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Saturday, July 02, 2022

A view from inside India’s crumbling health infrastructure

With or without support, health professionals march on, fighting survivor’s guilt and a crumbling system

Written by Satendra Singh |
Updated: May 24, 2021 8:40:42 am
Covid-19 patients waiting out side LNJP hospital in New Delhi. (Express photo by Anil Sharma)

As the weather turned windy one evening, I stood on the balcony with my little daughter. She exulted, “I can count the thunderclaps…one…two.” Little did I know then that the same night, another lightning would hit my hospital, extinguishing two lives: A middle-aged emergency medicine officer and a young junior resident, both lost to Covid-19.

On their first day at medical school, I often ask my medical students, “Why do you want to be a doctor?” Many offer answers along the lines of serving humanity, a few claim to fulfil their parental desires, and some others remain silent as they try to blend into the aura of a premier medical institution in the capital of India. Anas Mujahid belonged to the last category. He was often quiet, but whenever I saw him in the college foyer, he always greeted me with a wide smile. In January, the 26-year-old completed his internship and began working as a junior resident at GTBH (Guru Teg Bahadur Hospital), our teaching hospital. Returning from iftar to the hospital, he tested positive at 8 pm and was gone by 3 am. Towards the fag end, we struggled to find a ventilator in the very hospital in whose corridors he dreamt of becoming a compassionate doctor.

Two weeks ago, I texted my postgraduate student to see how his batchmate and best friend’s parent, who had Covid-19 and was admitted to our own hospital, was doing. He told me has was at the cremation. I was speechless. About the same time, I got a panic-stricken call with laboured breathing from my friend, a woman with disability, “No one is picking up the phone at the Delhi government helplines. I don’t want to die.”

During the same period, my wife and son tested positive for Covid. I quickly isolated all family members in different rooms. Sleeping alone in the living room, I would often be disturbed by passing ambulance vans — someone was fighting for their life, whether it’s for a ventilator or oxygen. As a disabled doctor, I am aware that people with disabilities are more vulnerable in this pandemic-turned-into-a-man-made disaster.

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According to a new New England Journal of Medicine report, people with intellectual disabilities are 5.9 times more likely than the non-disabled population to die from Covid-19 in the US. And we’re in Delhi, where a medicine required for care is hard to come by in hospitals but can be obtained quickly from a Member of Parliament’s office. What if I don’t get a bed in my own hospital? I was concerned. I don’t have medical insurance either, as disabled people in India still don’t have it in the 21st century.

I dread looking at my phone. It could be another frantic call from someone looking for a place to sleep. My medical college classmate from Haryana called at 2 am a week ago, asking if we had a ventilator at GTBH. There was none in Delhi, and the ex-army officer who had served the country, and for whom he had requested a ventilator, died on his way from the Army Hospital to Chandigarh in search of one. The daily struggle to get enough oxygen breeds a kind of moral cynicism born of powerlessness. We’ve been taught to save lives, not to resuscitate a failed infrastructure.

Another of my students, now a doctor, had to make the tough decision on who will receive a life-saving ventilator in a private hospital in Delhi. It would be difficult to make and execute such triage decisions, but living with them can be even more difficult. His senior, an alumnus from my institution who is now working in the US, experienced the moral distress first-hand during the US healthcare crisis last year, when he honestly said, “I am a soldier in this battle, and I am scared”. He is now pulling resources to help our hospital’s existing student-led mental health support network.

Policymakers and politicians in the capital appear to have become immune to the crisis. I got a number of requests from people outside of India. One medical university was eager to take on the workload of an entire tertiary care hospital in Delhi, but subsequent talks revealed their concerns about the “corruption” in the Indian system: They were wary of the money not going where it was most needed. No wonder, we spend just 1.29 per cent of GDP on health, even less than Bangladesh and Nepal, both of whom are not superpowers.

The most vulnerable in this pandemic are the disabled people. Door-to-door vaccination and drive-in campaigns at special homes, old-age homes, and halfway homes are still not implemented for disabled in the Delhi though such endeavours are being considered in other states and being done in other countries. The Centre declined the Karnataka government’s request to have a vaccination centre at old-age homes.

As we continue to rebuild an inclusive and resilient post-Covid world, it’s critical to give healthcare workers their due in both letter and spirit. We had to write to the Delhi government to request that healthcare workers at the University College of Medical Sciences and GTBH complex, who had given their lives in the service of the country, be granted solatium and martyr status. Health is a state subject. Odisha was the first state to accord martyr status to health workers dying on Covid duty. The Delhi government was silent on martyr status, but announced ex-gratia payment. This was done in an insensitive way. The order mentioned the sacrifice as “tragic, but inevitable”. As many health professionals fight survivor guilt, fractured infrastructure, we cannot afford to drop guard. With and without support, we march on!

This column first appeared in the print edition on May 24, 2021 under the title ‘Dr Powerless’. The writer teaches at University College of Medical Sciences & GTB Hospital, and is a disability justice activist. Views are personal

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