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Mortality Risk Up Many Fold If Op Done Within 6 Weeks: Study
DurgeshNandan.Jha@timesgroup.com
New Delhi:14.03.2021
It’s better to delay surgery, except for emergencies, if you have been diagnosed with Covid-19 recently. A new study shows that people who undergo surgery within six weeks of being Covid-positive are more than two-and-a-half times more likely to pass away compared with those who don’t have the infection.
The risk goes up further if the time of surgery is closer to the diagnosis of Covid-19, the study published in medical journal Anaesthesia says. The analysis was based on over 1.4 lakh surgeries conducted in 1,674 hospitals in 116 countries. This included 56 hospitals from India, including All India Institute of Medical Sciences.
Dr Shilpa Sharma, who led the study from AIIMS, told TOI, “While it is a known fact that SARS-CoV-2 infection during surgery increases the mortality risk, this is the first time a study has given evidence about the least amount of time delay in surgeries that would optimise final outcomes.”
“In all, 31 doctors from AIIMS participated in the study. We analysed deaths and pulmonary complications recorded within 30 days in patients who underwent surgery in departments such as paediatric, orthopaedics, cardiothoracic and general surgery and neurosurgery. It showed that patients with current and past history of Covid-19 were at higher risk of postsurgery complications and even death,” added Sharma.
The doctor said that this could be because Covid-19 causes systemic inflammation. “The infection affects the lungs. Administering anaesthesia isn’t easy. Also, most such patients have low immunity and the risk of postoperative infection is high. The decision to delay surgery needs to be balanced by the disease risk to the patient,” she added.
At AIIMS, RT-PCR and CBNAAT tests are carried out routinely to screen all surgical patients. Surgery is delayed for those who test positive, wherever possible, till the patients recover.
The study showed that time of surgery from the diagnosis of Covid-19 was inversely proportional to the risk of death and even pulmonary complications.
Of the 1,40,231 patients who underwent surgery at different hospitals during the study period (October 2020), 3,127 were diagnosed with current or recent history of Covid-19.
The 30-day post-operative mortality in patients who underwent surgery in 0-2 weeks of diagnosis of Covid-19 was 9.1%, 6.9% within 3-4 weeks of the infection, 5.5% within 5-6 weeks of contracting Covid-19, and 2% in those who were operated upon after seven weeks of being infected with the virus.
The doctors who charge less than what a cup of tea costs
Sharmila.Ganesan@timesgroup.com
Low-cost clinics have been set up near railway stations by Dr Rahul Ghule
On Independence Day last year, when Covid-19 was at its peak, Dr Vishal Wani, an “Ayush doctor” attached to one of Mumbai’s 25 railway-station-adjacent ‘one-rupee clinics’, was having lunch when he got an emergency call from the station manager about a “seven or eight month” pregnant woman in a Delhi-bound train with “severe stomach ache”. Suspecting labour pains, Wani had called gynaecologists who shrivelled away from the scene for fear of infection with the result that he found himself sitting on the bloodsoaked floor of the waiting room of Panvel railway station in Navi Mumbai with neither gloves nor mask delivering a baby girl.
To rewind a bit though, even without the compulsions of emergency deliveries, daily city life throws enough drama his way. Diabetes patients have flopped down unconscious right in front of the dispensary, after panting down the stairs of the escalator-free station. Some people have stepped in with dead scorpions in their hand as proof of the ticketless traveller that just bit them in the long-distance train. On various occasions, Wani has even entered crowded trains to check the BP of palpitating heart patients. And there was even the October night of 2019 when a private hospital nearby refused to admit a pregnant woman whose haemoglobin was low and Wani had to help her deliver on a platform bench.
Wani works for a private organisation that runs these one-rupee clinics across the city. Helmed by Dr Rahul Ghule, who dreamed up the affordable healthcare model when he was working as a medical officer at J J Hospital in Mumbai, the organisation has treated over 2 lakh patients so far.
The clinics were born after fate disrupted his life in 2014. “My parents met with a road accident but there was no hospital on the highway. My mother suffered a brain haemorrhage. She was unable to speak or move for nine months,” recalls Ghule, who decided to use his shock as fuel to apply for a loan of Rs 25 lakh to open charitable clinics that charged a token fee of one rupee at Mumbai’s railway stations, where around 10 people die every day in accidents.
Through subsidised diagnostic tests, including 300-rupee lipid profiles, 50-rupee glucose tests and cheaper MRIS, CT scans, and pharmacies, his clinics not only sustain themselves but also attract the ire of neighbourhood physicians who feel compelled by competition to lower their price. “The reality of the medical field is that 40% of the diagnostic fee goes to doctors as referral kickbacks,” says Ghule, not excluding himself. His real commission, though, he says, is “immense satisfaction” even though some patients don’t even pay the token fee, while some return to pay with interest. In fact, often, homeopath Wani’s friends wonder why he puts himself through such grave ordeals as pulling a baby out in the middle of a pandemic while working at a clinic in which the “fee costs less than the prescription sheet”. His reply is simple: “I enjoy it.”
Sumati.Yengkhom@timesgroup.com
Sushovan Banerjee says that for his own expenses, he relies on his UK savings
At 82 and battling a kidney ailment, Dr Sushovan Banerjee continues to tend to poor patients in and around Bolpur with the same fervour for the past 58 years, charging only one rupee as his fee since his return from the UK. Popularly known as ‘Ek Takar Doctor’ (one-rupee doctor), the Padma Shri awardee says he will go on serving poor patients as long as he can. “I draw my energy from tending to these poor patients,” he says.
