By Shaurya Kshatri
Kathmandu, June 30: Having a beloved family member hospitalised in COVID ICU can be extremely stressful. Families are suddenly immersed in emotional strain -- constantly oscillating between fear and hope. The situation is even worse during a pandemic when hospitals adopt restrictive policies to limit visitors from seeing their loved ones.
From an infection control perspective, the hospitals’ goal to minimise transmission is understandable, but emotionally, it seems cruel and inhumane.
H. Humagain (Name shortened for protecting the patient’s identity) a 46-year-old restaurateur from Kailali, Dhangadhi spent nine days in Kathmandu Medical College Sinamangal’s ICU away from his family. He was rushed to the hospital on May 4 from his hometown in Kailali after being diagnosed with pneumonia. His oxygen saturation level had dangerously dropped down to 32 per cent. Humagain was immediately placed under a noninvasive ventilator (BiPap) at 60 litre of oxygen per minute.
“I look back to those days in the ICU with utter fear and horror. There were other patients like me huddled in their beds hanging on to their dear lives. Death and illnesses were all around but not a single familiar face to calm the nerves,” he recounts. Apart from a damaged lung, Humagain was also going through a mental strain of not being able to have his beloved wife beside to support him. KMC allowed family members to visit for no more than 30 minutes twice a day. “I yearned to see them, but unfortunately, their visits also seemed to coincide with routine blood tests, x-rays, doctor rounds. I could hardly get 15 minutes of quality time with my family,” he shares.
Hospitals around Kathmandu and elsewhere are addressing the collective trauma of COVID-19 patients being separated from their families.
In Kathmandu, there is substantial variation in visitation policies among hospitals. Grande International and Nepal Mediciti Hospital both adopt stringent traditional ICU policy, which means that family members are completely refrained from visiting their patients. According to Mediciti Hospital Management, doctors carry out daily telephone counseling to inform family members. Likewise, Bir Hospital only permits one family member per patient with the condition that the visitor can arrange his/her own PPE. At Hams Hospital, outsiders can visit in-patients only once a day from 8:30 am to 9:00 am. Himal Hospital and Norvic have also put a cap on visiting hours.
Sanepa-based Star Hospital also doesn’t allow visitors at the ICU. “However, there are exceptions to the case,” elaborates Dr. Abhishek Sharma, Medical Officer at Star. “If the patient refuses to wear an oxygen mask, and gets overly anxious we do permit a visitor inside,” he added.
Personally, Dr. Sharma is more inclined towards lenient visitor policy. “From a medical standpoint, ICU patients need to be protected from outside infection. But, if I were to think sentimentally, having a closed one right beside you greatly helps in both recovery and moral support,” he opines.
Dr. Sher Bahadur Pun, Virologist at Sukraraj Tropical and Infectious Disease Hospital, Teku, also harbours similar sentiment.
As per Pun, the presence of a single-family member can be an important strategy for preventing additional complications like delirium, anxiety, and panic attacks among critically ill patients. “Visitors can be an extra set of eyes and ears for patients who can help improve hospital safety surveillance and catch medical errors,” he adds.
During a time when the second wave of the pandemic was at its peak, constant vigilance from family members had become a necessity. Nurses were overworked. Hospitals were overwhelmed and running short of oxygen. Jorpati-based Nepal Medical College had even issued a notice asking family members and relatives of all its patients to arrange oxygen cylinders. Other hospitals were forced to cut down on oxygen supply.
At a time like that, Kapil Shrestha, a BBA student who was acting as a caretaker for his aunt at Civil Service Hospital had to constantly keep an eye on the hospital’s oxygen flow. “When a ventilator operated in another room, the oxygen supply went down in other cabins,” he shares. Since he was at the bedside of his beloved aunt 24/7, he was able to correctly judge the situation and quickly salvage three oxygen cylinders as standby for his aunt.
Contrary to the approaches of other hospitals, Civil Hospital has by far the most lenient visitor policy in place. In fact, there isn’t a visitor policy at all. Most of the visitors sleep in foldable chairs right beside their ailing loved ones. There are also tents erected by WHO outside the ICU for the visitors to spend the night.
At Civil, caretakers like Kapil aren’t mere visitors but an essential part of the treatment. In addition to providing emotional comfort, they encourage food intake, help maintain proper sanitation and also accustom the patients to their surroundings. “ICUs are grim places. A person can die right beside you. Several people have breathed their last in front of me and my aunt. My aunt used to cover her eyes to avoid seeing the plight of the dying men and women. At the time, I had to soothe her,” informs Kapil.
“Worldwide, ICU visiting restrictions are being denounced. Research has also shown that allowing visitors far outweigh the risk of infection,” informs Dr. Pradeep Tiwari, Critical Care Physician at Civil. However, Civil’s lenient policy has also resulted in the spread of viruses among visitors. Kapil himself tested positive.
According to Dr. Tiwari, a better way forward is to make a strict policy wherein COVID ICU can permit only those visitors who have been vaccinated and have been tested negative after contracting the virus.
Even with loved ones around, COVID pneumonia is a profoundly distressing experience. Going through such an experience by oneself is even worse. As we plan for the pandemic’s next wave, hospitals should reevaluate their visitor policies to ensure that their most vulnerable patients do not have to suffer alone.