New Delhi: While doctors are being hailed as the ‘frontline heroes’ of the coronavirus crisis, the oft-ignored and yet crucial contribution of the paramedical staff is the ‘backbone’ of the ‘test, test, test’ mantra that all states and union territories are trying to follow.
From rude customers to enduring the sweltering heat in their Personal Protective Equipment (PPEs), these paramedics continue doing their jobs despite a massive risk of contracting the infection themselves.
Yet, most of them say they will not stop doing their jobs for fear of the virus.
For Kamlesh Thakur from Dr Lal PathLabs, a prominent private laboratory in Delhi, it’s their responsibility to perform their duties, just like a “soldier” does.
The rampant public stigma of Covid-19, however, has made their lives much more complicated.
A lab technician from Dr Dangs Lab said 20 per cent of the house calls they make end up with patients withdrawing their request for testing after they see the paramedics in their PPE suits.
Each paramedic in a private lab collects at least 15 to 20 samples in a day, and that increases the risk of them contracting the virus. The risk factor in a government lab is much more as they collect many more samples every day.
A technician working in Delhi’s government-run Ram Manohar Lohia Hospital said they collect over 300 samples every day.
Testing was also recently ramped up in Delhi after Chief Minister Arvind Kejriwal and Home Minister Amit Shah’s meeting on 14 June. While Delhi had averaged at 5,000 tests until 13 June, the figure increased to 10,000 from 15 June onwards.
The pandemic has also significantly altered the lives of the paramedics in other ways. They have to isolate themselves from their families, with many opting to live away from them to reduce risk of transmission.
According to a study published in the Indian Journal of Medical Research last month, 1,073 healthcare workers in India had contracted the virus until 23 May. This study was authored by ICMR Director-General Dr Balram Bhargava and Dr R.R. Gangakhedkar, ICMR’s head of epidemiology and infectious diseases, among others.
The data for this study was collected between 8 May and 23 May. On 23 May, India had recorded over 1,30,677 Covid cases in total. This meant that 0.82 per cent of the total Covid patients in India were healthcare workers.
There has been no other official data yet on Covid-19 infections among healthcare workers.
House calls are tricky to navigate
For almost all labs, the day starts fairly early.
At Dr Dangs Labs, the day for each paramedic starts at 7.30 am with a pep talk by Director Dr Navin Dang, who encourages his staff to keep fighting the “good fight”.
According to Deepak Baid, head of operations at Max Lab, another private lab in Delhi, “We go to the lab around 8 am and are done with a day’s work around 9.30 pm or 10 pm.”
Thakur, a lab technician at Dr Lal PathLabs, said, “Each morning, we get a call assigning us the houses we have to go to collect the samples.”
Lab technicians explained that technicians are divided into several categories at the lab, ranging from ones who are responsible for picking up calls made by patients, collect samples, testing in labs to waste disposal of the samples.
The paramedics also revealed that they have to call the patients well in advance before reaching their houses to collect samples.
Thakur explained, “We also have to call them in advance to tell them that we need a separate space allocated for wearing PPE.”
However, house calls can be extremely tricky to navigate. According to Mamraj Yadav, another paramedic with Dr Dang Labs, “Sometimes a patient calls us in advance asking us not to tell the colony guards that we have come for a Covid test.”
He explained that people are scared of letting their neighbours know that they were potentially Covid-positive. However, Yadav said he understood everyone’s fears and concerns regarding the virus.
Typically, most technicians who collect Covid samples are 25 to 30 years old. Thakur explained that before leaving for the tests they have to keep their equipment bags ready and also wear their PPE, which includes an N 95 mask, gloves, double masks and head covers.
While PPEs are crucial to prevent the virus, wearing them in Delhi’s stifling heat makes the technician’s job much harder.
A lab technician at Dr Dang Labs explained, “Wearing the PPE for such long hours is very exhausting, we can’t even scratch ourselves.”
Paramedics who collect samples from Covid-19 patients have to wear PPEs for over two hours, while those who work in the lab have to keep the PPEs on for five to six hours at end.
“We can’t eat or drink anything, neither can we go to the washrooms,” said the technician.