An MBBS graduate from R G Kar Medical College, and a gold medallist in pathology from Calcutta University, Banerjee could have settled in London comfortably, where he worked as a senior registrar in a hospital after completing his diploma in haematology. But he chose to return to his roots in 1963 and opened his one rupee clinic. “My patients should not feel that they are taking an obligation from me. That is why I charge a token amount. I lead a simple life and the sum that I had saved during my stint in the UK, which I have kept as fixed deposit, is enough for my expenses,” says the octogenarian, whose clinic opens at 9am sharp every day even though he undergoes dialysis twice a week. On those two days, he shows up at the clinic after returning from the hospital and attends to around 30 patients as opposed to the daily average of 100.
Even during the lockdown, Banerjee had kept his clinic open on all days. In fact he got numerous patients with Covid-19 symptoms who were advised immediate testing. Many of them tested positive but he was fortunate to stay healthy. “My daughter and son-in-law (both doctors) were concerned because of my age. But I didn’t want to shut the doors on my patients.”
Jaideep.Deogharia@timesgroup.com
The only time Dr S P Mukherjee hiked fees is during the pandemic
In the heart of Ranchi’s busy Lalpur square, a small old-time building distracts because of the large queue standing outside. The interior is also packed with patients waiting for a sharply-dressed octogenarian doctor about whom the prosperous tea seller nearby says in gratitude: “Doctor saab charges less than me.”
Padma Shri Dr S P Mukherjee, who charges patients Rs 5 per consultation, does not remember any single trigger that prompted him to start his charitable service back in 1957. However, the doctor — who never increased his fee in the last 50 years he has been consulting — admits that the pandemic forced him to increase his fee recently to Rs 50 so that he could sanitise his chamber, and offer hand sanitisers and face masks to the patients. “For those who cannot pay, my consultation and medicines are for free,” says the doctor who thanks his stars for being safe from infection “even after seeing 50 patients every day.”
Has he come across patients with the dreaded virus during the last one year? “Dozens. I advised them to get tested. I have also got patients who came with other complaints after being cured of Covid-19 and got treated here. We cannot shy away from any disease when people are suffering,” says Mukherjee.
He was once asked by Amitabh Bachchan on the show Kaun Banega Crorepati whether his friends ever objected to his low fee. Mukherjee deflected the question by asking all doctors to treat at least one patient daily for free.
Milton.lawrence@timesgroup.com
S C Shankregowda
of Mandya
When Vinutha, a Mandya health worker, got a skin problem she decided to step into the ever-crowded home of the famous local ‘fiverupee-doctor’ S C Shankregowda, the one whose “magical” hands work the fields in the morning and prescribe skin medicines during the rest of the day. A week later, when her face cleared up, Vinutha realised that it wasn’t just the nominal fee that drives around 300 people towards the fiverupee doctor every day.
Whether he is tilling the farmland in a lungi or walking on the streets with his family, Shankregowda — who even contested the Assembly polls in the ‘sugar district’ of Mandya as an independent candidate — commands instant respect among the people of Bandi Gowda Layout. They join their hands and say ‘namaste doctor’ when they see him and trust him with everything from itching sensations to sexual health issues.
It has been 38 years since Shankregowda, an alumnus of Kasturba Medical college, Manipal, opened his five-rupee clinic in Mandya soon after his diploma in 1982. Unlike others, he hears the problems of patients in groups — men and women separately — and prescribes low-cost medicines. He runs a clinic without assistants and never handles money. Patients simply place the consultation fee of Rs 5 on the table or don’t.
Ashok.Pradhan@timesgroup.com
Shankar Ramchandani has a full-time job at the medical college but he takes out time in the mornings and evenings for destitute patients
Even though Odisha’s Sambalpur city has a government-run college called Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR) that offers completely free treatment, 38-year-old Shankar Ramchandani’s newly-born ‘onerupee’ clinic is doing rather well for various reasons. “If I go to VIMSAR, it will almost be a one-day affair because of the queues. I will lose my entire day’s earnings of around Rs 200. But I can just walk into Ramchandani sir’s clinic after work,” says Bishnu Goura, a 68-year-old rickshaw puller who visited the clinic last week for his knee pain.
Ramchandani works in VIMSAR as an assistant professor. He runs the clinic for an hour before and an hour after his duty in the medical college. “It runs well beyond 8pm most of the days since it is difficult to see 30 to 40 patients in an hour,” says Ramchandani, whose late father Brahmanand wanted him to set up a nursing home and serve the poor. “But since setting up a nursing home requires a lot of investment, I decided to open a clinic instead,” he says, adding that even Rs 10 is a big amount for the poor, destitute, elderly, differently-abled and underprivileged patients he attends to.
“The destitute tend to be apprehensive of big hospitals. They easily walk in here,” says Ramchandani, who had earlier drawn media attention when he carried a leprosy patient in his arms and dropped him in his house in 2019. He also shifted a Covid-19 patient to VIMSAR in his own car in October without worrying about the virus.
Ramchandani — whose wife Sikha Ramchandani, a dental surgeon, also helps out — hopes to start a mobile medical unit to take medical care to inaccessible places one day. Till then, he’s happy making treatment accessible to the poor.
