Creaking healthcare system pushed to brink
India
It had taken a long time for Pramila Minz, 28, to persuade her mother to relocate from her remote village deep in Odisha’s tribal belt to New Delhi.
After Gurubari Minz, 55, began showing Covid-19 symptoms and had a suspected stroke, her daughter was comforted by the belief she would receive the best possible healthcare now she lived in the Indian capital.
She took her mother to Safdarjung Hospital on June 10, but after conducting a CT scan and X-ray, a doctor refused to admit her because of a shortage of staff and beds.
Gurubari Minz was rejected by five other major hospitals in New Delhi during a frantic 24-hour search. Her condition was worsening, and she was experiencing breathing difficulties and drifting in and out of consciousness.
Despite these grave symptoms, her daughter still could not get her admitted, despite explaining to doctors that Gurubari Minz had suffered a stroke 18 months previously and was extremely vulnerable to coronavirus.
Social media is full of similar stories, helping to build a picture of a healthcare system in crisis as India battles the fourth-highest number of Covid-19 cases in the world. The extreme challenges faced by hospitals have been worsened by the number of doctors and nurses contracting coronavirus themselves.
‘‘Everyone is focused on beds and ventilators, but I am more concerned about the shortage of medical personnel,’’ said Dr Ramanan Laxminarayan, director of the Centre for Disease Dynamics, Economics and Policy.
‘‘Qualified doctors and nurses are working flat out and are exhausted. They then face additional stigma in their communities.’’
Pre-coronavirus, Indian public hospitals were already short of 600,000 doctors and two million nurses.
This scarcity is compounded by the fact that among 1.2 million ‘‘doctors’’ registered, more than half have no medical qualifications, according to the World Health Organisation.
For years, the Indian government failed to allocate more funding to train medical workers to fill the staffing gap or provide existing healthcare professionals with the knowledge to provide advanced care.
‘‘Healthcare workers have been referred to as corona warriors,’’ said Dr Saurabh Sachar at Safdarjung Hospital. ‘‘It can take 10 years and discipline to reach that stage – to develop a person who can work well independently in an intensive care unit, can work in a team, and decide what’s best for the patient.’’
Poor working conditions and stagnant wages have also prompted 100,000 doctors to emigrate to countries such as Britain and Australia.
Pramila Minz saw the shoddy conditions in many hospitals when she took her ailing mother on the tour of Delhi, trying desperately to get her a bed. At one, there were not enough staff to lift her mother on to a stretcher and she had to do it herself.
Eventually, Gurubari Minz was admitted to Lok Nayak Jai Prakash Narayan Hospital for treatment after her daughter’s local MP intervened following a plea on social media.
This week, India passed 500,000 coronavirus cases, but the pandemic’s peak is not predicted until November.
New Delhi has the largest number of infections out of any city in India, at 73,780, but the city’s deputy chief minister has predicted that by the end of July it will see 550,000 infections and require 80,000 more hospital beds.
‘‘Our current healthcare workforce is under a lot of pressure at this moment, not only due to the duration of the epidemic until now, but also to cope with the spurt in cases. We wonder how the government will manage to get enough healthcare workers to support the expansion of hospitalisation facilities,’’ said Malini Aisola, co-convenor of the All India Drug Action Network.
The shortage of healthcare workers is being exacerbated by the lack of adequate personal protective equipment, with doctors contracting Covid19
from patients. Healthcare professionals in Delhi, Mumbai and Kolkata said that while supplies had increased since the lifting of a nationwide lockdown on June 1, there were still shortages and they were often having to reuse torn PPE.
‘‘We understand these are difficult times, and it would be extremely wrong to think of our selfish interest now,’’ said one Delhi nurse. ‘‘We are not asking for money or anything like that. After all that we try to do, we just want to be treated like humans.’’
Another nurse in New Delhi said more than 300 workers in his hospital had tested positive for Covid-19.
A government doctor in a hospital in the city of Surat said shortages meant each employee was having to care for 30 coronavirus patients.
Private hospitals are not faring well either, with three facilities in Mumbai closing after a large number of staff tested positive for coronavirus. Healthcare professionals are also facing pressure to stop coming to work.
‘‘Most of the staff left the hospital when it was converted to treat Covid19 patients, because their families said they shouldn’t be around the sick,’’ said Dr Pankaj Solanki, the owner of the Dharamveer Solanki Multispeciality Hospital in New Delhi, which specifically treats coronavirus patients.
‘‘We have had to hire new nursing, laundry and security staff four or five times over the last 20 days because everyone is so scared, they refuse to come.’’
Solanki fears he will have to shut his hospital and many others will follow suit over the next few months, due to staff shortages.
Reports of patients being refused admission by hospitals has prompted the Indian government to step in and take control away from the Delhi government.
To cope with the predicted 80,000 extra beds it will need by July 31, the Delhi government is converting 500 train carriages and setting up a 10,000-bed Covid care facility in an ashram in the centre of the city.
It announced 25 luxury hotels would house patients, with unqualified staff expected to deliver medicines instead of room service.
The upcoming couple of months will be ‘‘mayhem’’, predicts Dr Yogesh Jain, a public health expert.
The onset of India’s monsoon season, and with it a surge in diseases such as malaria and dengue fever, will put further pressures on hospitals.
There is, however, good news for Gurubari Minz, who has been moved from an ICU to a general ward after 17 days.
But Pramila Minz has not received a phone call from anyone caring for her mother since her admission and has instead been receiving updates from a sympathetic ambulance driver.
She has been told that, while her mother is showing signs of recovery, her prolonged battle against Covid-19 is a result of her delayed admission.
‘‘I will do all that it takes to have her back,’’ she said. ‘‘Will you please pray for us?’’
– The Daily Telegraph