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The Health | august-September, 2020
| People |
BY CAMILIA REZALI
The United States has one of the
highest number of Covid-19
infections and deaths in the
world. As it struggles to contain
the spread the deadly virus, we
hear of shortages of hospital beds,
ventilators and even personal protection
equipment (PPE).
Inevitably, the doctors, nurses and
other frontliners are stretched to the limit,
putting in long hours. One of them is a
young and talented Malaysian, Dr Avinesh
Bhar who has made his home country
proud.
Born and raised in Kuala Lumpur,
Avinesh is a pulmonary, critical care and
sleep medicine physician and recipient
of the Asia 21 Young Leaders Award, Class
of 2016. The Asean scholar, who is an
International Medical University (IMU)
graduate, has an MBA from the University
of Chicago. He is also the founder of the
first integrated sleep and pulmonary
telemedicine practice, named Sliip, while
based in Macon, Georgia.
He was one of the 33 professionals from
24 countries – representing the private,
public and non-profit sectors – selected
from across the Asia-Pacific listed on
Asia Society which is founded by the
Rockefeller Foundation. The only other
Malaysia previously listed was politician
Khairy Jamaluddin.
Avinesh has spent months treating
Covid-19 patients. Interestingly, he is
married to Dr Manvin Gendeh who is
also in the frontline treating Covid-19
patients. He was featured recently on Asia
Society’s Asia Blog where he spoke on
telemedicine, the future of healthcare and
the imperishable moments of his career.
What struck him most treating
coronavirus and what makes the virus
so unique and difficult to deal with
One thing that we’ve learned is how fast
people seem to fall apart. They come in
short of breath, requiring a little bit of
oxygen, and then take a turn for the worse
very quickly. Not all of them do this, and
that’s another thing: Covid-19 is difficult
to predict. We don’t know which patients
will decompensate, and when they
decompensate, they do it very quickly.
On who are more susceptible to dying
from COVID-19 and to what extent
factors like one’s sleeping and eating
habits contribute
Typically, a pre-existing condition has to
be something that’s been going on for a
while — but there’s a lot of gray area. If you
have diabetes and poor sleep, for example,
does that increase your risk? Or is having
really bad diabetes enough? Various things
interact with each other, and that we just
don’t know the answer right now.. I don’t
think people with a touch of diabetes, for
example, or sugar levels that are slightly
above normal are truly at risk.
We know that age is a big factor. The
risk to people above 70 is much higher
than to people above 50, which in turn is
far higher than to people above 30. If you
have obstructive sleep apnea or chronic
insomnia, does that accelerate your risk?
And at what level? We just don’t have
insight into that.
His views on the rise of telemedicine
and whether it will be more widely
accepted post-Covid-19
There are a lot of preconceived ideas of
what telemedicine is. I think it’s the
same thing as with massive open online
courses: People think you don’t get the
Life in the US
behind the
hazmat suit
Malaysian specialist Dr Avinesh shares
on the challenges and imperishable
moments of being a frontliner treating
Covid-19 patients
Dr Avinesh Bhar
actual essence of an education online,
since you don’t get to participate in group
discussions, etc. But when you actually sit
through an online course, you realize that
you actually get what you need.
You have doctors in rural areas who have
been into telemedicine for a while now, out
of necessity. They’ve bought into the concept
already. But physicians in big cities haven’t
needed it because patients can just jump on
the subway or take an Uber to see them in
person. A lot of doctors have also held onto
the idea that they actually have to see the
patient, to read body language, etc., in order
to treat them best.
But if we’re actually being honest, and
assessing how much physical examinations
change our diagnoses, the answer is less
than we think. And now because of COVID-
19, the barriers are slowly coming down.
Incentives change behaviour.
Has Covid-19 changed the way we should
think about healthcare?
We’re realizing that a lot of treatment can
be done remotely, and a lot of things can
be tracked remotely. The old way, where
patients had to walk into a doctor’s office
every three months to get refills, and so on,
is probably going to change. And I think
that’s going to be for the better.
Another change might be how we
manage patients in the hospital. We’re
going to need a larger outpatient or
ambulatory surgery apparatus to augment
any health care system. We’d like to think
everything needs to have the most cuttingedge
technology, but if we focus on what’s
basic — caring for human beings — then I
think that’s where the value of medicine
will always lie.
On whether he felt his own personal
health was at risk when treating
Covid-19
I did not think much about my risk. Doctors
are always at some risk of contracting
a disease. However, that changed when
I was exposed to a Covid-19 positive
patient without my personal protective
equipment for a considerable period of
time and in close proximity. I questioned
my “recklessness” in examining the
patient (who did not exhibit any Covid-19
symptoms) and my ability to infect my
family and other patients. I felt guilty and
foolish for putting myself and my family in
such a position. It was not a good day. One
of my colleagues had even written a living
will, just in case.
Looking back on this period decades
from now, what is it he will always
remember?
There are many, but I’ll tell you two. I
treated a lady who was asthmatic. Her
boyfriend had been exposed to a Covid-19
patient. She came into the hospital, on the
general floor. At first, she wasn’t so sick —
she was comfortable — but then she began
to feel much worse. I was called into the
ICU at 2am to see her. She was in distress,
rapidly declining. I was going to intubate
her. I felt so grateful that I could give her
the time to talk to her daughter because
I knew what direction she was going in. I
wish I could give more patients the ability
to do that.
I’d heard on social media and for
this, I’m grateful for Twitter - how other
physicians were using FaceTime for
patients to speak to their loved ones. We
were so uncertain about the trajectory of
the disease and patients on ventilators
had such poor outcomes that people
often didn’t get a chance to say goodbye
to their loved ones before they died. This
woman had a cellphone that she gripped
in her hand. I encouraged her to call her
daughter, even though she was short of
breath. And she was able to say things
to her daughter that she’d always
wanted to.
Thankfully, the story had a happy
ending: Even though we put her on the
ventilator, she recovered and is now doing
well. I felt so grateful that I could give her
the time to talk to her daughter because
I knew what direction she was going in. I
wish I could give more patients the ability
to do that.
The second story is more tragic. I met
a woman in her 40s who had lost her
father two weeks prior to Covid-19 in
my hospital’s ICU. Two weeks later, her
mother was there on a ventilator and not
doing well. We’d implemented some strict
visiting rules but it was confusing because
they were changing on a day-to-day basis
as more information was being gathered.
Rules sometimes lag behind data. We were
realizing that these rules prohibiting
visitation were very restrictive and
inconsiderate.
The woman on the ventilator wasn’t
doing well. I came by and realized that I
couldn’t predict what would happen in the
next couple of hours, much less whether
she’d survive the day. Despite the rules,
I felt very strongly that the woman’s
daughter, who had already lost her father,
should at least be called and given the
option to visit. We were able to get her
permission to come. And her mom died
within half an hour after her daughter’s
arrival.
For me, to see the woman at her
mother’s bedside, even though it was a poor
outcome — it would have been a lot worse
if we had just followed the “no visitors
allowed” rule. We’re glad that we were able
to bring her daughter to her bedside. So,
these are the images that will stick with
me. – The Health