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Wednesday, April 29, 2020

Chp 810. ZMC CoVid-19 warriors

Today is Day 36 of the Total Lockdown in India, and Day 39 of a Lockdown in Mizoram.

Today is also 36 days since Mizoram had its first CoVid-19 positive patient, and fortunately for us, there had been no other new cases within Mizoram since then, from a total of 153 cases tested so far as of 28th April 2020.

In fact, our lone positive patient tested negative for the first time 2 days ago, and this could soon pave the way for a CoVid-19 free Mizoram, if things continue the same way.

As I have mentioned in my earlier blog posts, even before PM Modi announced the national lockdown, Mizoram had been taking tremendous steps in preventing the spread of this pandemic. The Village and Local Level Task Force at every locality helped in flattening the curve, not just in terms of maintaining the curfew but also in distributing essential items to all those who are in need. Various people have stepped up and donated vegetables or volunteered to stitch PPE's, while our police forces and brave youth volunteers are sleeping in shabby outposts guarding our borders.

I even talked about what it's like to visit a hospital during this lockdown period in my previous update. People were extremely vigilant and careful at Civil Hospital Aizawl. To enter the gate, you have to compulsorily wear a face mask, practice social distancing at all times, wash hands and sanitize them before entering any department, and the number of inpatients are kept at a minimum, like how my cousin who had a major knee operation was discharged in just 2 days.

And Civil Hospital Aizawl is a non-CoVid-19 hospital.

What about a CoVid-19 hospital? What is life like there? Is it any different from the other hospitals across Mizoram?

In this post, I would like to take you through what goes on at ZMC Hospital, Falkawn, which is the official hospital designated to treat all CoVid-19 patients in Mizoram. Here are some of the brave doctors of ZMC hospital who are currently battling CoVid-19 for us.

First and foremost, perhaps the biggest difference between the medical staff of ZMC and other hospitals is that, the ZMC staff do not have the luxury of going back to their cozy, comfortable homes after a long, hard day at work. Protocol commands that they live within the hospital itself, with no physical contact with the outside world except new incoming patients, for as long as this battle may rage.

That is why I call them true warriors. People who are willing to give up everything they have in the line of duty. Reminiscence of the Coliseum days of ancient Rome, when a gladiator would salute the emperor with "Ave Caesar morituri te salutant!" which means "Hail Emperor, those who are about to die, salute you!"

[A painting by Jean-Léon Gérôme, 1859]

These selected few, from the doctors and nurses right down to the Group D personnel, are our modern day gladiators, the relentless samurais, the swashbuckling knight in shining armour, and their weapon of choice is not an AK-47 or a Valyrian Steel sword, but their knowledge in Science and Medicine.

Today is also 36 days since my cousin Dr. VL Hruaii, or "Mash" as we lovingly call her, left our colony to fight this invisible enemy at ZMC hospital. I miss hearing her banshee shrill laughter resonate from her bedroom into mine, or how she would drop into our house on her way back from her clinic just to talk about how much she loves Jon Bon Jovi, for the millionth time. :D

[Our recent family photo with Mash]

By the way, I just want to point out that no sensitive or confidential information had been shared with me about ZMC hospital or the CoVid-19 patient. This dedicated team reports directly to the Director and Health Minister of Mizoram, and they're not even allowed to discuss their ongoing case with their doctor-friends or the medical fraternity outside ZMC hospital.

I know the boundaries of what can and cannot be disclosed in public, and in this post, I just want to take you all through what these people go through every day.

First up, the CoVid-19 doctors of ZMC are divided into different teams. There are those who handle the confirmed cases, and these include both the Isolation and ICU wards. The other teams handle the high-risk, low-risk and screening wards, and they also manage the incoming suspected cases, check their history and send out samples for testing.

Doctors of a particular team can only treat patients belonging to their jurisdiction. For example, Mash is a part of the team that is currently treating our lone CoVid-19 patient. Doctors from other teams cannot come and treat him, and likewise, Mash cannot go and treat patients in the other wards.

When it comes to "rounds", since there is only one positive patient so far, all the doctors who are handling his case do not visit him at the same time. This guarantees that the patient is continuously visited by one of the doctors within a good interval of time, and that he is also kept accompanied and engaged in a friendly conversation from time to time.

To visit the patient, the doctors must first change into their protective gear in a "donning area", where they put on their scrubs and wear their PPE on top of that. The PPE comes in a package, and each package consists of a jumper type suit with a hood, shoe cover, goggles, and 2 pairs of gloves, along with a separate N95 mask. Each piece must be worn in a specific order.

