Doctor who treated the first Covid-19 patient shares his experience
March 5, 2020. It was a usual day at the national referral hospital in Thimphu. Dr Guru P Dhakal went homeafter attending to his patients.
At 1:30am, a phone call startled him out of sleep. He knew something was amiss. Unless an emergency occurred, the 54-year-old gastroenterologist would not be bothered past midnight.
The hospital’s medical superintendent dropped the phone after a hurried conversation.
“We have our first Covid-19 case and the patient has multiple pre-existing medical conditions. How should we go about managing him?” inquired the medical superintendent.
Dr Dhakal had the answers. He told the superintendent to start with the usual antibiotics, aware of the complications. “We did not discuss any further management until the next morning when we convened a meeting to discuss the case.”
Flashes of news clips and videos of people dying from coronavirus and doctors in China succumbing to the infection became vivid for the gastroenterologist. “Although the hospital was prepared to handle Covid cases, we did not anticipate our first cases to appear this early given the precautions the government had put in place.”
Next morning, Dr Dhakal said that as an infectious disease, Covid-19 case management fell on the Department of Medicine in absence of an infectious disease specialist. “We knew it would be our department that had to manage the positive patient but we had not decided who would go first.”
As the head of the medicine department, Dr Dhakal volunteered to manage the American patient himself. “As the HoD it was ethically not correct for me to ask someone else to attend the patient. Moreover, it was an opportunity for me to serve the nation when needed the most.”
Not an easy task
It was quite an experience for Dr Dhakal despite 29 years of experience under his coat. “Before I went to the isolation ward, I was scared because we had heard so many things about coronavirus,” he said.“I couldn’t tell my wife that I was going inside the Covid isolation ward. I later called her after we put the patient at the new isolation facility.”
Dr Dhakal said that the initial apprehension and fear disappeared as he started treating the patient, donning the strenuous personal protective equipment (PPE) and the coverall gear. “We are all trained to do this. Knowing that Bhutan has one of the best quality PPEs available, and that if we use them properly, the risk of contracting the virus is very low. This gave me more confidence.”
Dr Dhakal was also tasked to inform the patient that he had tested positive for Covid-19, a disease that was wreaking havoc across the globe. “As I entered the isolation ward, the patient was gasping for breath and was not able to complete his sentences as we spoke. His condition was very bad.”
To add to the difficulties, the initially identified Covid-19 ward at the old mother and child hospital was not the most ideal facility to keep patients and treat them. “The large hall was wide open and it was freezing cold at that time of the year.”
Dr Dhakal said that as the team was struggling to manage the patient, His Majesty The King had commanded the newly constructed eye hospital at the JDWNRH campus to be turned into a Covid-19 hospital. “This was a huge blessing for all of us there.”
After much struggle, men and machines were installed at the new isolation ward that had an intensive care unit (ICU) facility. However, the patient showed no signs of improvement. Finally, on the fifth day after testing positive for the virus, he was put on a ventilator.
After a few days, the patient was airlifted from Paro international airport to his country, America.
A collective success
Despite limited manpower and uncertainties surrounding the pandemic, Dr Dhakal said that the team of doctors, nurses, and other support staff successfully managed the first Covid-19 positive case in the country.
“We had a very wonderful team. Nurses did not shy away from doing extra hours of duty and doctors were equally involved in assisting the nurses. The cleaners without any fear did their job and the support from our colleagues outside was reassuring.”
The gastroenterologist said that with no specific guideline to treat Covid-19 patients, they were mostly treating just the symptoms. “If one medicine was recommended today, it did not work the next day, and some new medicine would be recommended.”
While the team was struggling inside the isolation ward, the hospital management was equally worked out as none of the hoteliers were willing to volunteer their facilities as quarantine centres for the health staff managing positive patients.
Dr Dhakal said that after the American patient was airlifted, his team was put up in the old hospital ward where they slept on the floor. “Because the structure was old, the bathroom was leaking, the lone heater was not heating the room enough.”
A few days later, one of the hotels in Thimphu agreed to house the health workers at their facility.
Improved for better
More than 18 months after having dealt with the first-ever Covid-19 patient, Dr Dhakal said that things have improved. “Hospital staff are no longer scared of going inside the Covid ward and treating patients. This is because we have become more systematic today and we all know what we should do when a new patient comes in.”
He added that health workers are confident in managing patients as facilities have improved and drugs and equipment have become readily available. “The guidelines are much clearer now and many other things have also improved for the better.”
In the event of a major outbreak in the country following a possible third wave of the pandemic in India, Dr Dhakal said that the health system in the country is prepared. “We have trained all our doctors on Covid management and have also identified adequate facilities to accommodate patients should there be an outbreak.”
“Most importantly, it is the confidence we have in our health workers that gives us the assurance that Bhutan will do better than the majority of the countries in handling this pandemic.”