Mumbai: After a patient at a hospital in northern India tested positive for Covid-19, it wasn’t long before some of the medical staff began showing symptoms, too.
Doctors at Nalanda Medical College in Bihar state, short of protective equipment, treated the patient while wearing only a standard surgical kit — three-ply mask, gloves and plastic-coated apron. They ate in a mess hall shared by 83 doctors, all of whom now worry they were exposed to the coronavirus.
But when the doctors asked the hospital superintendent if they could be quarantined, they were told to keep working. With a pandemic spreading — and in an impoverished state with just one government doctor for every 28,000 people — the hospital couldn’t afford to lose them. So they took medication and kept seeing patients.
As the World Health Organisation warns of a global shortage of medical equipment in the Covid-19 pandemic, India’s beleaguered hospitals find themselves fighting an accelerating outbreak with too few doctors, health workers, test kits, beds, ventilators, protective gear, masks or other essential supplies.
A week ago, Prime Minister Narendra Modi called for a nationwide clanging of plates to show support for health workers. But after Kamna Kakkar, an anaesthesiologist in Haryana state, spoke out on social media about the lack of protective equipment — “When they arrive, send N95 masks to my grave,” she tweeted — Modi supporters hounded her on Twitter and called her “fake doc”. She deleted her tweets and took her account private.
Doctors and hospital personnel are particularly at risk of contracting Covid-19, and the parlous state of India’s medical system has raised concerns that its health workers will be exposed to the virus in even greater numbers.
Medical staffers at a few hospitals have threatened to go on strike over a lack of equipment. Experts worry that others will cease working due to illness, quarantine or fear of being infected.
“Because we know we are exposed to the virus, we are always insecure,” said Ravi Raman, a doctor at Nalanda Medical College. “I used to live with my parents and sister, but I’ve moved to another apartment. I need to protect my family.”
Lack of health insurance
India as one of the smallest health care work forces per capita of any country, with just one government doctor for every 10,926 people. (The WHO recommends a ratio of one doctor to 1,000 people.)
India’s public spending on health care is among the lowest of any major economy. Private hospitals treat a growing share of patients, but most Indians lack health insurance. That increases pressure on the government health system, with some states now moving to take over private facilities to fight Covid-19.
Experts say India’s failure to stockpile essential medical supplies could jeopardise the safety of front line medical professionals, risking a collapse of the health system in the midst of a pandemic. Some scientists believe that by mid-May, India could have hundreds of thousands of infections, meaning it would run out of hospital beds.
“If the medical fraternity starts crumbling in this situation, things will spiral out of control,” said Jerryl Banait, a Mumbai doctor who has petitioned India’s Supreme Court to address the shortage of protective equipment.
Health workers rely on personal protective equipment known as PPE — including gowns, gloves and N95 masks, which guard against the spread of respiratory pathogens. A senior doctor at a leading public hospital in Kolkata said it had only about 100 sets of protective equipment, not enough to last a week if coronavirus patients begin pouring in.
“The staff is demoralised, with older surgeons going on leave as they are in the high-risk age group,” said the doctor, who requested anonymity to protect his job. “The younger doctors are worried about countrywide shortages of PPE kits. Even if 10 per cent of the health workers, technicians and cleaners take leave, it will be difficult to run the hospital.”
The situation is more perilous in rural India.
In one remote district of Maharashtra state, doctors were wearing raincoats to treat suspected Covid-19 patients. Health workers’ fears multiplied last week after Modi imposed a three-week nationwide lockdown with four hours’ notice, stranding hundreds of thousands of migrant workers in cities far from home.
“Rural areas are still relatively excluded from the pandemic,” said Manu Gautam, president of the United Resident and Doctors Association of India.. “But what happened over the past few days could be dangerous.”
Doctors are also facing other challenges. Last week, physicians at the All India Institute of Medical Sciences, a leading university and hospital, said health workers treating Covid-19 patients were being forced out of their houses by landlords who believed they would spread the virus.
Modi said he was “very pained” at the reports. But experts said health workers had already lost faith in the government’s ability to protect them.
“There is always risk in treating patients, but taking a risk and committing suicide are different things,” said Vikas Bajpai, an assistant professor at the Centre for Social Medicine and Community Health at Jawaharlal University in New Delhi.
“When you force people to treat patients without taking even minimal precautions, then the impression is that the government is playing with the lives of the people.”