Behind the Curtain
By Upeksha Gunatilake
Long before the COVID-19 crisis, Samson*, now aged 93, underwent spinal surgery after suffering a back injury.
Several years later, he developed scoliosis, causing his upper body to curve sideways. Scoliosis if left untreated, can lead to severe back pains. If the curvature worsens, it can cause lung and heart damage as well.
As the scoliosis worsened, Samson became uncomfortable, and soon it became painful for him to carry on his daily activities.
So, he consulted Dr.Mervin*, a physiotherapist working at a leading hospital in Sri Lanka, for private home-visit sessions.
“After examining him, I realised that he needed regular physiotherapy sessions of at least three times per week to keep his condition in check,” said Dr. Mervin.
On 27 January 2020, the first Coronavirus case was identified in Sri Lanka (a 44-year-old Chinese woman), and nationwide curfew was implemented on 20 March 2020, which later extended to strict lockdowns.
As the number of confirmed cases soared, the authorities prioritised treating COVID-19 patients and containing the spread of the virus.
However, this meant that patients such as Samson, who require long-term regular treatments via home visits or clinics due to illness or disability, are pushed backstage.
This makes it difficult for them to access proper, timely treatment in light of the added restrictions and risks.
The risk for doctors
Dr. Mervin had been providing home-visit physiotherapy services within Colombo for over 20 years.
However, after the pandemic, he states that the risk of contamination was not his only concern.
The instructions given by the Ministry of Health in response to the first and second waves of COVID-19 make no mention of the conduct for doctors such as Dr. Mervin who work outside of hospital bounds as well.
“How am I supposed to explain myself if a cop stops me? He’d only check the hospital I work at, compare it with my home address and reprimand me for being off-route,” said Dr. Mervin, voicing his concerns.
“If I say that I am home-visiting, the police would reprimand me for doing so. I have nothing to show that these patients need regular care.”
Dr. Mervin continues his home-visits, taking care not to get stopped by the Police.
“I can’t simply stop treating some patients,” he added, explaining that for some of his bedridden patients, not receiving regular care could be life-threatening.
Patients receiving long-term treatments via clinics face a similar plight. Anthony*, for instance, visits a clinic regularly to monitor the state of his dilated cardiomyopathy.
This progressive disease of the heart musclemust be monitored to ensure that it is not worsening.
However, with the risks of contamination at clinics, Anthony could not receive his regular treatments.
“There was a tablet I took which decreased the thickness of blood. But I had to get a monthly medical report to monitor the dosage closely,” said Anthony, explaining how being unable to safely visit regular clinic sessions affected his health.
“Since I couldn’t monitor the dosage, I had to stop taking the tablets.” An increase in blood thickness can lead to higher blood pressure which could place Anthony in critical conditions.
The cost of the damage
A few weeks of missed therapy sessions not only undo months of recovery but also puts patients who need long-term care in an extremely painful condition.
Moreover, the costs of rectifying the damage caused by delays in treatment may be difficult for such persons to bear.
For example, Mia* a congenitally disabled young girl, wears specialised footwear to assist her mobility.
These must be maintained monthly to keep the wear and tear in check for which she visits a clinic.
During the lockdowns in the first wave of COVID-19 in the country, patients could not travel to the clinic, and it had to be shut down.
When the clinic reopened, and travel restrictions eased, her footwear was worn out to the point that it had to be replaced, costing Rs 8,000 to an otherwise free clinic visit.
Also, wearing improper footwear had undone a year’s worth of improvement in her foot structure.
Common regional issue
Most countries in low and middle-income levels, similar to Sri Lanka, in the South Asian region imposed broad restrictive measures in March 2020, a practice that continues to date.
For instance, on 1 July, Bangladesh imposed a strict lockdown, refraining people from leaving their homes except for emergencies or buying essentials.
These restrictions take little notice of the needs of the patients who need long-term care within the country.
A report commissioned by UNICEF and implemented by SickKids evaluatedsuch indirect effects of the COVID-19 pandemic and restrictions in South Asia.
It identified that governments of the South Asian region would need to balance the need to control the pandemic, along with the impact of critical primary health and other services on the health and wellbeing of the most vulnerable of their populations.
Response from medical officials
Two months after the lockdowns during the first wave, health authorities gave numbers through which regular outpatients could request delivery of their medicine.
This was, to a great extent, a relief for patients whose conditions did not have to be closely monitored.
However, it was hardly useful for those who required more attentive care.
Kahatuduwa Medical Officer of Health (MOH) Dr. Danuka Padmaraja stated, in response to questions on this matter, that hospitals are taking every measure possible to ensure the safety of clients attending clinics.
“I understand that catering to the majority in trying to contain this virus can lead to unfairness to some persons,” he said, acknowledging the difficulties faced by patients receiving home-visit treatments.
However, he is hopeful that with widespread vaccinations, it would be possible to allow home-visits with appropriate safety guidelines in place.
*Names have been changed for privacy concerns.
(The writer is a student from Sri Lanka College of Journalism)