Dr. Ananda Sankar Bandyopadhyay

Dr. Ananda Sankar Bandyopadhyay considers himself a foot-soldier in the battle to eradicate diseases. Ananda grew up in Kolkata, India and completed his medical graduation from Calcutta National Medical College & Hospital (2005) with multiple honors certificates and a Gold Medal. He received his Master of Public Health (MPH) degree in Global Health from Harvard School of Public Health (2010). In his public health career spanning more than 15 years, Ananda contributed to India’s successful polio elimination effort working in five states in the country and later on worked as a Medical Epidemiologist in the United States planning and implementing disease control programs. Ananda currently supports global polio eradication initiative focusing on vaccine research initiatives across multiple countries and geographies. Ananda has published more than 50 research articles in leading peer reviewed medical journals and is associated with advanced degree programs in public health and vaccinology in several globally renowned teaching venues as a guest faculty.

A pandemic is raging across the world with a stark reminder of the fragility of our health systems to cope with such unprecedented global health challenges. With hospitals overflowing with patients, health care professionals – themselves vulnerable to the imminent threat from the virus – have been on the frontline, battling the World War (III?) of our times. There is no magic bullet to guarantee success in such multi-factorial response strategies, and overall, the pandemic response across the nation, including in the State West Bengal has largely been successful on several fronts, given the constraints. However, if there is one single metric where successive administrations in the State of West Bengal have failed with an abysmal consistency, it is to provide a uniformly safe working environment for its health care professionals: both literally, from an infection control standpoint, and figuratively, from the threat of physical (and political) assault. There are two broad challenges we face on the issue of providing health security and healthcare workforce security.

Microbes: Infection control in most healthcare settings needs an overhaul. First, at the level of healthcare providers, and at times pharmacists and even general population who have web-based medical guidance on their fingertips with un-authorized access to prescription-only medicines, the indiscriminate use of antimicrobials has led to a healthcare crisis that is unprecedented. The World Health Organization has categorized the issue of antibiotic-resistant bacteria (ARB) and antibiotic-resistant gene (ARG) as the two major threats to public health in the twenty-first century and the situation is disproportionately more catastrophic in developing, high disease burden settings such as ours. Persistent focus on health education and follow up monitoring to rule out misuse of anti-microbial agents at all levels will be critically important to manage this emerging threat. Secondly, the culture of routine hand hygiene and cleanliness need to percolate down from the highest level of care providers to the care recipients and beyond. Public health practice begins at proper hand washing with soap and clean water, and it is evident that the importance of this simple, yet powerful intervention remains poorly understood. Third, access to Personal Protective Equipment (PPE) should be ensured for all front-line health workers. We could have probably saved lives and prevented disease spread among the front-line health professionals if appropriate PPEs were made available during the initial phases of the pandemic. Finally, cleanliness at institutional level would require renovation of the existing facilities – from enforcing strict penalties to visitors who do not follow cleanliness guidelines to authorities taking ownership of poorly maintained facilities. A random sampling of health care facilities in rural and peri-urban areas would reveal the real-world living condition the healthcare professionals. From dilapidated buildings to overcrowded, inadequately ventilated rooms to poorly maintained toilets catering to many – such precarious occupational settings of medical and nursing students, and health professionals warrant immediate attention across the board to protect the health of the healthcare workforce.

Miscreants: The culture of assault-at-will on healthcare professionals with the excuse of alleged medical malpractice seems to be widely prevalent. Having worked as a public health physician in remotest corners of India – from the hilly northern terrains to the riverine Sunderbans of West Bengal and beyond – my shoe-leather epidemiology experience made me realize the enormity of the challenge of delivering quality services under minimal infrastructural support. If the front-line health worker remains vulnerable to violent crime, the quality of healthcare delivery will invariably be affected. Graphic images of the broken, sunken frontal skull bone of an injured medical intern from a Kolkata Hospital went viral in social media in June 2019 and struck a chord with the medical fraternity and beyond across the State, nationally and globally. Such incidents of crime against medical professionals appear to be agonizingly frequent, with significant variance in the level of reporting and documentation. The threat from within – from a section of our own societal elements – needs to be tackled effectively. First and foremost, meaningful safety measures at health-care institutions should be instituted uniformly, backed up by a functioning law enforcement system. Also, public messaging against such crimes needs to be unambiguous and decisive for preventing recurrences. Finally, decisive reforms in medical education system with focus on criticality of ethics and health communication should strengthen the physician – patient interface. Rationalization of workload at overburdened health institutions should favorably impact efficiency of health care delivery as well.

The health of our political, ethical, and societal system needs attention, care, and nurturing. The COVID-19 pandemic demonstrated the criticality of being prepared on the health care front to mount a sustainable public health response. We need Change Agents across the spectrum of political, healthcare, and administrative leadership to inculcate a culture of evidence-based policy making for health protection and disease preparedness before the next pandemic or health crisis strikes the human race. Interdisciplinary, decisive, and reformative steps based on core principles of equity and empathy should empower us to remain protected against both the microbes around and the miscreants within.
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