Dr. Zulfikar Bux – an ER Specialist on a mission to help end COVID-19

May 24, 2020 News

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By Sharmain Grainger

Originating in Wuhan, China in late 2019, COVID-19, the novel coronavirus, within a matter of months, was able to spread its contagious tentacles across the globe, not only crippling many health sectors but crumbling economies by virtue of necessitated lockdowns.

Quelling its spread has been a trying task even for developed countries with astounding medical and scientific advances. To date, there are still many unknowns about the disease and the best of experts have conceded to this fact.
But being resilient and never willing to back away from a challenge, mankind has kept the wheels of laboratories turning. They have become hubs of experimental activities aimed at finding a solution, multiple even, that can bring, perhaps, a definitive end to the dreaded COVID-19.
Once there is a will, mankind will always ensure there is a way to outwit any perceived threat that presents itself as invincible. While some countries have been seeing more successes than others, all have a few quiet geniuses who have been analysing the threat in the quest to understand its weaknesses. The intent, quite pellucid, is to conquer the threat in order to resume some semblance of normalcy.
UNSUNG HERO
Here in our 83,000 square miles, we have Emergency Medicine Specialist, Dr. Zulfikar Bux, an unsung hero if you will, who since learning of the disease has been plotting its demise. Dr. Bux on a weekly basis, in these very pages, has been sharing some tactical moves that can help thwart the spread of the disease, if adhered to.
“From day one, I have realized that this is a disease where the biggest impact lies in preventative measure rather than in hospital care. The more preventative measures we take as a country, the more lives will be saved and the easier it will be for me and all the health professionals who are on the firing line,” Dr. Bux recently shared.
In fact, he embraces the belief that “We all have a role to play when it comes to this pandemic, I have just been doing my part. The more awareness there is about this disease, the more lives we may be able to save.”
Among the measures being valiantly pushed by this Emergency Medicine Specialist, is the importance of boosting the immune system, mask wearing for all, staying at home, social distancing, and very importantly, the practising of proper hygiene. Promoting these are crucial, Dr. Bux said, since as an Emergency Room (ER) physician, “I am in the business of saving lives. It will be wrong for me to not share what I know especially knowing that it may be able to save lives.”
Dr. Bux sits at the helm of the ER Department at the country’s premier public health institution, the Georgetown Public Hospital Corporation (GPHC).
THE PREPARATION
Recognising the potential of the coronavirus disease reaching our shores, Dr. Bux said that the GPHC decided to initiate a theoretical COVID-19 response plan in early February.
This plan, he said, was operationalise after patient zero was diagnosed with the disease in March. “It (the response plan) has of course evolved over time as we learn more about the disease and its presentations,” said Dr. Bux who revealed that the hospital’s response is guided by its COVID-19 taskforce which meets daily to review recommendations and plans, taking into consideration challenges and other factors that may arise.
But even as medical experts grasp a bit more knowledge about the disease daily, there remains a challenge to characterise a suspected case. This, Dr. Bux said, is due to the fact that the disease continues to have a varied spectrum of symptoms and signs. Nevertheless, the hospital utilises a screening checklist to determine the possibility of a case.
“We rely on the checklist, our medical training and our evolving knowledge of the disease to filter characteristics that may indicate that the patient may have COVID-19 or not, (but) the only way to be certain is to have a test done. This of course takes longer than we would like, but it is the reality of having a new, unknown disease. When we are not sure, we err on the side of caution to ensure other patients, and staff, are not placed at risk of exposure,” he intimated.
Dr. Bux’s department, understandably, is the first to assess all cases, COVID-19 or not, that arrive at the hospital. Because of the dynamic nature of the department and the spectrum of cases that present, Dr. Bux said that, “we always have to be on the alert for patients with atypical presentations who end up being COVID-19 positive.”
Although there are specific areas within the ER to manage COVID-19 cases, he explained that the entire team on duty is always in COVID-19 response mode. “Sometimes we have multiple suspected cases presenting and it takes multiple staff to deal with each case. At the same time, we have to balance our staffing to ensure that we also have sufficient staff for non-COVID-19 cases as well,” he added.
Essentially, the ER Department does not have the luxury of dedicating staffers to only COVID-19 cases. Moreover, doctors and nurses assigned to that department are expected to cater to a COVID-19 case, and then return to attend to a non-COVID-19 case after they would have changed their protective gear without breaking a proverbial sweat.
A RISKY SITUATION
The risk that ER staffers face every day has been amplified since the COVID-19 outbreak.
From time immemorial, adhering to safety measures in the ER has been paramount. But with COVID-19, these measures have been ramped up to the point of all patients being thoroughly screened upon presentation.
