The Bruhat Bengaluru Mahanagara Palike (BBMP), the metropolitan municipal corporation of Bangalore, has started fever clinics in the city, inviting public-private partnership as the city continues its fight against COVID-19. These clinics will work on all days including government holidays from 9 am to 4.30 pm and hold fever test camps within its premises.
We have been collaborating with Dr.Hema Divakar, an extremely well respected, recognized and internationally awarded Doctor, who is rolling out a training series to help members of the Private Hospitals & Nursing Homes Association (PHANA) - Bengaluru and others set up Fever Clinics in Bangalore.
Dr. Hema has been an early adopter of AI-driven digital platforms to build awareness for preventive care. She firmly believes that engaging patients on the digital platform is the only way to make healthcare widely accessible to all. So it is no surprise at all that given the lockdown and necessary precaution of Social Distancing, she would leverage the use of Zoom, to respond to the need of the hour - a training for her peers as they set up Fever Clinics.
We caught up late last night on the sidelines of the multiple virtual engagements at #COVIDactionCollab thanks to Dr.Angela Chaudhuri, a designer of The Collaborative who as Hema and I both agreed, shares our love for action points and getting things done. ????
Here is an excerpt of our very engaging conversation.
Shrirupa (Shri): Tell me one memory that brings you a lot of joy, even today?
Dr. Hema: My first insights into the power of public-private partnership! It taught me how I can move out of my comfort zone and serve many others going beyond the boundaries of only my patients in my own settings. Partnership and collaborations can really reach out where the need is the most - which I will not be able to totally shift gears into alone - but there is so much scope in the ways we have collaborated with many initiatives across the board in the whole of South Asia - through our organization, through the government and other private partners and more.
When I look back, that is the moment that I decided that I will open doors to many many partnerships that enable everyone to do better work and reach more people and communities with the right services, even under the most difficult circumstances, together.
Shri: Tell me about the fever clinic?
Dr. Hema: The idea of Fever Clinics came from the Government of Karnataka which absolutely makes sense because the COVID-19 symptomatic individuals - i.e. - those with fever, cough, flu like symptoms - are people who would need to undergo the 3Ts of Test-Treat-Trace.
Those who have fever are higher priority. And there are 2 reasons why it becomes important for private clinics to offer this facility.
- In terms of sheer numbers that we can prevent spread - For instance, if we were to estimate the number of hospitals in even a small subsection of South Bangalore and 10 patients walk in everyday with fever - a rather realistic number - we would have 2000 patients with fever in that area. And, if we have even 5 Fever Clinics, then these 2000 people instead of going to several different hospitals and risking themselves and others with this very contagious infection, could walk into any fever clinic near their homes to seek testing and care. If of the 10 walk-ins if even 2 are positive, the hospital can follow the Standard Operating Procedure and refer them to the nearest government hospital where the confirmatory test gets conducted followed by treatment and contact tracing.
- We have a responsibility to provide care - As a country, we know that about 60% of the patients avail healthcare services in the private sector and the adoption of government services in this population sub-segment is going to be low, if not impossible. This means, if we do not set up Fever clinics, we essentially do not have services for them and it will lead to individuals - with Fever moving around to seek healthcare - therefore defeating the purpose of “lockdown” and “social distancing.”If not already Covid-19 positive, there is a fair chance that the individuals may pick up and share the infection at every hospital setting that they step into seeking care. The maximum scope of contact and contamination is in the hospital setting!
Shri: Would you break that down for us?
Dr. Hema: Yes. You see, people who are being attended to in the hospital are already ailing - we can safely assume that their immunity is low. Even if a visitor accompanying a patient comes in with no symptoms and may still be Covid +ve, chances are that those who are ill may pick up the infection from them. And the visitor may still not be exhibiting symptoms even while the patient who has picked it up from them, may deteriorate quickly.
So, while we cannot enthuse every single private hospital to set up a Fever Clinic or a Fever Corner and dedicate staff in the way it should be done, the least that we can do is have a network of willing Private Hospitals and Clinics that can undertake this service in the larger interest of humanity.
What we essentially need today are COVID-19 Response Friendly Clinics and Hospitals.
Shri: Would you like to elaborate on that?
Dr. Hema: Sure. Let me give you an example. One of the norms followed globally is the Baby Friendly Hospital - Hospitals that have this poster as a sign, stand for breastfeeding. Similarly we need to have systems for COVID-19 Response Friendly Clinics and Hospitals.
