Indian Armed Forces Are Helping, But Where to Get Trained Medicos?

Armed Forces may not be able to resolve some issues, the main one being availability of trained medical manpower.

After being co-opted into the fight against the COVID-19 induced pandemic, the Indian Armed Forces instituted (early May 2021) a number of steps to assist the country. The primary, over-arching measure was the launch of Operation CO-JEET, an integrated, tri-Services effort under Deputy Chief of Integrated Defence Staff (Medical) Lieutenant General (Dr) Madhuri Kanitkar. Op CO-JEET envisions utilising the personnel and resources of all three Services (Army, Navy, Air Force) to provide assistance to the civilian administration in managing the pandemic now ravaging India.

As expected, there is clear coherence in the efforts of the India Armed Forces, with the size, capacity, capability and core competency of each Service being utilised optimally, in conjunction with the DRDO, in the cause of the nation.

How the Indian Armed Forces Have Stepped Up to Help COVID Crisis

• Tri-Service Effort: About 200 short-service Armed Forces Medical Services officers retiring early this year have been granted an extension till December 2021. Additionally, medical personnel who have retired in the last two years are being recalled for service of eleven months, while those who retired earlier are being requested to join on contractual basis for service in hospitals or for manning medical emergency helplines.
• DRDO is facilitating the setting up of new COVID management hospitals, as well as in the resuscitation of some existing hospitals (at Ahmedabad, Dehradun, Delhi, Haldwani, Lucknow, Muzaffarpur, Patna, Varanasi, etc). Additionally, it is installing 500 oxygen production facilities, as also expediting research into anti-COVID medicines (the Drugs Controller General of India has already approved DRDO’s anti-COVID drug 2-DG).

What the Various Forces Are Engaged In

• Indian Army: With a task force that reports to the Vice-Chief, it is:

1. ramping-up the COVID management capacity of existing military hospitals (example: Barmer, Bhopal, Gwalior, Jabalpur, Kamptee, Lucknow, Namkum, Prayagraj, Pune, Sagar)
2. establishing additional hospital facilities (example: Budgam, J&K)
3. mobilising some of its field hospitals (used by fighting formations during exercises and war) for deploying ‘500-bed/100-ICU-bed’ facilities in selected states (example: in Patna)
4. operationalising new 100-bed facilities for treating mild-to-moderate cases (example: Punjab University, Chandigarh; Shri Atal Bihari Vajpayee Hospital, Faridabad; Rajindra Government, Hospital, Patiala)
5. providing manpower (doctors, nursing staff, medical attendants, Battlefield Nursing Assistants, etc) to man the new facilities being set-up by the DRDO as well as for selected civilian hospitals across India (example: Ahmedabad, Patna)
6. deploying engineers for repairing oxygen production plants at various civilian hospitals
7. providing assistance in transportation of oxygen tankers (by road and rail), as also for in-land movement of those landing at airfields

• The Indian Navy:

1. has designed, and made available oxygen supply systems that can assist six patients at one time from a large cylinder
2. has established a COVID management facility in Odisha
3. and is transporting oxygen containers from the Middle-East, and medical kits from Singapore to India

• The Indian Air Force is heavily involved in air transportation of oxygen cylinders, containers and concentrators, along with other medical equipment, both from abroad and within India

Beds Don’t Treat Patients — We Need More Trained Medical Personnel

As evident, given the imperative of force preservation for external threats, the scale of the endeavour undertaken is disproportionately large vis-à-vis the overall size of the Indian Armed Forces, and befits the capacity, sterling reputation and professional acumen of the Indian Armed Forces. And the effort has already started to make a dent in the country’s overall effort in the management of the COVID-19 pandemic.

Yet, there are issues which the Armed Forces may not be able to resolve — and the foremost one is related to the availability of trained medical manpower for the new facilities. Every day there are news of hospitals with such-and-such number of beds being established, or beds being added to hospitals.

The harsh reality is that beds do not treat patients — patients get well only through sustained efforts of, and care by, trained medical personnel.

It is not just a question of merely slapping-on an oxygen mask on a COVID-afflicted patient — as is happening at various ‘langars’, mandirs, masjids, and even in car parks — but of monitoring various parameters of each patient, testing and adjusting the line of medical treatment appropriately.

Merely establishing a hospital ward with a monitoring island in the centre — without adequate staff — is mere psychological assurance. It needs to be noted that the total manning requirement of every hospital in a pandemic is about three times the size of each shift.

The Big Challenge Ahead

The existing medical staff in civilian facilities, fighting the pandemic since last year, are strained, tired and diminished by infections. The Armed Forces’ Medical Services too are fully stretched, managing the existing but now overloaded military medical installations. As I had written in my previous column for The Quint, over the decades, the obsession, particularly in the Army, to add more ‘teeth’ has led to cutting the ‘tail’; this has denuded military hospitals to the bare minimum functional staff.

Thus, except for large hospitals (Base, Command, Army level), most military hospitals have 1-2 of each type of doctors (surgical, medical, gynaecology and obstetrics, orthopaedics, ENT, ophthalmologist, dermatologist, dentists, etc) — and as evident, some of these specialities have no connection with pandemic management. Further, given the skill-sets required, Battlefield Nursing Assistants (BFNAs) from infantry units will not be able to substitute nursing staff/medical attendants.

Thus, the big challenge now is the availability of medical staff in both existing and new facilities — and it is not clear how this scarcity of medical personnel can be overcome in the immediate and short terms.

However, this is the best that can be done in the circumstances — which underscores the need to prioritise building of State capacity over State power, as also an economy of ambition in foreign policy so that funds we are giving as aid to other countries can be better used at home to boost healthcare and education.

(The author is a retired Brigadier of the Indian Army. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)