Koi Louta De Mere Beete Hue Din : Resident training in COVID ERA in a Public hospital – Challenges faced : A Chairman’s perspectiveDr Sujata Patwardhan
The covid pandemic started with a bang. All the existing patients were discharged, operation theatres shut down. We went to work only managing daily routine, OPD dropped to 20-30 from 350 patients.
The first few weeks went on with worrying about PPE kits which were yet to be manufactured. A stress reaction emerged, looking for funding, N-95 masks, sanitizers, starting new protocols, lapping up the WhatsApp university news and TV updates, series of webinars with information- both ‘relevant and irrelevant’.
In April the COVID patients started to rise slowly, COVID centres started to mushroom and many of the specialities had to convert their wards and ICU for COVID care only. Urology was not initially posted at Kasturba which was the first infectious disease COVID epicentre. Soon, by mid-April ,urology residents and faculty were asked to do COVID duties .
Students from all speciality from Anatomy to urology were put on duty and our residents shunted between Seven Hills hospital and KEM Hospital. It was a new experience for them staying in Hotels, living off suitcases and taking only rounds, doing all things except surgery. The urology team was divided into 3 sets – Ward duty, COVID duty and rest. Surgeries came down to stenting and Percutaneous nephrostomy (PCN) and a few emergency surgeries that could not be deferred .
Protocols were formed and extra precautions were exercised. Being a public hospital Emphysematous pyelonephritis, Placenta percreta , transplant complication, prostatic abscess, Road traffic accident , Fournier’s gangrene, fracture penis and priapism dominated the scene.
One by one residents became positive followed by OT Staff and faculty but all recovered uneventfully. We started crowd funding, providing masks, PPE, footwear, scrubs, face shields and help started pouring. Hospital helpline to direct non COVID patients was started along with IIT Mumbai.
Soon fear took a backseat and frustrations started mounting. The entire exam going batch of urology residents a beating of 6-8 months of regression. A third year resident who used to perform 80-100 PCNL, now did nothing. The hands-on training has taken a major back step. The stigma of being a COVID Hospital and problems related to travel, stay, expenses prevented patients from opting for routine surgery. ESWL, UDS, andrology have lagged behind the usual numbers . Apart from academic activities online and in person, the actual surgical skills could not be imparted. The flourishing of webinars seems to be a good endeavour but retention of knowledge by residents and ability to reproduce it within few days was poor.
A comparative data of the pre and past COVID depicts the decrease in patient load which in turn will affect the training of residents in all the three setups, OPD , ward and OT.
Change in management protocols:
This was evident in many urological diseases as routine operation theatres were not available. For example a patient posted for Ureteroscopic lithotripsy was only stented and patient to be posted for radical prostatectomy was given GnRH agonist / antagonist and asked to follow up after 3 months . Whether the decisions were justified or not is a point of debate but such decisions at the discretion of the department were taken.
The impact on reconstructive surgeries is evident and the senior faculty are devoid of exercising their skills. To conclude it’s a huge loss to everyone in the field of urology and its not clear when things would return to normal.