A couple of weeks ago Asis Karmakar showed his aching leg to his doctor through a window. He stood across the doctor’s pavement garden and explained his symptoms over phone, holding up his leg as high as he could, the pain notwithstanding.

Far from complaining, the Kestopur resident was grateful. “This Sector I doctor is the only one who agreed to see me,” he says. “All other doctors I know in Kestopur and Salt Lake have shut their chambers because of the pandemic.”

Moinak Dutta was to take his father, a cancer patient, for check-up in end-March but the hospital put it off. “I called their helpline for weeks but no one picked up,” says the AJ Block resident. “Finally they called and fixed an appointment for this week.”

Dutta’s year-old daughter was also due to get her hepatitis A vaccine during the lockdown but the hospital has put that off indefinitely too. “The doctor says the delay won’t matter but she has two more shots lined up in the coming months. Can an infant take so many shots together?”

Like other industries, healthcare has taken a hit because of the lockdown. Covid-19 may be the most infectious disease doing the rounds but that’s not stopped heart attacks, strokes, TB or UTI, and without doctors to consult patients are in the lurch. Even as some doctors finally start reopening clinics, the problem is far from over.

Doctors can be patients too

Patit Paban Paira, homeopathy doctor of CE Block, is 78 years of age. He has chronic obstructive pulmonary disease (COPD) and his daughter is a doctor at an all-Covid hospital. “I am already in the high risk group. Would it be safe for me to come in contact with patients who may have Covid-19?” he asks.

The doctor is tending to patients over the phone and those that are landing up anyway, he is seeing through a netted window without letting them in.

Eye specialists are among the most at risk of infection. “When we use an ophthalmoscope, our nose almost brushes that of the patient,” points out Purnendu Bikash Sarkar, an eye specialist who runs a clinic in IA Block. Since March 19, he is staying cooped up in his Purbachal 4R apartment, keeping his chamber shut. “I had seven operations that day and decided not to take any more risk. I am a senior citizen myself.”

Dentist Sambit Sourav Panda says it would be a huge challenge to reopen his clinic in Downtown Mall outside Uniworld City. “Other doctors work on pen and paper but we work on people’s open mouths, from where oral infections readily spread. So susceptible are dentists to viral infections that every six months we get ourselves checked for illnesses like hepatitis, but what to check for Covid when there is no definitive vaccine or cure?”

Apollo Clinic City Centre has reopened and Dr Adrija Rahman Mukherjee has resumed her visits. “But nothing is foolproof,” says the BB Block consultant physician and specialist in family medicine. “My patients are coming with N95 masks but I am wearing a flimsy surgical one as I could not lay my hands on an N95. I have no gloves, face shield or PPE either. Some rooms at the clinic have no windows to allow air circulation (ACs are not advisable now) and there’s no provision for changing sheets after every patient lies on the bed for examination.” However, she has noted that up to 20 per cent of patients who could have been treated over phone are insisting they come to the clinic just so they can get out of the house.

Medical oncologist Gouri Shankar Bhattacharyya has been on duty throughout at DD Ten hospital but he knows many doctors who have backed out. “Can we blame them?” he asks. “PPEs are so few in number, their quality is suspect, there are no clear directives on how to use them…”

Hiding symptoms

Rajesh Kumar Chel was home-bound for the first 15 days of lockdown. “And the feeling was mutual. Even patients were wary of calling outsiders home. But now I am as busy as ever,” says the HB Block doctor.

But he calls for transparency. “Sometimes patients with fever are calling me over citing stomach ache as they think I would not come otherwise. If a patient describes Covid-19 symptoms over phone I shall ask him to get tested. But if I get Covid what will happen to my 4,000-strong family of patients?”

A patient whom dentist Santanu Roy treated three days before the lockdown tested positive for Covid-19 four days later. “This other patient was feverish while I treated him. Afterwards when I was chatting with him he revealed that he was just back from the US,” says the CD Block resident. “Patients are suppressing facts for fear of getting quarantined but this will spread infection.”

