The Bhutanese Leading the way.
General doctors and nurses at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) are being trained in Intensive Care Unit (ICU) Management to handle any surge in the number of patients in ICU.
JDWNRH has divided its health staff into six teams. Each team consists of two doctors, two nurses, one X-Ray technician, a ward boy and a ward girl and a wet sweeper. Currently, Team Three is looking after the three COVID-19 patients.
The Medical Superintendent of JDWNRH, Dr Gosar Pemba, said the biggest challenge faced by the medical team is the discomfort caused by the full Personal Protection Equipment (PPE) suit that they have to wear throughout the shift. PPE restricts the body mobility and makes it difficult for the doctors to examine patients, like using their stethoscopes. Nurses have to wear full PPE suit for eight hours straight until their shift gets over.
The medical teams also worry about getting infected, Dr Gosar said. Another challenge is finding an effective treatment against the Novel Coronavirus. “This is a new disease, and as of yet, there is no standard treatment and so clinicians have to look up for so many other ways,” he added.
Doctors and nurses also do bundling of care, where they do their work at a time like giving injection, medicine, checking vitals and others. All the work is done in one shot as the more time one is exposed to a positive patient, the more is the chance of getting the infection, even with the PPE suit on.
Another purpose of bundling of care is to reduce the use of PPE. Currently, there are enough PPE to last for a month. However, the hospital is using PPE judiciously. A total of 11 health workers are looking after the three patients, and approximately 30 PPE suits per day are required. Sometimes less PPE suits are used in a day, as medical examinations like X-ray may not be required. In case there are more than 50 COVID-19 patients then the hospital would require approximately 1,300 sets of PPE, said Dr Gosar.
Food is provided for the three patients by the hospital, but sometimes, home food is allowed, said Dr Gosar. At the moment the number of patients is manageable. JDWNRH can comfortably manage less than 30 patients coming to the hospital. But if the number of case is more than 100 in day, then the hospital cannot manage, he added.
JDWNRH has the capacity to manage more than 50 patients, as only about 20 percent of them will be categorized as serious case. “The hospital can manage them and in other countries, patient with normal condition are kept in home quarantine, but in Bhutan, we are keeping them in isolation to prevent from spreading,” Dr Gosar said.
A search-capacity to increase the capacity of the hospital to respond to more patients has been developed in spite of the limited number of infrastructures. The government has already purchased extra ventilators and beds in order to meet such challenges.
Meanwhile, Team One who looked after the first COVID-19 case has returned back to work, and Team Two who looked after the partner of the index case will be discharged from quarantine this Sunday and will resume their work.