Hospitals have extremely strict protocols when it comes to sanitization and more. With this move, the safety in every little interaction will get augmented with a significantly better move towards health and well-being for all.
For instance, if anybody arrives at the reception exhibiting flu-like symptoms, they will be immediately directed to the Fever Corner in the hospital or the nearest Fever Clinic. Plus we are through the training we begin from tomorrow are trying to build the capacities of the in-house hospital staff as well to let them know why they are doing this and really internalize that reasoning. The staff may not know right now why it is important for people in the waiting room to sit away from each other. We want to eliminate all possible gaps in understanding including “Why Social Distancing?”.
COVID-19 Response Friendly Clinics would ideally have no knowledge gaps among any of the staff around COVID-19 thus making the experience of the patient less stressful on all fronts. These Clinics and Hospitals may also need to invest in PPE for their staff and really get down to explaining every minute detail around COVID-19.
The staff will know why handshakes are best avoided, why the hand-sanitizer is being used at entry, why the surfaces need to be repeatedly disinfected, regular hand washing continued and why social distancing needs to be maintained. It will also dispel several myths around how the Virus spreads, the right use of Personal Protective Equipment (PPE) including masks and create better understanding about the Virus.
This would be good for all - those with COVID-19 will be rightly guided and those who come in for general check ups will be protected.
It is a myth that hospitals are places with great immunity for all. But with the right care, we can protect everyone who walks into its premises.
Shri: Tell me how this training came about?
Dr. Hema: Yes, you know when we absorbed the purpose of the Fever Clinic, we sent out a google form to all the Private Hospitals through PHANA and received a sign up of around 35 individuals and their clinical establishments. We then examined the SoPs from the BBMP and realized that the training needs were crucial for this to even get started. The BBMP SoPs identify the Security, Housekeeping, Staff Nurse and the Doctor as 4 personnel required for the fever clinic. And each of these cadres would need to truly understand COVID-19.
The Security for instance is tasked with ensuring hand sanitization is undertaken before the individual steps into the clinic and if s/he is suffering from fever, a mask would need to be given. S/He is also tasked with ensuring social distancing and that the patients go in one by one. Everytime the patient sits and gets up from the chair, the Housekeeping staff will need to mop it. These are some of the rules that we will all need to stick to - and if we don’t, we run the risk of infecting others.The staff in the fever clinic will need to be guided on the usage of the Personal Protective Equipment and mandatory handwashing after every patient. For more information on this topic visit. The Training is thus absolutely crucial for the Clinicians and their Clinics and Hospitals that have already signed up and those who are yet to.
Shri: Could you take me through the structure of the training?
Dr. Hema: What we are talking about is very simple, and little things - things that are not rocket science but those that need to be particularly told - and that is the training from tomorrow between 1pm and 2pm. It is a short 20 minute deliberation after which there is a demonstration on wearing of the gloves, the gown, the wearing of the safety glasses, covering the nose and face with the mask and all of that. This is going to be followed with a Q & A session. We will be running this every afternoon, 1pm to 2pm.
We understand there are shifts and changing staff and hence this will be running. More clinics may join in and they may have other doubts that then go into the module. Previous trainees may want to repeat the training because they were not available or need a recap. There may be new issues that need to be ironed out.
PPE is a must and if need be, the hospitals would need to buy for their own staff.
This training series can also be replicated wherever fever clinics need to be set up.
Shri: And all of this is through Zoom?
Dr. Hema: Yes. And, anybody can join.
Shri: Thank you for your time, Dr.Hema and these very powerful insights. Here is hoping that every clinic and hospital becomes COVID-19 Response Friendly Clinic and Hospital for a safer world for all. Dear Reader, you can click to join the training.
Dr. Hema Divakar serves as the Medical Director for Divakar Speciality Hospital (DSH); is the FOGSI ambassador for FIGO, the international organization of Obgyns and a renowned lead in the Diabetes field in Pregnancy Initiatives; CEO and Chairman of ARTIST (Asian Research and Training Institute for Skill Transfer)- the academic wing of DSH. In acknowledgment of her great contribution to the field of women’s health, Hema has been honored with several meaningful awards. She has been presented the Lifetime Achievement Award by Bengaluru Society of Obgyns, FIGO Women Achievers Award, FRCOG honorary fellowship by Royal College London, Social Entrepreneurship award from USAID and MSD, among others.
