical Association (IMA), said medical and nursing students must be engaged to help out during this critical situation. “We are at the brim of a crisis. Doctors are overstretched and many of them are affected. In the last month, 46 of our doctors have died.”
Even before the pandemic, India was combating the issue of shortage of medical care staff.
The Economic Survey 2019-20 revealed that the doctor-to-population ratio in India stands at 1:1,456. This falls short of the World Health Organization’s standard that states there should be one doctor for 1,000 people.
According to the Indian Council of Medical Research’s National Health Profile data from 2019, many states of India witness a poor doctor-to-people ratio.
All states in India fall short of the WHO’s standard of doctor-to-people ratio. In states like Bihar, one doctor caters to 43,788 people, while the figures for Uttar Pradesh and Jharkhand, respectively, are 21,702 people and 21,157 people for one doctor. The ratio is relatively better in Delhi, Goa, Sikkim and Manipur. Each doctor in Delhi caters to 2,028 people.
Dr Shetty proposed that final year students in medical and nursing schools be inducted to treat coronavirus infected patients. On this proposal, several doctors and public health experts believe that while this may be the need of the hour, final year medical students and nurses can only be used under supervision from senior doctors.
India needs to produce at least 2 lakh nurses and at least one and a half lakh doctors in the next few weeks “who are dedicated to managing coronavirus for the next year, because the current pandemic is likely to last for about four to five months”, he said.
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Students only offer ‘supportive care’
Dr Jayalal explained that final year students are currently awaiting their post graduation exams. “Till the exams are over, no one will be interested in joining Covid wards since they will be preparing for exams,” he said, suggesting that this process be expedited.
He said the same must be done within the timeframe of two to three weeks, after which these interventions will be “of no use”. “We have brought this to the knowledge of the government many times but the government is not responding,” he said.
Dr Dileep Mavlankar of IIPH, however, is sceptical of the move. He asserted that students weren’t “qualified doctors” and could only offer “supportive care”, adding the final decision has to be the responsibility of senior doctors.
Mavlankar suggested that asking students to step in was a “cheap solution”. “Why not hire doctors from the open market. There are thousands of local practitioners who don’t have jobs, their clinics aren’t working. They can be asked to work at the hospital,” he told ThePrint.
Students can work under supervision
K. Srinath Reddy, president, Public Health Foundation of India, said introducing final year students to Covid wards was a “reasonable suggestion” in light of the pandemic, particularly because younger people aren’t likely to succumb to the severity of infection or experience a greater degree of exhaustion in comparison.
“Having students coming as reinforcements and work under supervision of some of the seniors would certainly augment our capacity.”
Reddy added: “Under normal circumstances, it is right to insist on completion of training and examination. Right now, it is a question of apprenticeship by fire, it can be done under supervision.”
He gave an instance of final year medical students being equipped to vaccinate people and that they shouldn’t have to wait for their internships to do the same.
Dr Jacob John, Public Health Physician, CMC Vellore, noted that in an ideal scenario, final year medical students wouldn’t be equipped to make clinical decisions. At the same time, they are capable of doing limited procedures.
“Fortunately, in the context of Covid-19, everything is protocolised, there isn’t much clinical judgement that decides things because most things are based on a certain set of parameters,” Dr John explained.
Ideally, they should work under supervision as part of a team, he said. However, Dr John raised concern over whether they might be “abandoned without support” in certain hospitals in India.
The students are trained enough to start IV lines but they cannot incubate patients, he said. “They also know how to do basic things like measure blood pressure, saturation and understand where the patient is really sick and be able to report back,” John said, adding that this could offer great support to overworked senior doctors.
In 2020, shortly after the pandemic struck India, such an experiment was carried out in Mumbai’s Seven Hills Hospital in Andheri, which was at the time the largest one treating Covid-19 patients in the city. A batch of 45 medical students was brought from Wardha’s Mahatma Gandhi Institute of Medical Sciences to work in the Mumbai hospital’s Covid wards.
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