They had been thoroughly trained on how to wear the PPE outfit on their own, and they must take utmost care in doing so because they are entering the eye of the storm after that. Consider it like a parachute jump from a plane. You better make sure you are thoroughly trained in how to wear a parachute and deploy it properly before jumping, otherwise... toodles.

Once every PPE piece is in place, they enter the ICU and carry on with their business of checking the patient or conducting tests or any other medical procedures.

After they are done with their visit, they say goodbye to the patient and then go to a "doffing area" where they slowly remove each PPE piece one by one. Again, there is a specific order to follow while doing that. Extreme care must be taken to ensure that they do not touch any of the exterior parts of the suit, mask, gloves, shoe cover etc., as they are now considered to be contaminated.

Try to imagine yourself removing your clothes without touching the outer layer! It seems easy at first, until I actually tried it out myself, and it is hard AF. And that is just my pyjamas and t-shirt I'm talking about, these doctors have to remove the whole PPE gown, hood, shoe cover, gloves and goggles that way.

And oh, not to forget, they must sanitize their hands after every step too!

It's like that time when you just got married and you're lying in bed excitedly waiting for your wife to join you but she's still busy removing all the jewelleries and make-ups in front of the mirror and then you finally fall off to sleep by the time she is done undressing... Well, it takes much longer than that for the doctors to undress, is what I'm trying to say :D Also, those are the experiences of my friends and I am still very much a bachelor :P

Once the doctors have undressed, they place the PPE pieces for disposal and enter the bathroom directly where they have to take a compulsory long hot shower. Washing their hair is a must as well. The clothes that they are going to wear after the shower are also already placed there in advance.

And that is what the doctors go through for every round they make. Other than the anaesthetist who must be on call next to the ICU room 24/7, the other doctors can go back to their quarters after their round and do normal human stuff again, like reading a novel, listening to music, watching Netflix, taking a nap, dreaming of a blogger etc...

The previous Director of ZMC had recently retired and his quarter was lying vacant, and so these CoVid-19 doctors are currently accommodated there.

They get their food (breakfast and dinner) delivered from the hospital mess to their quarter as they are not allowed to dine and mingle with the other hospital staff members.

One of the few times they can briefly come out from their isolated enclosure is to receive the many donations of vegetables, fruits, beverages and other items from various people and localities in Mizoram.

My sister too regularly sends stuff for Mash whenever my uncle and aunt are parcelling stuff for her. Like here's the time she made Poha and chutney for Mash and her friends, which apparently the team really loves.

As Mash tells me, the nurses are actually the real heroes, because they apparently have it much worse than the doctors. While the doctors take like an hour or so approximately to do their work in PPE suit and be done with it, the nurses have to remain in their PPE suits for 8-12 straight hours, and they cannot even pee or drink water during that entire shift!

Luckily for me, my dear friend HT Lalbiakhlupuii, more famously known as "Hmar Nula" in the online world, slayer of those who try to kill her in the gaming world or win her heart in the real world, was one of the nurses activated at the CoVid-19 ICU ward of ZMC hospital.

"Was" because she fell ill during her posting and after serving her quarantine period, she was tested and cleared of CoVid-19, after which she was relieved of her duties and ordered to go home. In fact tonight she'll be rejoining her team at ZMC again. Thanks to her short break, she was able to feed me enough information on what the nurses posted at ZMC go through.

[Hmar Nula packing her bags to rejoin the ZMC crew tonight]

In preparation of transforming ZMC into a fully dedicated CoVid-19 hospital, the nurses were already involved in preparing the ICU and other wards long before the arrival of the first CoVid-19 patient. All existing inpatients at ZMC were slowly transferred one by one to other hospitals. Even the ones at their ICUs were transferred in an ambulance to the ICU of other hospitals in Aizawl, accompanied by a nurse and wardboy or female attendant.

That was a bittersweet moment for most of the nurses, as they had to say goodbye to patients they had been taking care of for a long time, while at the same time sensing some sort of relief to see that those patients were not going to be near CoVid-19 patients.

The nurses too are divided into different teams, like the ICU team and Isolation team that directly deals with positive patients, and then there are the high risk team, low risk team, screening team and makeshift ICU team that deal with unconfirmed cases. And since some of them are dealing with a positive patient, the teams don't mingle with each other.

The nurses are supposed to work in three shifts - morning, evening and night of 8-hours each, but since there is only one positive patient as of today, they are currently functioning in two 12-hours shifts, so as to minimize the usage of their PPE stock.