“We now have a team at the entrance of the ER that screens and performs primary triage (sorting out) of patients,” said Dr. Bux. This initiative was fast-tracked, he explained, after several of his staffers were exposed to COVID-19 cases that were not typical upon presentation. Those staffers had to be quarantined but none have tested positive.
To ensure safety in the department too, he revealed that suspected COVID-19 cases are managed in a separate section while the other cases are managed through the normal pre-existing channels. Though admitting that this approach is not fool proof, Dr. Bux insisted that, “it is the best way of triaging and managing patients given the circumstances”.
Operating in the forever bustling ER is a not an easy role to play since specialists like Dr. Bux are not only expected to think on their feet but oftentimes win a mental battle that can easily beset their flow.
“Being a member of the ER team, especially now, requires that you fight your protective instincts and be mentally strong,” said Dr. Bux.
Seeking to further quality the intense nature of the ER, he explained that while patients on hospital wards are already stabilized or differentiated for the most part allowing doctors a controlled environment in which to work, the ER demands a more “fast lane” approach.
“The patients who come to us are undifferentiated and sometimes unstable. Anyone that comes off the street can have COVID-19. They can have COVID-19 and be involved in an accident and present with multiple injuries. There is no way we will be able to determine that it’s a COVID-19 case. At the same time, we cannot wait to find out that patient’s status. Time is not on our side and there are times when we have to put ourselves at risk to save that person,” the ER Specialist asserted.
WILLING TO SACRIFICE
Interestingly though, there are some who do not have an appreciation for the tedious work of those operating out of the ER. Asked to share his thoughts on this, Dr. Bux said, “You have to be heartless to not appreciate what we are doing and how much we are sacrificing to ensure we keep as many persons healthy as possible. There isn’t much I can say to those who do not appreciate what we do during this time.”
Turning his attention to those who continue to be irresponsible by failing to adhere to measures to safeguard themselves and others, Dr. Bux made it clear that “This is a disease where it only takes one irresponsible citizen to put the lives of everyone else at risk. I cringe when I’m going to work and see so many persons socializing, not wearing masks and taking risks that they shouldn’t be taking at this time.”
Considering too that recently “we have gotten more relaxed”, the ER Specialist worried whether “we need to see more devastation” before the need for adherence is fully embraced. “I hope that we all come to our senses and be responsible citizens before it’s too late,” he added.
More than two months since Guyana recorded its first case, the numbers have steadily increased to upwards of 120, with 10 deaths at the time of writing this article. Unless persons embrace precautionary measures, Dr. Bux fears that the cases will continue to soar. “Countries with responsible citizens have better control of the disease spread. We need to sacrifice a bit to save a lot. The faster we all sacrifice and behave responsible, the quicker we will have control of this disease spread and be able to minimize on the restrictive life and save so many lives,” he asserted.
GOING FORWARD
But there are not only risks to consider in wake of COVID-19. In fact, according to Dr. Bux, the local public health sector, the GPHC in particular, is poised to have a stronger focus on communicable or infectious diseases in the future. He, with confidence, assured that “once this is over, we would have put systems in place to deal with outbreaks in a more efficient and effective manner than previously.”
In testing the resilience of the local health sector, Dr. Bux believes that COVID-19 has helped to create some changes that many didn’t even know were needed. “It has pushed us to the brink and has brought unity among teams of providers that has helped us to be more efficient in healthcare delivery. It has made it more difficult for us to approach patients without having that fear of risk. It is a mental battle with each patient, but it is helping us to evolve our minds to see the good during the tough times,” said Dr. Bux.
This outstanding medical practitioner also embraces the view that “this will help boost the relationship between patients and healthcare providers. Of course, a lot of us are mentally scarred and hopefully we use it as an experience to build our resilience with the right support.”
Even as he eyes the future, his focus continues to be in the present and often it is trained on his hardworking staffers who work beyond the call of duty. “I do worry for my staff…at this time, we cannot go on leave and I worry how long we can sustain this level of commitment without needing breaks. Hopefully, our citizens behave responsibly and help curb the spread so that we can get enough breathing space to take small breaks and catch up with our lives,” said an optimistic Dr. Bux.

“Countries with responsible citizens have better control of the disease spread. We need to sacrifice a bit to save a lot. The faster we all sacrifice and behave responsible, the quicker we will have control of this disease spread and be able to minimize on the restrictive life and save so many lives.”

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