Dangers of self-medication

With doctors missing in action, some patients are resorting to self-medication, says dermatologist Dr Imran Wali, “and with disastrous consequences.”

“When medicines and home remedies are ledaing to reactions, they are being forced to forget about Covid and come over anyway,” Wali says. Last week one such patient — a 90-year-old at that — landed up at his CL Block chamber all the way from Sundarbans in an ambulence.

“I don’t have screening equipment like thermal guns at home at home but I couldn’t refuse him.”

Bhattacharya also blames social media for spreading wrong information and misguiding patients. “It’s a pandemic of stupidity facilitated by the university of WhatsAap and Facebook,” he says.

Indeed Dr Rupa Ghosh of AB Block has had patients who are “sanitising” vegetables by soaking them in Lysol or pressure-cooking them with Dettol. “Vegetable surfaces are porus and these people are foolishly ingesting harmful chemicals. More than medicines my prescription to them is to stop following fake news.”

Tele-medicine

Though operations are off the table, eye specialist Sarkar is seeing patients through teleconference. “I am doing WhatsApp video calls. That way, I can deal with simple cases like conjunctivitis or iritis.” He is sending patients power checking charts by WhatsApp, asking them to place the phone six feet away and read the alphabets that appear on its screen one by one, by shutting one eye at a time. Family members are being asked to help out by holding a torch to the eye as he asks the patients to look right or left. “They are also clicking close-up pictures of their eyes and sending me. There are magnifying apps available through which I am checking the pictures.” Sarkar has seen close to 150 patients this way, using virtual wallets to collect fees.

He admits that with tests like telemetry, biometry and funduscopy not being done at his clinic, treatment was proving difficult in many cases. “This morning, someone called me to complain that he could not see in the left eye. On checking him on screen, I could make out that he needed a funduscopy. So I told him to look for places which are doing it,” said Sarkar.

Back in the day, Chel would look down on tele-medicine but now there is no other way out. “Patients get some confidence seeing the doctor, even if over video call,” he says. Chel has left it up to patients to pay him or not in such cases.

Wali says the medium has its challenges. “If the patient’s phone isn’t a high end one, the pictures they send of the problem aren’t clear,” he says.

Panda is prescribing medicines over video calls but is backing out in severe cases. “Some cases cannot be treated arbitrarily. I’m forced to refuse such patients. I’m asking them to try their luck in big hospitals that may have the infrastructure to sanitise their chambers,” he says.

Rahman Mukherjee says tele-medicine juggles with many variables. “Even if a patient has a blood pressure machine at home, does he know how to use it properly? Is the machine working properly?” she asks. “As for online payment, rural folk and the elderly are not familiar with the system.”

Bhattacharya is asking patients to download health apps that check their pressure, pulse and oxygen saturation. “The apps are reasonably accurate, at least under such extreme conditions. If patients have wear-on bands that indicate these levels I’m asking them to use them too.”

Before reopening clinics

On Sunday dentist Dr Roy reopened his clinic, equipped with thermal guns and sanitisers. He himself is treating patients wearing PPE, face shields, N95 masks, shoe covers and protection goggles. “We cannot use the AC now and so I’m getting bathed in sweat under all this equipment,” says the CD Block resident. “It’s too risky to use aerosol-generating equipment now so tooth filling, scaling etc are out of the question. Only extraction and pain management is on.”

Dr Papiya Dutta has roped in two different agencies to sanitise her CK Block chamber every week. “I’m seeing one-tenth of the patients I would before. The rest I’m advising over phone. Even the patients coming in are being asked to wait for their turn in their cars,” she says.

Sharmishtha Ghosh of CD Block is making patients sit behind a curtain while narrating their case history. “I’m calling them in for examination, after which I’m asking them to sit outside so I can write out the prescription. I’m wearing a mask but not gloves as they are ruining my handwriting,” she says.

Panda plans to open his chamber in a fortnight but he will make patients sign a form beforehand, declaring that no one in their family has Covid symptoms.

