GNRC Neurosurgeon Dr Navanil Barua spoke exclusively to The Sentinel Assam

Dr Navanil Barua, Director, Neurosurgeon, GNRC, Guwahati, spoke exclusively to The Sentinelassam.com on a range of issues starting from challenges being faced by the healthcare specialists, things that need fixing in the health sector and healthcare 2.0 post COVID. Here are the excerpts.

Sentinel Assam: We all know a vaccine or cure for COVID is yet to be found. In such a scenario, a large number of people coming in. As a doctor are you worried. Is there a cause of concern for the people at large.

Dr Navanil Barua: With so many people coming in, I would anticipate that at least few of them would be carrying the virus with them. And there could be asymptomatic carriers which is more dangerous than the symptomatic ones where you can know and segregate them and can be interned in hospitals but in case of asymptomatic, you cannot do anything except quarantine. We have been following the World Health Organisation standards for 14 day quarantine but we have had cases or have come across cases, patients who have shown symptoms or tested positive long after 14 days. This is definitively going to be important.

Second is, the challenge of accommodating so many people coming from outside. Yes, they are one of us. We have to accept them, whether we like them or not. We cannot abandon them. They too will have to accept the condition that we are a resource-constrained state, our health minister has done what is practically possible and he has also sounded a warning that facilities wont be good, they could be put up in schools where there could be only one or two toilets, not bathrooms as such. So this is also telling people indirectly that if you are comfortable where you are at present, be it Bengeluru, Mumbai, do not come for emotional reasons. Come if you are forced to due to economic reasons or any other reason if you are forced to come back, do come back, we will accept you but then usual precautions of COVID is the only way we can survive. That is hand wash, social distancing, masks and the usual care.

This whole emergency has exposed a lot of shortcomings in the healthcare sector, be it healthcare facilities or the overall healthcare infrastructure. What are the top five or top three things that you have noticed and your suggestions.

First and foremost, something that I have always been saying in my political commentaries. We have to stop giving freebies. Freebies are nothing but what politicians used to give from their pockets, now being resourced from the state government's exchequer. We do not want money to be spent on consumer goods being gifted to the voters. We should make it a point that the economy is made so strong that the ordinary voter is able to buy these consumer goods. Distributing mobile phones, cycles these are consumer goods. I would rather want the state government to spend on infrastructure. And infrastructure also means not just the building or the machines. It's the human resource which also needs to be very very actively promoted.

COVID has exposed a lot of things, for example we have always envied Gujarat as a very developed state. Yes, it is a very developed state speaking materialistically. It is spending thousand of crores to build a statue but when it came to the pandemic it lay exposed in its woefully inadequate medical facilities. People always thought that Assam has excellent medical facilities, we had created a lot of things, but look at the situation. When COVID came it was exposed very woefully. Sadly, our intensive care facilities, ventilators are so short. There is a huge shortage. So I would request, what is gone is gone. We cannot undo the past. But there is nothing stopping us from improving things in the future. Let us invest on infrastructure of all kinds, health infrastructure specially. When there are sick people, we must realise that Corona is not the only disease. You have diabetes, you have people dying of strokes, people dying of head injuries and so many other diseases. That means they also never got the facilities they deserved or the state government never created the facilities. So, we have to carry it forward from here. Sarusajai temporary quarantine facility is not the answer. God forbid if there is another disease, another pandemic we should be prepared with a hospital. Our engineers should be prepared to emulate China where they built a 10,000 bedded hospital in just one week. If Chinese can do it then why cant we Assamese do it, we should have this attitude.

Another point is, develop infrastructure in agriculture, in livestock production and everything. We need to be self-sufficient. This is the time we need to do away with the syndicates where the producer and the consumer gets direct access to each other because this has happened during the lockdown period. So, we need to capitalise on this and carry this forward. WE should focus on making Assam self sufficient and that Assam is able to export its surplus. Do not believe in all that nonsense that all those companies planning to move out of China is going to come and invest in Assam. No they are not going to do it just because we have 250MW of power. We do not have land and first of all we do not know if they are actually coming out of China or not and if they do they have a lot of other options like Phillipnes, Vietnam, Sri Lanka. Even Bangladesh is a better option than Assam. So, we must be realistic. Let us build our infrastructure of our own, be it media, be it electronics, be it anything we can do it here, that must be the real mantra. A white collar worker has mopped the floor and swept his home, let this be the habit, let us not be dependent on anything, lets use the experience of lockdown for future gain.

Though you might be directly involved but would like to hear from you your thoughts on the Rs 20 lakh crore economic package announced by Prime Minister Narendra Modi yesterday.

Actually the details are still awaited from Finance Minister Nirmala Sitharaman. I can give you my opinion on the totality of it. Rs 20,0000 crore is a huge amount. Its 10% of the GDP and roughly translates into 14,600 per person in India. And if I am not wrong, India's national budget is 30 lakh crore and the economic package is 20 lakh crore. So where is the money coming from. It should not be a political rhetoric. We all should know where is the money coming from. Eleven per cent of the revenue comes from car sales and the automobile sector contributes 11% to the revenue. Automobile sales has been zero in April. So a direct 11% shortfall in revenue and this is not going to pick up easily. The high revenue areas for the government are the consumer goods, the hospitality sector. This sector is totally dead. So where is this 20,0000 crores coming from.

