The COVID-19 Pandemic

On 18th March, MDMI was visited by the Army: Commandant of CMH and Deputy Commissioner to see the current process for COVID- 19 at the hospital. Like our patients, all visitors were screened at the hospital entrance using a thermal scanning thermometer. The visitors appreciated the screening efforts, looked at the OPD, were interested to know what capacity we could accommodate and wanted 50 bed capacity. OPD workflow was adjusted to protect against cross infection. COVID-19 screening had only begun the day before at the hospital and already delegations were impressed with Midland Doctors Medical Institute. The hospital and the trained staff are a testament to donors across the world who have donated and supported this facility. We are already a model for how things can be. The next phase was to secure processes for in-patients and to see if we can support the AJK effort as a whole. A vital team member, Nurse Muqaddas, joined MDMI to train the staff in terms of droplet protection which was vital in the fight against COVID -19. Hand washing and Hand Rubbing had been intensified at the premises along with screening of every patient approaching the premises.

By 21st March, MDMI staff were screening patients in full blow. The Administration of the MDMI: Mr. Bilal Hussain, CEO; Mr. Syed Shahbaz Shah, COO; and Mr. Ahmed Najam, HR Administrator were doing excellent preparations in acquiring all the necessary equipment, protective gear, masks and medications so as to receive patients affected with the COVID-19. The MDMI is the first unit in AJK to develop and run a COVID -19 program and a model for others to follow. The challenge faced by the hospital now was to keep regular patients at home and keep them from gathering in multiples. We advised the patients with multiple warnings to stay at home. Our staff showed a lot of dedication to the local community, despite the challenge befalling all communities near and far. For the first time, we were facing a humanitarian crisis with the rest of the world. We knew the local impact could have global consequences and knew it was our responsibility, as a healthcare facility dedicated to the people of the region, to ensure we did our absolute best in preventing the spread of the virus. MDMI was dedicated to serve the community in this testing hour and we are thankful to the medical team at MDMI for what has been achieved in overcoming this massive challenge.

AJK Chief Secretary Mr. Mathar Niaz Rana also visited MDMI. The MDMI facility was fully equipped to accept and treat COVID-19 patients. The preparations at the MDMI were examined by the authorities. The government inspections ensured that we were equipped and trained to handle such a massive disaster response that the world was challenged by. The necessary medications, equipment and protective gear was set up as the week came to an end. The medical team was accessible by telephone during this period for any emergency response. The hospital was converted into an isolation ward and was not delivering regular medical check-ups. Any patients requiring medical attention could contact the emergency numbers circulated in the region by our staff and also mentioned on our website home page.

Midland Doctors^®, with the help of experts who are frontline healthcare workers in the UK, US and the UAE, trained its medical and tertiary staff towards the handling of patients, focussing on all the aspects of protocol including Donning and Doffing of PPE for the staff, segregation of MDMI into Low Dependency and High Dependency Units. By 7th April, MDMI was divided in to zones to isolate patients that would be received as a part of the COVID-19 response. The various departments would include Red Zone consisting of the High Dependency Unit (HDU) and the Intensive Care Unit (ICU); the Yellow and Green Zone would have patients will have patients with less severe symptoms and would comprise the Low Dependency Unit (LDU). The HDU would provide 6 beds and the ICU would provide 4 beds with the provisions of 3 functional Ventilators. The HDU would have patients with more aggressive symptoms and will be dependent on external oxygen for breathing. The Yellow Zone and Green Zone together would accommodate 30 patients and they would provide the necessary care and medications depending on the severity of their symptoms. In total, we started the MDMI COVID-19 response with 40 beds and did not receive any walk-in patients. MDMI worked in tandem with the Pakistan Health Authority to isolate patients and ensured the patients were treated with the best possible guidelines shared with us from across the world.

There was a strict no visitor policy in operation at the hospital. The staff would inform the family of the status of patients with daily calls and update the condition of their loved ones. All the necessary laboratory and testing equipment were made available at the MDMI. The MDMI Executive Management would continuously update the clinical guidelines for the medical officers and nurses. The trustees made all the necessary precautions to ensure the safety of the staff and the patients and strict protocols will be maintained to ensure that there was no community spread.

MDMI, after much preparation and with established standard operating procedures in place, opened its Outpatient Clinic strictly to patients with appointments with a limit in the number of attendees per day. The staff was trained to run a Triage service to filter patients and advise them over the phone, if necessary, instead of them making a personal visit to the hospital. MDMI is continually following strict policies to maintain social distancing and flow of patients is being maintained in a way to ensure there is no crowding in the premises.

Unfortunately, unlike other disasters, this was not short-lived and is continuing to impact the world gravely. We pray for the safety of all and ask you to continually help us in our efforts to support people in need.