After detecting the first COVID-19 positive case on 8th March, Bangladesh stands at a whopping number of 63,026 as of 8th June (WHO) . The Government of Bangladesh (GoB) ministries coordinated quickly in managing the spread of the pandemic. Many communities and upazilas (sub-districts) were put under lockdown from 26th March and was extended until 30th May. Public places such as malls, bazaars (local markets), mosques, garment factories, local and national transport, airports, and educational institutions were closed. Private and public offices implemented work from home modality. Amidst these, the first responders and frontline workers’ category were declared essential by GoB who continued working even during the festival holidays; these include workers in healthcare facilities, pharmacies, police, armed forces, banks and grocery stores. Healthcare providers are an essential workforce for COVID-19 detection, the care for positive patients and taking measures for the burial of deceased positive patients. However, given the shortage of medical equipment, human resources, and other protective gears, this is surely a challenging time worldwide, not just in Bangladesh. The Upazila or sub-district level hospitals have a designated Upazila Health and Family Planning Officer (UH&FPO). The GoB arranged for their accommodation and food inside their respective hospital campus with transportation (vans or motorcycles) which they use for collecting samples too. Although the majority of the doctors are staying in the hospital ground, a few are staying in the nearby area, but none with their families at this point of time. With such setup, their commute time has reduced significantly as the hospitals are a mere walking distance now. They have been provided essential PPE such as masks, gloves, and face shields. A typical day generally looks like this: The doctors wear PPE and other protective materials before leaving their accommodation and reach the hospital by 8 am. The outdoor patient visiting hour has been reduced from 8 am-2 pm to 8 am-12 pm to minimize exposure. The patient flow is less than pre-pandemic time, as patients are visiting less for the fear that they might catch the “ominous disease” from hospitals, as many patients are admitted there with various illness. While treating the patients inside the consultation rooms, they have to come out frequently to announce to keep a three-feet distance among people. However, the patients do not listen and they go in and out of the hospitals, even indoor patient wards without paying any heed to the doctors. Within the time that they are treating patients, they are also managing the crowd simultaneously. After the visiting hours, the UHFPOs either have to attend an online meeting with their local Civil Surgeon’s office or central Directorate General of Health Services (DGHS) from the capital city, Dhaka. This meeting involves reporting the status of the Upazila to the higher authorities in the health system. The doctors also received training on Coronavirus management at least twice a week through GoB’s online platform. Apart from the training and online meetings, the UHFPOs also are informed of the suspected people that need to be tested. They make a list with the help of Union Parishad, Police, Community Clinics and fieldworkers to provide to sample collectors who then collect the sample from suspected patients. Some Upazila had volunteer sample collectors, and some Upazila had UHFPOs taking samples. They also have to monitor the home quarantined population and report to the Civil Surgeon on a daily basis. The PPE received also are constantly being distributed to other healthcare providers where deemed necessary. Telemedicine service is provided for the local community where the majority of UHFPO has provided their personal mobile phone number, in a few cases resident medical officer took upon this responsibility, hence their phone is open for service even at late hours at night. They also make sure that regular disinfection of the hospital spaces is conducted. Every day, they are reporting all these numbers back to their local DGHS office which is then reflected on the daily health bulletin by Additional Director of DGHS from Dhaka. Apart from the outdoor patient visiting hours, even though they try to finish by 5 PM, their work hours spread over the night as well. They are working until they go to bed every night. Their hours are based on a duty roaster where different medical teams are formed to reduce the exposure of a larger team. One UHFPO from Haor region mentioned, “We work for 10 days straight…no breaks, then we are in self-quarantine for 14 days. Another medical team comes in after us and work for 10 days straight again. We have three medical teams for each month in the duty roaster. This is what we have been doing since the pandemic management order has been issued. We do not get to stay with our families within quarantine time, we stay in the residence provided by the government.” A day in an Upazila level doctor’s life appears to have no rest. They are staying away from families, working day and night with minimal sleep, serving the community as duty calls. They are the unsung heroes of our nation. Written by Sairana Ahsan, Reporting and Documentation Manager of SHOUHARDO III, CARE Bangladesh.
May 3, 2020