“None of us have been trained to work during a pandemic”: family medicine clinic struggles to maintain care

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Much has changed at Dr. Javed Alloo’s family medicine clinic in Toronto because of COVID-19.

When possible, appointments are now made by phone or Skype.

Others have been canceled or postponed. This is particularly important, as many of Dr. Alloo’s patients are older and have compromised immunity due to chronic illness, and are therefore at high risk for the virus.

“The routine of telling us that the best thing I can do is to see you back here in two weeks or two months, suddenly it may not be the safest thing for them to do because of COVID” he said.

The clinic’s waiting room, which accommodates approximately 650 people, was also closed.

Now, if a patient has to go to the clinic, he sits in his car until the doctor is ready to see him, then he is taken directly to one of the examination rooms.

And after each visit, Dr. Alloo disinfects all hard surfaces. He says that due to all the new precautions in preparation and cleaning, it takes almost three times as long to see a patient in person, so there is more pressure on the clinic than ever.

Dr. Javed Alloo works in a busy family clinic in Toronto where he is doing his best to adapt to the new realities of the COVID-19 epidemic. He treats patients remotely where possible, and when they come to the clinic, Alloo is worried because he still has not received protective equipment from the province. (Nick Purdon / CBC)

But these are the easy changes to make, he says. What is more difficult is how to provide primary care during a pandemic.

“The reality is that nobody knows how to practice this way,” he says. “None of us have been trained to work during a pandemic.

“We have all been trained to work in a stable environment where we know the variables involved. “

Protect yourself from COVID-19

The changes that Dr. Alloo has made to his practice are not only about protecting his patients – they are protecting him.

Alloo understands better than anyone the risks of working in a front line medical clinic. He made his debut during the SARS epidemic.

“The doctor I replaced [at the practice] was then a victim. He died of SARS. He caught it from a patient he was caring for. So that’s the reality, “says Alloo.

Dr. Javed Alloo, who runs a busy family medicine clinic in Toronto, discusses the risks faced by healthcare workers during the COVID-19 pandemic. 1:19

So far, during this epidemic, the government has not provided protective equipment for its clinic. The only masks he has remained from the H1N1 epidemic in 2009.

“I don’t have what I need to do the job safely. It’s scary and overwhelming, “he says.

“We are ready to get on the starting line – being on the front line – knowing the risk, knowing that we have to do more than we are used to and being prepared for it,” says Alloo. .

“The general public can afford to stay away. We cannot – every day we are back here. “

“He is dead”

At the time of SARS in 2003, Dr. Alloo had just left medical school. The Ontario Medical Association asked if it could replace a family medicine clinic in Scarborough, Ontario, which had been badly affected by the virus. One of the clinic’s doctors was quarantined at home with SARS-like symptoms – two others were sick at the hospital.

Dr. Nestor Yanga was in critical condition.

“One day, the nurse came crying and saying” he died “”, “says Dr. Alloo.

“And so we all knew that the person we had been working with for so long would not come back after SARS. “

Many of Dr. Yanga’s patients have stayed with Dr. Alloo, and he still cares for them today.

“It created a strong bond between me and the patients I inherited,” says Alloo.

“It is something that really brought us together – recognizing the common humanity and the risks we take together to get care when we need it and give it when we can.” “

“We are no longer doing the best we can”

On that day, Maria Demurrell had to bring her 15-month-old son Ethan to the doctor to get a vaccine – something the Canadian Pediatric Society says shouldn’t be delayed during COVID-19.

Despite this, she and her husband debated whether to cancel.

“My husband and I had a conversation about this – he was more terrified than I was. Her concern was, what are you going to do if someone out there is sick, who has COVID-19? “

Maria Demurrell, 40, came to see Dr. Alloo with her sons Ethan and Liem because Ethan, 15 months, needed a vaccination. Even during the COVID-19 pandemic, the Canadian Pediatric Society recommends that these types of treatments be continued. (Nick Purdon / CBC)

This is the risk that Dr. Alloo must balance with the provision of the regular care that his patients need to stay healthy.

“We are trying to make the best decision between the risk of not entering and the risk of entering,” he said.

“There are people we will protect this way, and there will be people who will hurt themselves this way. So we are faced with the reality that we are no longer doing the best we can – we are doing our best, given two very bad risks. The risk of managing the disease and the risk of COVID. ”

Dr. Alloo explains that some patients will receive substandard care because it will be too risky to see a doctor face to face – or their appointments will be delayed.

“It means you may be taking liberties in the way you manage their illness,” says Alloo. “And maybe a bad thing will happen and not be caught, because we are not as vigilant as usual. And that’s a big concern. “

“Who will we not save because we are distracted by COVID? “

Dr. Allo says his experience during the SARS epidemic helps him in many ways during COVID-19. He understands the risks for front line workers and must be mentally prepared for everything.

“I saw the family of the deceased SARS doctor. I saw his children grow up without their father, “he says.

“And so it wasn’t something I could pretend or deny was a reality of this job. It was very fortunate that the time to test this reality had not returned so far. “

National Purdon Nick visits a family doctor’s clinic to see how they coped during the COVID-19 pandemic. 2:48

The other lesson he says he thinks about with every patient he sees today is about a near accident he had during SARS.

“I remember this man, it was the first time I met him and it was at the height of SARS, and I did his physical checkup – something we don’t want to do at the moment, we postpone it for COVID, “he says. “And during the exam, I realized he had cancer. And so I was wearing all the equipment – the mask, the blouse, the gloves, the most stripped-down way of two humans talking about something so horrible. And I said ‘hi, we just met – but I think you have cancer. Then I had to plan for him to receive his care. ”

Due to Dr. Alloo’s diagnosis, the man was operated on three days later and survived. He is still one of Allo’s patients today.

“I don’t know if he realizes every time I see him or his family, I remember what he went through during that time. And right now, this worries me about the people that we will not take care of because we are so worried about COVID – that we are going to defer their care.

“Who will we not save because we are so distracted by COVID right now?” ” he’s asking himself.

Whatever happens in the coming weeks, Alloo says he will do everything he can to take care of his patients.

“We chose this profession to serve people, and it’s hard to give it up. This is the bond and the obligation I have to them, “he said.

“This is the relationship I have with them when I made the decision to be their family doctor. And that’s why I’m still here. “

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