CD Block dentist Santanu Roy examines a patient wearing PPE, gloves and mask that he had to arrange before reopening his clinic Sourced by the Telegraph

New Town model

Faced with the plight of residents, a residents’ body in New Town, called New Town Forum & News, has created a panel of doctors who are local residents and, more importantly, who are willing to attend to calls from patients. Of them, Bibek Panda has been the most active. “I have attended to 30 to 40 calls ever since the lockdown started. The calls invariably come late in the evening and are mostly from senior citizens who have hurt themselves or their spouse has been hurt by falling and they needed stitches,” said Panda.

A resident of Rail Vihar, he picks up an assistant from near Tata Memorial Center and sets off. “I cannot do a stitch alone,” he says. Another couple of calls has been for catheter blocks. Panda is aware that many doctors are refusing to meet patients, leave alone see them at home. “Someone has to go.” He attends to patients in a three-ply mask and gloves. “I do have PPE in the car. NKDA gave me two. So far I have used a PPE just once. I ask before going whether the patient has any Covid-19 symptoms.”

“NKDA has also asked us to prepare a database of doctors in each block. There are about 20 doctors on an average in a New Town block, of which barely one or two are stepping out on call. The rest stay cooped up, often not revealing their professional identity to even their next-door neighbour. They have their reasons as people tend to call them for even cough and cold or to check their blood pressure at night. If they refuse to attend, they become villains,” said Ankur Roy Choudhury, a member of the forum.

“Even as we draw up the list of doctors, the majority are requesting not to pass on their contact to NKDA,” he added.

In the name of Hippocrates

Rupa Ghosh says her AB Block neighbours have been asking her not to let in patients during the pandemic but she has shut them up saying this is what she became a doctor for.

Bhattacharya feels that such narrow-minded behaviour by the society is a stark contrast to a few Sundays ago when they loudly clanged on steel plates to thank doctors for their services.

Sharmishtha Ghosh has turned a deaf ear to her family and friends and not stopped working for even a day during the lockdown. “Previously I would return home at midnight but these days it is so deserted at night that I’m returning by 10.30pm,” she says.

How she returns home is a saga. Usually her son drives her to and from her chambers at Ultadanga and Maniktala but if he has office work, she happily hitch-hikes. “If I can get a rickshaw till Bengal Chemicals (and Pharmaceuticals), I walk the remaining 5km,” says the 60-year-old. “Sometimes I take lifts from bike riders, the Maniktala police sometimes drops me back till Labony and from there I walk home till CD Block…”

“When graduating medical college 30 years ago I had taken the Hippocratic Oath and it is my duty to serve the sick without thinking of myself. Besides, I believe fortune favours the brave,” she says.

Dentist Panda’s wife Namrata Dhar Choudhury is a doctor at a government facility in Diamond Harbour and she has been hiring a driver to ferry her to work. “My friend’s cousin passed away during the lockdown when they couldn’t find a doctor and I find this very sad. My parents are doctors too and none of us can imagine refusing patients in need,” says the lady who lives near City Centre 2.

Animal kingdom

The situation is just as bleak in the animal kingdom.

Back in the day Cats n Dogs pet clinic in CJ Block had three vets coming. “Not one of them has come for one day during the lockdown,” says Arijit Mukherjee, who runs the centre. “It’s been so difficult managing without vets. There was a complicated pregnancy of a Labrador that had to be performed by a para-vet in the absence of a trained professional. Anything could have gone wrong.”

Vet Krishanu Ghosh started online consultations from the first week of April and says it is working out so well that he shall continue it even after lockdown. “I’ve got calls from Pune and Bhopal too,” he says.

He has recently resumed sitting at New Town’s Animel Planet once a week. “We are taking bookings of no more than eight patients to avoid crowding but somehow double the number are landing up,” he says. Krishanu has postponed vaccines of adult dogs for now and is giving shots to puppies alone.

A few customers are backing out upon learning that the vet is charging Rs 300 for the Zoom video call consultancy but he reasons that this is his bread and butter. “The fee is less than face-to-face consultation and since they would have paid for the latter anyway, then why not this?