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When the Health System Became the Cause of Death

In 17 months of a global public health emergency, the Indian government miserably failed to prepare the health system for attendant-less care for Covid-19 patients.
Covid 19 Health System

Representational use only.

Well-known Hindustani classical singer and Padma Vibhushan recipient Pandit Channulal Mishra, who was one of the proposers of Narendra Modi in the 2014 Lok Sabha elections, lost his wife, Manorama, and an older daughter, Sangeeta, to Covid-19 in private hospitals in Varanasi. His younger daughter, Namrata, has accused a local hospital, Medwin, of charging Rs.1.5 lakhs to treat her sister and failing to explain her cause of death. Mishra has asked Uttar Pradesh Chief Minister Adityanath to organise a probe into Sangeeta’s death. The family has demanded the CCTV footage of the ward where she was admitted for a week.

Madhurima Kundu, a PhD student at Jawaharlal Nehru University, was admitted for four days at the Sultanpuri Government Isolation Centre for Covid-19 patients in Delhi. She has described the pathetic conditions at the centre in great detail—inadequate access to doctors, badly-behaved medical staff and doctors, poor sanitation and food, lack of medicine, dirty linen and virtually no monitoring of patient oxygen levels. Covid-19 patients had to go down to the reception to ask for anything they needed and made to stand in queues in the scorching heat to get medicines. Kundu filed a petition in the High Court of Delhi seeking redressal.

These are just two instances of the negligent behaviour of hospitals and the state over the last two months of the second wave of the Covid-19 pandemic. During this wave, a shortage of essential supplies led to a surge in deaths more than the disease itself. If hospitals are incapable of dealing with patients, why did they disallow family members from attending to their relatives? Provided they used Personal Protective Equipment and followed other precautions, the relatives of patients should have been allowed to care for their near and dear ones. After all, how many government-run and private hospitals do we know in India where attendant-less care is possible? Caring for and supporting patients is critical to the healing process. Our healthcare system, barring rare exceptions, is built so that every hospitalised person requires a battery of attendants. Given this, was it not disastrous to forcibly execute Covid-19 isolation and quarantine based on an attendant-less approach?

In 17 months of a global public health emergency, the Indian government miserably failed to prepare the health system for attendant-less care for Covid-19 patients. Moreover, rights-based access to care remains a mirage for a majority of the population. That is why many people concealed that they have Covid-19 and stayed home: They were afraid of being dragged to a hospital by the administration. Seeing the acute shortages in hospitals, they reposed greater faith in family members and local doctors. That is also why entire families contracted Covid-19, for some of the new strains of the Novel Coronavirus are more virulent than others. Most people who could access a hospital when they needed one belonged to the middle classes or the wealthy strata. Those who live in densely populated areas, such as JJ clusters, should have been more prone to contract Covid-19, but they were not in the hospitals in as many numbers. Surprisingly, the per capita rate of infections was lower in slums and lower-income group localities.

The government’s response to this crisis failed to acknowledge the mistrust generated by its top-down approach among communities. The highly centralised command-and-control system put in place to manage the pandemic made healthcare inaccessible. The profiling of Covid-19 patients and criminalising and harassing whistleblowers who raise concerns about the government’s response (such as shortage of oxygen) still dissuades people from reporting infections.

People died in large numbers in hospitals because of several institutional failures. One of them was allowing bureaucrats, instead of people from the medical field, to make decisions, even select the course of treatment. For example, in Uttar Pradesh, command-and-control centres decided the hospital a patient would get admitted to. It supposedly depended on where beds were available. So, a simple system wherein a patient could find a bed in the hospital closest was not set up. And then we make much hullabaloo about Digital India and Atmanirbhar Bharat.

Some patients died as they went from one hospital to another, seeking treatment or admission. Member of Parliament Kaushal Kishore exposed how ventilators and BiPAP machines at Balrampur Hospital were lying unused for want of technically-trained personnel. Nobody knew how to operate them. Over a hundred oxygen beds in respiratory medicine wards, including the ICU of King George Medical University, were not being utilised.

The failures of the healthcare system were criminal. For example, Remdisivir, a drug that could shorten the stay in a hospital, was widely prescribed and administered and then discouraged. Plasma therapy was declared ineffective against the new variant of the virus (though a few studies show its possible utility in the initial days of infection). However, so long as they were part of the “prescribed treatments”, they were chronically in short supply. Patients ran from pillar to post to arrange for them, at whatever price they could. The government was busy chest-thumping about “plasma banks”, with no concrete evidence to back its buoyancy. Finally, plasma therapy was dropped from the treatment protocol by the Covid-19 National Task Force on 18 May 2021.

Despite knowing fully well that there is no cure for Covid-19, which is a viral disease on which the science is new, and data on clinical management is limited, the government has failed to prioritise prevention. Breaking the chain of transmission of the infectious virus should have been at the centre of its Covid-19 response from the beginning of the epidemic. Our frontline healthcare workers not only contracted the illness, but an alarming number also died. How can we forget the nurses, doctors and other healthcare workers who raised their voice against the acute shortage of PPE or masks when the pandemic began? Why was the health system not fully prepared to use all evidence-based measures to prevent transmission of the virus among frontline healthcare workers?

The pandemic has reminded us of the values and rights enshrined in our Constitution for every human being. Instead of fostering a people-centric approach and delivering the promised “Health For All”, the government has let select companies mint profits and hoard or black-market essential drugs and devices. Profiteering from illness and death struck even deeper roots during this pandemic. The Union and state governments now seem to be competing over relief measures for children orphaned by Covid-19. As if we needed a pandemic to remind us of society’s responsibility towards children—all of them, not just those who lost their parents or guardians to Covid-19! Considering the underreporting of Covid-19 deaths, how many such orphans or their well-wishers will be able to prove their parent(s) cause of death to secure the “benefits” from our labyrinthine bureaucracy? Will the government stop its event management approach and focus on its duties towards all people? People had to bank on their social capital to secure a bed in a hospital, a spot in a crematorium or a vacant burial ground—is it not high time the system becomes sensitive and responsive to citizens?

Courtesy: Indian Cultural Forum

Bobby Ramakant and Sandeep Pandey are associated with Socialist Party (India).

Disclaimer: The views expressed in this article are the writer's own, and do not necessarily represent the views of the Indian Writers' Forum.

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