A Pakistani doctor’s tale: Why more ventilators alone are not the answer

As an ER physician I can tell you that more ventilators and equipment aren’t the answer to all our challenges

The coronavirus has triggered a global surge in demand for ventilators and masks worldwide. The challenge posed by the virus is forcing companies across a variety of industries to innovate. For example, car manufacturers in the United States such as General Motors (GM) are now required by law to manufacture life-saving medical equipment, while fashion houses such as Gucci and Prada are working to produce face masks.

Pakistan has also ordered nearly 3,000 ventilators to deal with cases of the coronavirus. While there is a clear need for such devices, as a practicing emergency room (ER) physician I can tell you that more equipment isn’t the answer to all our challenges. We need to think innovatively to address three other crucial shortages – skills, facilities and equipment – in order to save lives while keeping frontline healthcare workers and other patients safe.

Putting a person on a ventilator is a nerve-wracking experience. You know that a patient’s life is in your hands and it takes years of practice and refreshers, under the supervision of seniors, to correctly intubate a person. Besides learning the techniques to put a patient on the ventilator, doctors need to know how to correctly set the machine’s oxygenation and ventilation settings. You also need nurses who are experienced and comfortable with providing regular supervision and care for those patients on ventilators in intensive care units (ICUs). Since time is of the essence, healthcare providers will need to think beyond the typical, time-consuming process of supervised learning on rounds to teach these skills. For example, hospitals will need to come up with new ways to provide refresher training to experienced staff, as well as basic training to senior doctors and nurses. Developing training innovations such as the use of video-conferencing or inter-professional training where teams learn together using mannequins and high-fidelity simulation techniques are possible solutions to this shortage.

The second challenge is of space and facilities. While most of today’s ventilators are compact and can be easily accommodated in most patient settings, coronavirus patients also need to be treated in specially-equipped negative pressure rooms or bays. These negative pressure facilities are in a very limited number in most hospitals as they require special ventilation and filtration systems that eliminate airborne contaminants which can result in the spread of the virus.

Treating an intubated COVID-19 patient in an open ward or in a setting with other critically-ill patients presents a very high risk of contagion which means that hospitals will have to redesign and revamp facilities before installing the new ventilators. Equipping treatment areas with such facilities is a major challenge for our healthcare system that requires multidisciplinary teams of engineers to work side by side with specialists in emergency medicine, critical care and infectious diseases. On a positive note, there are private sector hospitals in the country that are already engaged in this work. The question is how can we effectively share this expertise so that hospitals around the country have access to these facilities?

Another critical issue is the shortage of protective gear for frontline healthcare workers such as N95 masks and protective gowns. That’s because if poorly-protected frontline workers become victims of COVID-19 then they’ll be no one to take care of patients. Besides these shortages, hospital management must increase the supply of ‘temporary’ respiratory aids known as ambu bags. These inflatable silicone rubber bags act as a bridge for patients waiting for ventilators which are almost always in short supply, especially in countries like Pakistan. If staff using the ambu bag lack the correct personal protective equipment then they remain at risk of being exposed to the virus. The challenge here is how to develop a ‘mechanical’ ambu bag that automatically inflates and deflates which can be easily disinfected and hence re-used. Such an innovation would keep healthcare workers safe and free up their time to care for other patients.

Public sector hospitals are the first port of call for the majority of Pakistanis and are therefore likely to suffer from the most pressing shortages. Arranging ventilators won’t solve all our challenges that affect the quality of care received by patients. That’s why my colleagues at the Critical Creative Innovative Thinking Forum, which is based at Aga Khan University, are putting together an online hackathon, the Jugaad Innovation Challenge, which allows individuals to pose medical and non-medical challenges on our forum and to work with others from different specialties.

The coronavirus has radically reshaped how we think about our way of life. The three shortages I mentioned above are just some of the challenges that we hope to address by forming teams of specialists from different disciplines or ‘hackers’. We’re also inviting civic society to pitch ideas that may relate to the current pandemic or post-pandemic recovery phase. It doesn’t have to be about ventilators alone. For example, we’d love to work together on how to tackle the challenge of fake news about the virus on social media or on how to maintain people’s mental and physical well-being during these difficult times. So come and join our challenge!