Reality check for Indian city dwellers, who are shocked to discover they have to fend for themselves
A majority of Indians have long ceased to expect much help from the state. But the public health crisis has now left Indian middle classes feeling orphaned and exchanging 'Get Well Soon' messages
Residents’ Welfare Associations (RWA) in the National Capital Region are busy making anxious enquiries about oxygen concentrators and cylinders. Several associations have already bought or booked them for emergencies, aware that their members may not get them when needed. ‘Fend for yourself and help each other’ is what people in NCR are being told as hospitals, helplines and doctors stopped receiving distress calls.
The RWAs however are walking into a logistical and ethical nightmare. Oxygen cylinders last only a few hours and require to be regulated and monitored. If trained hands are not available, they can do more harm than good. What is more, two or four oxygen cylinders and concentrators are not sufficient if the number of serious Covid cases spill into double digits. With most housing societies hosting 50 to 500 families, such a scenario is not improbable. Determining who gets to use the oxygen and who doesn’t is a dilemma that doctors are facing and RWAs soon will.
India’s middle classes are waking up to the reality that they are on their own. The majority of Indians have always known this. But privileged Indian city dwellers didn’t. The idea that neither money nor strings can get a hospital bed, oxygen or even a technician to take samples at home for Covid tests is something they were not prepared for. As Covid cases pile up, people also face the prospect of delayed or wrong test results arriving too late for hospitalization. Ambulances may take hours to turn up and when they do, they may charge exorbitant amounts.
After ignoring warnings for months, fuelled by ignorance and mixed messages from the government, people are now in such state of panic that neighbours who have tested positive are shunned like the Plague or worse, if that is possible. Seeing a ‘positive’ patient sitting on the terrace unmasked is enough to make calls to the local police station.
People have also woken up to the sad reality that the ‘government has given up on people’ as someone who had to spend a week in the AIIMS facility at Jhajjhar (Haryana) confessed. What he meant was that the government has also abandoned the middle class. Being a retired government official, he was lucky to get a hospital bed. As a scientist, who lost his son to Covid, reflected philosophically, “it pays to be a politician or a serving bureaucrat in Delhi today”.
A hospital bed, however, is often not enough. While the government boasts of having ‘added’ thousands of beds in Covid wards, there are few doctors, trained nurses and technicians to attend to the patients. Several hospitals in tier2 and tier-3 cities hired doctors and nurses on contract last year but terminated them when cases receded. In several other hospitals, unemployed and untrained youth were hired to help with little or no exposure to monitors, ventilators or other equipment.
A doctor from Ranchi recalled that while a fellow doctor was said to have died of Covid, it was revealed after weeks that his lungs had actually collapsed, unable to bear the pressure exerted by a ventilator. The ‘technician’ manning it had no experience of handling the ventilator. While only very few Covid patients require to be put on ventilators, as is now known, the government last year rushed scores of ventilators to district hospitals. But in most cases there is nobody to operate them.
Doctors and healthcare workers, overwhelmed by the sheer number of patients and fighting the trauma of losing their own colleagues and family members, confess they are demoralized. Working relentlessly for the last one year, some of them have opted out, adding to the already acute shortage of doctors. Some are resigned to going through the motions while those testing positive are isolating themselves.
Anecdotal evidence suggest that private hospitals are turning away serious cases because of non-availability of beds. In any case, some doctors believe, private hospitals would tend to treat less severe cases which cost less to treat but yield more revenue. That this is not true of only private hospitals is borne out by a video from a government hospital where a patient is seen sitting on a bed with books around him, reportedly preparing for the CA (Chartered Accountants’) examination. If he is well enough to prepare for the exam, what was he doing in the hospital?
The entitled, conceded a doctor, have occupied hospital beds even when they do not need one. “They would say they have elderly parents or young children at home and would like to stay in hospitals to avoid infecting them,” he volunteered. If such people have the capacity to pay or are well connected or know the hospital management and senior doctors, he explained, there was little that people in charge of admissions can do.
