Mumbai's doctors rely on webinars to deal with patients amid COVID-19

Even before we open the clinics we are going to have to spend thousands on disinfecting the clinic says Dr Rose Davies a periodontist practising at Mulund WestIn a postlockdown world where the risk of the novel Coronavirus infection hasnt completely died down but life must continue practicing medicine is going to be a task fraught with risksmdashboth for the practitioner and for the patient And already Mumbais doctors are lining up various protocols and tech supplements that can help keep their spaces free of infectionDr Mukul Dabholkar Bandrabased dentist says patients will be asked to use hand sanitisers and hexidene gargles and give their contact history at their clinicsThe first step in the battle begins at the gate itself Before a patient enters the clinic a security officer will test their temperature Anybody who has fever is being sent to the nearest fever clinicmdashtheres one close by says Dr Carlton Pereira a senior ENT specialist who runs the Worlibased Bosco ENT Nursing Home He adds that because of the nature of his field coldcoughfever were once standard in patients however those showing these symptoms typical of COVID19 are now being directed for testing firstFeet wrapped in plasticDentist Dr Mukul Dabholkar who runs a practice near Bandras Mehboob Studios describes the protocols He admits there are chances that some may come to the doctor having popped a pill to dodge the temperature check To ensure that they too are being accounted for all patients will be asked questions regarding their travel history whether they know or have come in contact with anyone who has shown symptoms or tested positive While the Brihanmumbai Municipal Corporation has issued a form that patients must sign affirming that they are Coronavirus free doctors say this form is largely based on checking travel history and thus no longer a foolproof method Patients says Dr Dabholkar will also be given the pulse oximetre which checks the level of oxygen in the blood If its anything less than 92 per cent hesitate to treat the patient and ask them instead to get a clearance from their physician first he adds At his clinic he says patients will be asked to leave their shoes outside and step with bare feet on a machine that will wrap the feet in plastic covers This he says will cost around R7000 Patients will also be given isopropyl alcohol hand sanitisers and hair caps as hair often carries bacteria We will advise patients to shave their beards and moustaches to keep facial hair to a minimum but not everyone may agree to that he addsOxygen level checks being doneBefore the patient enters the waiting area they will be given a betadine mouthwash and asked to do a deep gargle with a hexidene mouthwash which destroys 995 per cent of the virus sitting in the upper respiratory tractHexidene garglesThe clinic too he says will be swabbed three times a day with disinfecting surface liquid Ultrasonic units can be bought to clean the equipment People have also argued that water for drillingcleaning the teeth causes bounce back which can lead to infection So most dental chairs come with high vacuum suction or you can purchase one separately This is available for R13000 There are also chemicals available for flushing the tubings each time it is used on a patientDr Rose Davies periodontistDr Davies says that while there have been no definitive guidelines experts on various webinars have suggested not using air conditioners and if thats not possible to use HEPA filters HEPA or HighEfficiency Particulate Air filters that trap harmful particles such as pollen dander dust mites and tobacco smokeWhile the Indian Medical Association has guidelines on treatment and background checks of patients before they enter clinics and advisory on social distancing there has been no specification on infrastructural changes given that the virus is highly infectious So doctors are turning to webinars within the community to address concernsDr Davies says that some of these have even suggested usage of ceiling fans how the pedestal fan be positioned and that windows be used But where are the windows in Mumbai clinics Doctors operate from shop spaces that have other shops next to them or a small gala space In such a situation ventilation becomes difficult I have been operating with the door openBut this too becomes difficult when wearing the Personal Protection Equipment PPE kit Dr Davies for instance wears that along with double gloves a mask and face shield With no AC it becomes claustrophobic We are still procuring many items Not everyone has a fogging machine The air purifier is out of stock and visibility is hampered when using a face shield We will also have to train our staff in using the equipmentDr Carlton PereiraThe new safety measures dont come cheap A good PPE kitmdashone that fits well is of 90ndash100 GSMmdashcould cost as much as R2500 per kit per use The reusable ones require chemical cleaning drying and fogging and come at R350 ndash R500 Dr Pereira says steel tongue depressors have been replaced with usable ones And because there are now more in play it costs more Some hospitals have transferred this onto consumer bills The increase of disposables in medical equipment also means increase in medical waste with red bags piling up inside clinics and occupying spacemdasha different agency comes once a week to pick up material as this cannot be handed over for regular garbage disposalmdashit costs around R4000 per yearAnd yet though costs have been rising for doctors they will not be able to make it up by packing their schedule with patients If anything due to social distancing norms waiting rooms will wear an empty look Dr Anjali Malpani founder director of the Colababased Malpani Infertility Clinic says There was a time when people would judge a doctor by how crowded his waiting room was This should hopefully change that She adds that to cut down the numbers in her waiting room there will have to be some cuts in appointments Tele medicine which they have been practising for years now will gain priorityDr Pranjal KodkaniDr Pranjal Kodkani orthopaedic surgeon specialising in joint preservation arthroscopy and sports injury says not many patients are comfortable heading to hospitals and so will opt for smaller clinics where possible In addition to spaced out consults patients will be told to avoid being accompanied by someone else unless absolutely necessary If someone has arrived late they will be asked to wait outside until the waiting room gets cleared enoughDr Sheetal SabharwalIts similar protocols that are being following by Kharbased obstetrician and gynaecologist Dr Sheetal Sabharwal She says relatives are not being allowed to accompany patients during consultations or even minor surgeries Since the government is not allowing testing for attendants we are only allowing the husband to be present at the nursing home during delivery but not in the delivery room However in such cases the husband stays at the nursing home for three days and isnt allowed to step out No visitors are allowedIn addition to sanitisers and masks for patients and N95 masks for doctors the examination bed is covered with a rexine sheet that is disinfected after every consult We have to assume that everyone is a carrier now Those who are in containement zones are themselves not stepping out And while we try our best sometimes you cannot take all precautions We had a patient whose COVID19 test result hasnt come in and she went into labour She was due for a week later but what can you do She needed a CSection and we did the needful taking all precautionsWill the increased expenses translate to larger medical bills For now the doctors say no At some point yes But not now Right now the economy is down and this is not the time to charge people money Of course its more difficult for new doctors whove started their careers and have rent to pay for their clinics says Dr DaviesCatch up on all the latest 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