The strength and mettle of a doctor at the forefront of the COVID-19 and HIV response

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Dr Amit Tripathi is not just a doctor but a friend to his patients. He hears them out without being judgemental and they know that their secrets are safe with him. He is a naturally warm and open person, but he is particularly sensitive to his HIV positive patients since he is aware of their predicaments because of stigma related to HIV, more severely played out in small towns and districts where the level of awareness is low, making life quite challenging for those living with HIV. When his patients come to Dr Tripathi for the first time, they are gripped with fear, guilt and shame. He speaks to them in private to help them open up and cope better in their most vulnerable moments. “Even when couples come, I talk to them in private separately so each one can speak without any fear”, says Dr Tripathi who has counselled countless men, women, and children since the time he was posted as a doctor in-charge of ART Centre at the District Combined Hospital, Maharajganj, Uttar Pradesh in 2014. ART Centre is a unit of the national HIV programme to provide consultation and treatment to people living with HIV. Dr Amit reports to the ART Centre at around 8:30 am and typically examines 70-80 HIV patients until 2 pm.

As soon as the nationwide lockdown was announced, most economic activities came to a standstill. Healthcare being an essential service; guidelines were given for all ART Centres to remain operational. The hardest decision for Dr Tripathi was not reporting to duty amid pandemic but the separation from his young children, a daughter aged five and son aged four who were sent to live with their grandparents to protect them as both he and his wife are doctors. When asked if he feared for his life he said, “Not for my life but surely for my children and parents. Children are our future, and old parents are our experience, they must be preserved”.

Dr Tripathi may not have been able to meet many of his patients in person owing to the lockdown but he was busier than ever co-ordinating over the phone, ensuring supply and delivery of life-saving ART medicines to about 1700 HIV patients on an active treatment regimen. A clear guideline had been given to all ART Centres for the decentralized distribution and multi-month dispensation of ART medicines. The means and resources to implement the guidelines were scarce, however, Dr Amit Tripathi acted out of concern for his patients and resorted to every possible opportunity he could utilize to provide safe assistance to his patients. He tapped into his good relations with the hospital staff, the district chief medical officer, police personnel to co-ordinate the delivery of ART medicines. He utilized Asha workers, volunteers and ambulance services; anyone who was willing to help. He supported outreach workers of Vihaan Care and Support Centers who were physically travelling to deliver the ART medicines. “Sometimes, the outreach workers had to deliver in containment zones, they were questioned by the police personnel who were doing their jobs, so I told the outreach workers to put me on a call with the police in such a situation so I could intervene”, he said.

40cff1d2-18cd-4c8b-a9de-9d31c22ab1b6The contact tracing strategy in HIV response to ensure treatment adherence was most useful during COVID-19 as most patients were reachable through the phone and were provided with vital information. There was fear among them as to what if they have a medical emergency, Dr Tripathi assured them that they can always call for an ambulance and come to the hospital in case of a medical emergency. Commenting on working closely with the outreach workers of Vihaan Care and Support Centre, Dr Tripathi said, “They were dedicated and hard-working. They were proactive and had a sense that they are doing something good. That’s why they were going beyond their duties to help people living with HIV”.

Gradually when the lockdown was lifted, Dr Tripathi told his patients that the restrictions have been lifted, but COVID-19 is still around. He asked them to take preventative measures and encouraged patients to visit the ART Centre for a routine examination. The number of patients he sees in a day has dropped to 30-40 patients now. “One of the good outcomes of the lockdown was that we had very few drop-out cases as the medicines were home delivered. The drop out cases normally happens when patients cannot come to collect their ART medicine due to financial or other barriers they face”.

About 2200 HIV patients are registered in this ART Centre with 1700 on active treatment. The majority of them are from the Maharajanj district and a few from the neighbouring districts. Many of his patients are migrant workers who leave their districts for seasonal work. He has observed that most of these men contract HIV when they are away from home and get detected very late, by that time their health is frail and have already transmitted the virus to their spouse or newborn children. “Many women who were diagnosed with HIV are so unaware that they ask me, doctor, what is HIV, how long do I have to take the medication for”, Dr Tripathi says, “Women and children, especially children are innocent, lack awareness and if you meet a child with HIV, you will be moved by their plight. ”

Dr Tripathi is so involved in the life of his patients that he has even turned into a matchmaker for many people living with HIV as they struggle to find a suitable partner. He says, “It could be young people looking to settle down in marriage, or men and women looking for a second chance after the loss of their spouses, I connect them and many have come back and told me that they are happily married. As they age, they will need each other’s support so it is my joy to see them get married”. This is precisely why patients come seeking him, he not only gives them antiretroviral medicines but also the much needed emotional and morale boost.

Besides serving HIV patients, Dr Tripathi was also the trainer for COVID-19 in the District Combined Hospital. He trained the entire hospital staff and volunteers on the basics of COVID-19, what safety measures to take and how to help those who test positive. One of his favourite lines in every training is “be intelligently brave, not foolishly coward”. Dr Tripathi leads by example. He and his wife, who is also a doctor and is posted in another district in Uttar Pradesh, are selflessly serving amid a pandemic. They have not been in physical contact with their children for the past three months. About his plans to see them, he says, “We would have to first quarantine ourselves for at least a week, right now we don’t have the luxury of taking leave.” They continue to serve their patients at a heavy sacrifice on the personal front.

When appreciated and thanked for his services, he responded, “When our jawans are martyred in the border, we chant, ‘Bharat mata ki jai’, now it is our (medical professionals) turn to serve and be willing to lay our lives for our country. If anyone is unwilling to serve in these times, he or she has no right to chant ‘bharat mata ki jai’.

We salute the commitment and dedication of Dr Tripathi and many other ART doctors across the country who ensure that people living with HIV are given priority and provided assistance in the face of the biggest health and humanitarian crisis the world has witnessed in over hundred years.

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