Another thing which worries me is we are delving into our reserves and the economy was already bad before Corona. If we look at the economy even in the month of January, it was bad. So we are already in problem. Now the world is gradually becoming anti-China and we cannot expect China to sit idle. What if a war breaks out? Because for China, India is a sitting duck. What if a proxy war breaks out? Do we have the reserves needed to fund a crisis like war? This also must be kept in mind. I regret saying this but whatever, the Prime Minister said yesterday is not new in terms of he has not said these things in the past. Just improving sales of khadi is not a proof for going vocal for local. We also need to look at the track record of the Prime Minister. Its been six years and after six years you have to still wonder about these things, still talk about these things, hum karenga, we will achieve, I will take it with a pinch of salt but I will not be totally negative, I am still hopeful because the situation is different compared to the past. I hope and I believe that the Prime Minister means business and the government and the whole machinery will not see this 20 lakh crore as an opportunity for corruption but as an opportunity for nation building and if that happens from the Prime Minister to the lowest babu I think india can pull through but we must be aware about where this money is coming from and then only we will know that this is not just a rhetoric and is actually going to translate into a lot of things and I borrowed a leaf from the prime minister's page that is be vocal for local, we have been saying this, we have been fighting for local in everything for years now so let us all do this and another thing which I want to express is do not get deceived by the current demand for the Indian pharmaceuticals in the world. Now the world is at the mercy of the disease, so the quality consciousness is not there. This is not going to remain forever. Secondly, the things which we export goes to the west, now the west does not have a strong economy, will they continue to buy our things. For example, Iran buys a lot of Assam tea, will they continue to buy. All these things are going to impact. Our export market is also going to shrink. SO how are we going to manage that? Are we going to expand our internal market, which is also going to be difficult because there is going to be huge job loss, about 40% job loss in the country. SO the economy is also going to go down in the consumer sector. So what are the answers for all these, I am not an economist, I just gathered these from different sources. I expect economists to make a good roadmap and not just indulge in plain simple political rhetoric.

Is there a way we can beat Coronavirus.

We have to change out mindset. We are in a state of panic. Panic is not going to solve our problems. So let us be more pragmatic. Let us understand that COVID-19 is a kind of flu and we have all seen flus existing everywhere. What we do not know is that people die of flu as well, the common influenza I m referring to. So let us learn to live with COVID like we have learnt to live with flu, swine fever, bird fever and Japanese Encephalitis. How do we take care of Japanese Encephalitis? We take care that we do not get mosquito bites. Similarly COVID is going to stay here, it is not going to go away soon, but then our lives also has to go on. So the panic has to now change into precautions and protections. The precautions we all know – hand wash, keep washing your hands, maintain social distance, wear masks. Do not unnecessarily go out. Stay home. These have to be incorporated in our lifestyle. Make it a habit to use the mask in public like the Japanese.

The emphasis on healthcare is going to change. From curative healthcare we are going to into a phase of preventive healthcare. Social, preventive and community medicine which has always been relegated to secondary level will become as important as medicine and surgery. This is my appeal to the government that please invest in preventive healthcare so that we understand and stay safe not just from COVID but many other diseases.

There is a programme called Integrated Disease Surveillance Programme (IDSP) now we are doing surveillance of covid separately and IDSP separately. Maybe we can integrate both and have effective surveillance.

Will the entire healthcare consultation move to online. Will we see a paradigm shift in the doctor-patient consultaions.

Assam government has already started the e-Sanjeevani portal and the doctors are quite busy. I have to proudly say that GNRC, the hospital where I work in, was the first to moot this idea. This is going to be the trend world over where patients would access the doctors online and also there will a need for paramedical workers in the periphery to assist doctor who could do some basic examinations and assist the doctors. The legalities of it needs to be sorted now. This is yet to be done. The Medical Council of India has not yet really allowed online consultation in the form of Whatsapp or social media. These have to be sorted out very soon. Telemedicine is here to stay but it will not be free. Telemedicine will be the thing of the future.

What about patients in the rural areas. How will they access healthcare facilities. How will their consultations happen.

The doctor will need someone in the rural areas. For example, we have our system of Swasthya Mitras. Government has the system of ASHA workers. They need to be trained how to access telemedicine. All villagers do not have smart phones or phones. The health workers can have a mobile device and have a plan where they pick maybe 10 houses and connect these 10 houses to the doctor through the mobile device and a differemtial payment system can be worked out wherein urban centres pay more and rural areas are either free or subsidized.

When you hear about assaults on doctors, on Corona warriors, what crosses your mind.

I cannot say that society has been negative all around. Yes there has been cases where people were not even allowed to cremate, that was very bad and very sad. People who did this must introspect and the government machinery must visit them and ask them what was their problem, why did they do what they did. Let them at least repent their actions. In both the case it was a Christian cemetery, so the church leaders must ask their members why they did what was done. The lack of facilities for the doctors, I have always said that this is a war, COVID is a war. When there is an actual war, the soldiers are given preferential treatment in case they are injured or when they die, they are not left in civil facilities. So why cant the same be translated to COVID warriors by which I mean not just the doctors because we get to know about the problems faced by the doctors because they are more highlighted, but what about the cleaners, the ward boys, the nurses, we do not know much about what is happening to them because their stories are getting highlighted in general media or social media. The government must make sure that we have separate facilities when a COVID warrior falls sick while treating COVID, he or she must get special facilities. A system has to be created. Again the instances of doctors not allowed to return back to their appartments. People doing such things should hang their heads in shame. They are no different from the uneducated people who indulge in witch hunting in places like Assam. 

Also Read: Assam COVID-19 Positive Cases Rise to 79; Fifteen more test Positive