Supported by a pillow and slouched over his hospital bed, Jagdish Prasad Mittal, 79, watches his son Manoj frantically dialling people, enquiring if an ICU bed is available in any hospital along the 120-km stretch from their hometown Nim Ka Thana in Rajasthan’s Sikar district to Jaipur, the state capital.
Opposite him at the Covid ward of the Community Health Centre (CHC) in Nim Ka Thana, another septuagenarian Mariam Bano gasps for breath, her body suddenly convulsing. Bano’s grandson Syed Yunus cries for the duty doctor who rushes along with nursing staff to check on her. But a few moments later, a curtain is drawn around Bano’s bed. She is declared dead.
On May 14, Rajasthan Chief Minister Ashok Gehlot took to Twitter to say that with 2.11 lakh active cases, Rajasthan is fourth in the country in terms of active cases. A day after, he said given the rapid spread of cases in rural areas, there is a need to strengthen healthcare services right up to the lowest tier.
Travelling across villages, and stopping over at government hospitals in rural Jaipur and adjacent Sikar district, The Indian Express finds the healthcare system struggling to work despite multiple problems — oxygen shortage, idling ventilators, reduced staff strength with frontline workers turning Covid positive, and a flow of rural people complaining of fever and breathlessness.
On Saturday, Sikar registered 485 Covid cases, and the day before it had reported 674 new cases.
The Kapildev Government General Hospital, where both Bano and Mittal were admitted, also designated as a Sub-Divisional Hospital, serves as the CHC of Nim Ka Thana, and caters to around 180 revenue villages and 59 gram panchayats. Just over a week back on May 8, it had started a 30-oxygen-bed Covid care facility. All were occupied within a few days, says Dr GS Tanwar, Principal Medical Officer (PMO).
“We had to increase the capacity to 40 oxygen beds to accommodate more patients. We have a plant which provides oxygen to 16 points. We also use 30 oxygen concentrators and cylinders to meet any shortage. Private entities have donated 20 concentrators, and the district administration provided 10,” he said.
Manoj Mittal, a businessman, said it was the first time ever that he brought his father to a government-run facility because oxygen shortage at private hospitals was even worse. “My father needs an ICU bed. I have been trying since morning, but beds everywhere are full. Yesterday, my father’s oxygen saturation dropped to 80,” he says. He managed to get the bed in the CHC with a reference from a local MLA.
Clutching to her salwar kameez, Bano’s grandson Syed Yunus tries hard to hold back his tears. “We came here around 20 days ago. The Covid test of my grandmother was negative but she continued to feel breathless. Her saturation was around 69, but was not put on ventilator… She would have lived had she received continuous high-flow oxygen and had she been put on a ventilator,” he says.
Just beside the ward is the CHC’s Intensive Care Unit with eight ventilators kept beside beds. But the room has no patients, none of the machines were put to work on Saturday.
When asked why ventilators were kept idle, Brijesh Kumar, Sub-Divisional Officer, Nim Ka Thana, said, “Our oxygen plant has a capacity of 150 litres per minute. Each patient on the ventilator will consume around 50 litres per minute — equal to the requirement of eight patients who get oxygen generated from the plant and supplied through a line. We have 16 such beds being supplied oxygen through this line. We will have to either remove these patients or arrange oxygen cylinders for them.”
Officials from the health department admitted that with steady rise in cases, oxygen is in short supply. “The overall requirement for oxygen cylinders in our district is around 1,500 cylinders a day. At present, we receive only 750-800 cylinders. The hospitals are full of Covid patients. The doctors have to adjust the flow of oxygen consumption per patient to accommodate everyone. This has brought down per patient consumption to around 1.7 cylinders everyday,” says Dr. Ajay Choudhary, Chief Medical and Health Officer, Sikar.
Healthcare workers testing positive is also a major challenge.
“They may be vaccinated, but if they have mild Covid, their family members are often ending up in serious condition contracting the infection from them. The government should immediately prioritise family members of healthcare workers for vaccination,” says Dr. Choudhary, who is also the President of the All Rajasthan In-Service Doctors’ Association (ARISDA), a body raising issues impacting government doctors in the state.
Around 50 km from Nim Ka Thana, at the BDM district hospital in Kotputli in Jaipur rural, the emergency ward is full, with patients on stretchers being wheeled in every few hours, most of them gasping for breath. Here too, ventilators are not functioning.
“We have 15 ventilators but we are unable to use them because three doctors who are needed to operate them have tested positive for Covid-19. Moreover, the oxygen from the one plant in our hospital can cater to 30 beds and we supplement it with oxygen cylinders and concentrators. But there are 68 patients on oxygen currently. Our oxygen supply is not adequate to run ventilators,” said Dr. Ashwani Goyal, Principal Medical Officer, BDM district hospital, Kotputli.
Patients in need of ventilators were being referred to Jaipur, but most opt to stay here, fearing they may lose the oxygen bed in the hospital if they are unable to arrange a bed in the state capital.