The brunt of the work in both government and private hospitals are being borne by junior doctors. There are 541 medical colleges in India with 36,000 post-graduate medical students, and they have been at the forefront of the fight against Covid. Senior doctors were given supervisory roles and kept away from Covid patients because of their age. But these PG medical students, who are paid a pittance, often paid once in two months are denied leave and left exposed to the virus without adequate supply of protective gear. “We are cannon fodder,” one of them was quoted as saying.
At a hospital in Prime Minister Modi’s home state Gujarat, a PG medical student found he was the only doctor entrusted with the task of looking after 60 patients, 20 of them in the ICU. What is the point in adding to the number of beds when doctors are not there? “In the ICU if four of the 20 patients start sinking, who do I attend first and for how long,” asked the distraught doctor. Doctors having worked in Covid wards are being deployed to non-covid wards, increasing the risks of infection.
At the beginning of the pandemic, doctors would work for 10 days or two weeks at a stretch and were then quarantined and tested after an equal number of days. They were described as warriors and as they walked out of hospitals, they were garlanded. When they returned home, they were welcomed as heroes. At the Prime Minister’s order, Indian Air Force planes showered flower petals on hospitals. A year later doctors fear getting manhandled by attendants of the deceased.
PG medical students have foregone academic lectures for a year now. “We now know everything about the coronavirus but nothing about our own subjects,” one of them laments while worrying about the future.
Last year was marked by considerable chest-thumping. With the government particularly conscious of its public image and keen on publicity and photo-ops, Vande Bharat and Vaccine Maitri missions were trumpeted as great success stories. India took pride in developing an indigenous vaccine, refused to negotiate with foreign pharma, turned down offers of aid and a pompous Prime Minister told the World Economic Forum that India had proved the world and doomsday prophets wrong. India had defeated the virus, under his leadership of course. Months later, India is reduced to gratefully acknowledge ‘gifts’ of ventilators, vaccines and oxygen from even smaller countries like Mauritius.
Bangladesh has sealed its border with India and other countries have issued travel advisories and banned flights from India from landing. Member of Parliament Mahua Moitra in a tongue-in-cheek tweet quipped, “With Indians on the travel ban list of yet more countries perhaps the only place we’ll have left to go to is Pakistan.”
The top-down Indian system has been chaotic and inequitable at the best of times. It has also been acknowledged for a long time that if anything can go wrong, they do go wrong in India. When registration for vaccination by people above the age of 45 opened this week, the servers crashed. But even those above the age of 45 were not spared.
A retired Army doctor, tired of being locked up in his home in Delhi, moved to Andhra Pradesh in April to head a department in a hospital there. Being a doctor, he had taken the first shot of the vaccine in February itself. But a month later he was told that it would be advisable to wait for six to eight weeks before receiving the second jab.
The government’s Cowin website, he was told, was a nation-wide dashboard and he could register again in Andhra Pradesh. The website did provide him with a list of hospitals in AP and booked a slot for him. But when he was turned away in the third week of April. “We have been turning away people for the past five days because of non-availability of vaccines,” he was told with the hospital helpless in alerting or altering slots allotted by the ‘national website’.
By asking for online registration for vaccinations, a large number of Indians have been left out of the process. With only 30% of Indians having access to smart phones, the obsession is proving to be fatal. India has in the past successfully vaccinated equally large populations in the absence of the Internet. There was no reason why it couldn’t have done so again with arguably better medical infrastructure and more trained medical personnel. But centralized planning, aversion to consultation and an inability to think through processes required to implement policy have created an impasse.
When the US Secretary of State Antony Blinken held online consultation this week with 136 US based CEOs, many of them Indians, it was pointed out that the Indian PMO wanted to centralise all aid efforts. With speed and coordination of the essence, US officials were clearly sceptical and felt that a more decentralised approach might work better in a country of India’s size.
India needs to vaccinate its population at break-neck speed, say experts unanimously. But as things stand, it will take months, if not a year and more, to vaccinate the entire population. With limited testing capacity and shortage of testing kits, India is primarily testing symptomatic people and long after they’ve finished spreading it to others.
It is now clear that an equitable public health system has to be re-built in India from scratch. But then middle-class India has always found entertainment and extravaganza more alluring.
Views are personal