MAHARASHTRA ENFORCES NEW RESTRICTIONS
MUMBAI: Grocery and food shops will remain open only between 7am to 11am till May 1, the Maharashtra government announced on Tuesday as part of its efforts to curb the alarming rise in Covid-19 cases.
MUMBAI: On a balmy Sunday afternoon, 30-year-old Dr Vishal Rakh, a frontline worker at BYL Nair Hospital, is taking a quick shower. All the while, he can hear his phone ring.
In the 10 minutes he was away from his phone, he missed 12 calls and 15 text messages, none of which were personal. Over the next 20 minutes, Rakh patiently responded to messages and returned the calls, taking requests for bed, making allotments to patients, and helping relatives of Covid patients with contacts of pharmacists.
Having tested positive last week, he is in quarantine, but works remotely. Rakh, an assistant professor at Nair hospital, is responsible for the vaccination drive, as well as allotment of beds to Covid-19 patients as part of E ward’s war room.
Nair hospital has allocated 104 undergraduate medical students—all supervised by Rakh— to the war room facilities of the Brihanmumbai Municipal Corporation (BMC). Each of the city’s 24 war rooms receive calls from incoming patients seeking a bed; the war rooms also reach out to Covid-positive patients once the BMC receives their reports. Apart from civic-run hospitals, BMC also has command over all ICU beds and 80% of the other category of beds in private hospitals. In short, every allotment of a bed or a ventilator takes place through the war room. Hospitals are required to update the centralised dashboard signalling the number of beds, ventilators and ICU facilities, twice a day. Rakh’s job involves categorising patients based on the severity of symptoms using the triage method. He then allots beds accordingly to dedicated healthcare hospitals and Covid-care centres.
A cool bath, a quiet dinner and uninterrupted sleep are luxuries that frontline workers like Rakh cannot afford. On an average, Rakh fields around 500 calls a day but a single missed call notification can turn into a trigger for him. “Last year in May, I had confirmed a bed for patient coming from Chembur. However, upon reaching the hospital, he died while waiting. So, I feel like every call I miss is one person I could have helped,” he said.
Most healthcare workers can’t access their mobile phones in Covid-19 wards because personal protective equipment (PPE) gear makes it difficult for them to operate one. By the end of their eight-hour long shifts, the doctors we spoke to said that they often find close to 200 missed calls and countless messages seeking beds, oxygen or advice on Covid medication. During the first wave, several healthcare workers —doctors, nurses, technicians and support staff— pulled up to 12-hour shifts at a stretch and stayed quarantined from their family members; now as the second wave hits the country and stretches our healthcare infrastructure to its limit, frontline workers are facing the brunt again.
Making frequent calls to see if there are any beds available for patients needing urgent attention has become the new normal for 47-year-old Smita Mohite, sister in-charge of the casualty department at Rukminibai civic hospital in Kalyan. These days her workday begins at 9am and goes well past 5pm.
Two days ago, when a 50-year-old suspected Covid patient was breathless, Mohite looked frantically for a bed for him. However, when she managed to find a bed after two days, she finally decided against moving him as his condition had deteriorated. “By the time I found a bed for him, the patient was gasping. So, then I had to find a more advanced set up for his treatment, but he died right in front of me. The worst part is that even though I found a bed, I could not help him,” said Mohite, who has been associated with the hospital for 24 years.
“To see them (patients) in pain and not be able to find a bed has been straining on my mental health but I have to keep trying,” said Mohite.
Mumbai has been consistently recording around 8,500 cases on an average daily. And while the city is inching towards a crisis in beds – BMC dashboard, which is updated daily, on Sunday showed an 82.5% occupancy of beds, and 98.4% occupancy of ICU beds – it is currently facing a severe shortage of oxygen. Last week, BMC had to shift 168 patients out of six civicrun hospitals to jumbo centres; private hospitals aren’t immune either. It means that while beds may be available, medical grade oxygen needed for critical patients may not be available. For a majority of healthcare workers, however, it’s a limitation to the care that they can provide – and that’s hitting many of them hard.
Dr Jalil Parkar, a pulmonologist consulting at Lilavati Hospital, said, “Doctors have always felt a moral obligation towards patients, but it has been heightened during the pandemic, so much so that it has started affecting our mental health. There’s a sense of guilt I feel for not being able to take a call.”
“The work just doesn’t end. Treat Covid patients, go on rounds, perform procedures, teach students and the cycle repeats,” Parkar said.
Doctors, nurses and support staff agree that the second wave is much more challenging than the first one. “We are dehydrated, exhausted and constantly worried of missing a lifesaving call,” said Rakh.
Taking a bathroom break is a hassle as it entails removal of PPE and changing into new ones. To minimise this hassle, they limit their liquid intake but profuse sweating under the layers of PPE leads to dehydration.
Along with Rakh, two more doctors from Nair hospital tested positive last week. They are among the 2,000-odd frontline workers at the hospital who are yet to receive the vaccine as their names could not be uploaded to the portal due to a technical glitch. The vaccination drive in Maharashtra kicked off on January 16 for healthcare and frontline workers, which was later extended to senior citizens and those above 45 years of age. As on Sunday, BMC has administered 1.96 million doses. Among healthcare workers, 172,000 received their first dose and 93,642 got the second shot.
“Paristhiti gambhir hai. Logon ko samajhna chahiye (The situation is grim. People must understand that),” Usha Jagtap, a scale-4 staff at government-run Kasturba hospital, said in a fatigued voice. In her 13 years of career, she has not seen a disease of this magnitude.
Through the day, ward boys and caretakers end up making four to five rounds of the ward, distributing meals, at times feeding patients, filling water bottles, giving medication, ferrying patients in and out of wards, taking them for tests, and getting reports among a myriad of other tasks. “I think our biggest job is to help patients cheer up. In a gloomy ward, it is important to whisper positive thoughts into patients’ ears. Only if they eat well, take care will they get well soon,” Jagtap said.
Jagtap said she had no time to think about herself. “This is the worst outbreak of any virus that I have seen in my life. I can imagine how frightened the patients must be. So I tell myself that I must comfort them, for my sake and theirs,” said Jagtap, who is worried that she may contract the disease or worse, give it to her son and nephew, who reside with her.
Tushar Parmar, critical care specialist at Apollo Hospital in Navi Mumbai, feels the burden of the pandemic more keenly. “Aside from treating patients, we have an added responsibility of being spokespersons. With family unable to be near them, it is our duty to convey their messages to the family. Tthe next duty is to call each family and convey their condition and messages,” Parmar said.
“They are not mere patients anymore as I know much more about them. During the course of stay, we interact a lot and, in the process, start to know them even more. Since they don’t get to physically meet any family member, it becomes our responsibility to make them feel comfortable psychologically, too,” Parmar said. The longest stay one of the patients had stayed was for 90 days in the beginning of the pandemic.
One of the toughest decisions that Parmar had to take was to send his eight-year-old daughter away to his parents in Gujarat as cases rose—something he had done last year as well.
“She is safer there rather than with us as the situation is getting worse now,” said Parmar, whose wife is also a doctor. As the number of cases began to rise last year, BMC increased the number of beds steadily – from 16,000 in June to 18,000 by October. In September 2020, the number of beds available for moderate to serious patients in these facilities was 14,927; by April 17, 2021, the number has risen to 20,608. However, even as the health care infrastructure has seen an incremental increase, the caseload has also grown tremendously.