In fact they are doing an absolutely great work in preserving their PPE stock. Here is how they typically function - Once a nurse has gone through the entire donning process of the PPE (the same procedure as the doctors mentioned above), she walks into the ICU to relieve the other nurse.

But first, they spend around an hour together, doing all the things that require two people to do, like shifting the patient and holding him while the other person scrubs him or change the bedsheet etc. Once all that is done, the outgoing nurse then collects all the garbage and waste etc. for disposal.

Even though cleaning the room and collection of garbage and waste everyday is the responsibility of the Group D team, since the cleaners have to wear complete PPE sets as well, the nurses are minimizing that usage by cleaning the room themselves, and so Group D comes in to clean the room around once in three days only, hence saving up on PPE's.

The outgoing nurse then disposes of not just the garbage and waste but other PPE suits left behind by the previous nurse or doctor. After that she also carefully removes her PPE step by step, taking care not to touch any exterior parts and then hops in to take a long hot shower.

Meanwhile, for the incoming nurse, the long wait of 8+ hours shift begins. 8+ hours without touching her mobile phone (gasp, I'll die), and without peeing or drinking water. She has to disinfect the entire medical equipments and room every hour as well.

I asked Hmar Nula what was the toughest part of her shift, was it the no-peeing rule or the no-drinking rule, and her response actually surprised me. She told me that all the nurses had been trained and were mentally prepared to go through that ordeal of no peeing and no drinking rule, and the one thing she hated the most was actually the goggles she had to wear, as they were not only extremely tight, giving her a headache, but if the goggles became foggy or there was a smudge inside, there was nothing they could do about it. And so they had to stare at a foggy smudged vision for 8+ straight hours!

Man, that is such torture! No wonder my cousin Mash hails them as the real heroes in this.

While the doctors are accommodated at the previous Director's quarter as mentioned above, the nurses have different accommodations. The ICU and Isolation team are accommodated at Mizoram College of Nursing hostel, situated a few kilometres away from ZMC.

The current students have all been sent home due to the lockdown, and so the entire building belongs to these two teams. While the ICU team resides on the third floor, the Isolation team is on the second floor.

There are around 10 rooms on each floor, with two beds in each room, and since each team consists of just six members, they have the freedom to occupy a room by themselves or share it with their colleague in case they are scared of the dark.

It is a typical hostel room, so there is just a fan and table apart from the two beds in each room. There is a small hall on each floor that the nurses use as a recreational room to play carroms, which is their only means of entertainment during their spare time.

Food (breakfast and dinner) is also prepared by the Group D staff, and the nurses have their meals in the hostel before and after their shift at the hospital.

The food is also well provided, and according to Hmar Nula, they get eggs on every meal, along with an alternate choice of fruits or milk in the afternoons.

The Grade D staff who work behind the scene in all this, currently reside in the hospital annex. Just like the teams of doctors and nurses, they too have a dedicated CoVid-19 team as well.

Every now and then, just like the doctors, these nurses too would receive free snacks and goodies from concerned citizens in the city. Like this was the time "Roll and Wrap" came and gave them free pizzas, rolls and fries :)

Seriously, if you are reading this blog post and you are a food related business owner in Aizawl, please by all means go and give these awesome doctors and nurses more stuff to eat! It is the least we can do for our brave warriors. I'm looking at you, my dear friend and classmate Hmingthansanga of Pemarin, you better go and give these wonderful souls some of your awesome restaurant food. :)

Some of my friends have already stepped up as well. Like for example, one of my dearest friends from Bangalore days, Mami Kholhring, a renowned fashion designer, contacted me immediately when she heard that my cousin was one of the doctors assigned to treat CoVid-19 patients in Mizoram.

Yup, lucky Mash! Mami Kolhring will be making a wedding gown for her, on the house! So once this whole pandemic gets over, IF it gets over, and we are all alive and well by the Grace of God, then cousin Mash is all set up to get married! The only thing missing now is... the groom! :D

In case you haven't heard of my friend Mami Kholhring, here are some of her designs...

So great to know cousin Mash will be wearing one of those dresses above :)

As her idol Jon Bon Jovi once sang, "It's is my life", let us all remember to take proper care of our lives during these difficult times, and continue to abide by the law and practice social distancing.

Truth be told, I know many of us in Mizoram are starting to treat this pandemic lightly, probably because of no new cases since the first day, but know that the threat is still very much out there. We may be a disciplined community bonded together by a chain of trust, but also remember that a chain is only as strong as its weakest link.

So, let us continue to pray for our good doctors and nurses of ZMC as they continue to risk their lives for us in this battle against CoVid-19. God bless them all.

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