A lab technician at RML hospital echoed this sentiment. “The PPE is so airtight, there is a big issue of ventilation. So, we wear it in rotations.” A technician in the hospital wears it only for two to three hours at a stretch.
Testing is a ‘zero-error’ zone
The paramedics have to use the real-time polymerase chain reaction (RT-PCR) mobile application — launched by the government in April to avoid duplication of data — and fill in the details of the patient before the swab test.
The RT-PCR test has emerged as the gold standard for testing of Covid-19. Paramedics explain that they collect the sample from deep inside the noses and throats of patients using a swab.
A lab technician from a private lab, who did not wish to be named, revealed, “Sometimes when we’re collecting the samples from deep inside the nose, people end up either sneezing or throwing up.” He said that these were some of the hazards that had to be tolerated since nasal samples were better than throat samples.
Another lab technician said, “Often, we have to keep waiting outside in the sun while wearing PPEs because sometimes the RT-PCR app glitches and is slow.”
Later, these swab samples are treated with a chemical solution to remove proteins and fats. This process leaves only the RNA present in the sample, which is then ready for testing.
A lab technician at Dr. Dang Labs said, “The samples are put in boxes with proper temperature controls and then they have to be deposited to the lab before we can go on a house call again.”
The samples are then delivered to the lab and taken to the testing area. The testing area is cordoned off from the main part of the building to ensure maximum safety.
In most labs, two persons are responsible for bar coding the samples. In order to avoid the switching of names, this process has to be double checked.
The technician at Dr. Dang Labs described his work as “labour-intensive”. In order to complete the RNA extraction process, the sample is put into the RT-PCR machine.
“After putting the sample into the machine, the reading starts coming and we have to sit there with our eyes glued to take the reading. These readings are then put onto the ICMR portal as per guidelines,” he explained.
He added, “The whole thing is very tedious. The whole process is a zero error zone and requires many precautions.”
The arduous process of testing one Covid-19 sample doesn’t end there. It also has to be disposed off according to the guidelines set by the Central Pollution Control Board.
In order to dispose off Covid-19-related biomedical waste, the segregation needs to be colour-coded. A red bag includes infected plastics used in the lab, while the yellow bag carries swabs etc. According to the guidelines, the waste has to be transported to a biomedical waste treatment facility within 48 hours.
Public is ‘scared’
The most difficult part of this entire process is perhaps dealing with the “scared and anxious” patients.
The staff revealed that several times these patients lash out at the technicians during the testing process.
Moreover, the labs are often short-staffed compared to the number of demands for tests. And as a result, people are very impatient and are seldom polite. The technicians are often subject to verbal abuse at the hands of clueless patients.
A technician from a private lab said people once threw stones at him when he went to collect samples.
According to Baid, “Public darr jaati hai (the public gets scared when you come to collect samples).”
This fear and stigma has eroded their personal lives as well. Manjeet, from Dr Dangs Lab, was asked to vacate his house by his landlords because they were scared of contracting the virus.
However, several of them have found relief from the companies they are associated with.
Max Labs and Dr Dang Labs have provided the paramedics with alternate accommodation to reduce the risk of infection to their families.
Baid from Max Lab said, “I haven’t seen my family in the last three months. Right now, Max Hospital has provided us all with a community shelter to keep our families safe.”
In fact, Baid is a recovered Covid patient himself. Baid had tested positive for Covid-19 in early June and had been under quarantine for over a month.
Dr Navin Dang told ThePrint, “I am providing them accommodation, food, bathrooms, soap, towels, shampoos and even a dhobi to wash their clothes. They are all like my kids, I have to take care of them too.”
Dang also provides his paramedical staff with an ‘incentive’ of Rs 500 for every house call that they make. However, Yadav chose to forego the incentive.
He explained his decision, “I am doing this for my country. It is a difficult time.”
Baid also echoes this sentiment, “It is a very courageous job and it is not easy at all. All the paramedics only want good for society since it is a problem of the world.”
When asked if he was scared of contracting the virus again, Baid chuckled and said, “If we are scared, then who will do our job? Someone has to be on the frontline.”
Thakur from Dr Lal PathLabs said, “There’s nothing to feel scared about. This is our responsibility and we must fulfil it like a soldier does.”
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