For healthcare professionals, witnessing deaths in hospitals was never new, especially for those who have worked with HIV/AIDS patients for decades. But any death before this pandemic was never “normal.”
Weeks and months of working with COVID-19 patients and watching people die every day, young and old, helplessly, without advanced care, is making deaths “normal.” But the pain and burden of losing patients does not get any easier. Before COVID-19, I do not remember patients pleading for breath just before they died in distress while I could do little to comfort them.
On Thursday, India had its deadliest day to date, with reported COVID-19 mortalities nearing 4,000. On this day, there were over 850 deaths in the state of Maharashtra, the state most affected by COVID-19, with close to 700,000 active cases and about 25% of the national COVID-19 burden. Maharashtra also has the highest number of HIV-positive people in the country, estimated to be over 390,000.
I was trained as a clinician but chose to work in public health and HIV/AIDS programs for the last 10 years. As part of an organization working to strengthen health systems worldwide, I, like many other public health professionals, feel frustrated to see the pathetic situation of the healthcare systems around us.
To deal with this frustration, in late April I volunteered as a clinician at the Indian Red Cross Society’s Bel-Air Hospital in Maharashtra. This 100-bed hospital used to be a tuberculosis (TB) sanatorium, established over a century ago on the top of the hills of Panchgani. The hospital was converted to an HIV/AIDS and TB care and treatment center in the early 1990s and is famous in the region.
The day I joined the hospital, I witnessed five COVID-19 deaths among patients ages 35 to 65. This is a secondary-level facility with limited resources in terms of equipment and trained workers, but this hospital is the only hope for the estimated 300,000 people that live in the nearby hilly terrain.
More than 1,000 COVID-19-positive cases have been treated in the hospital so far. Even though the district administration is financially supporting some of the beds in this hospital, a short supply of oxygen, medicines, and test kits presents a daily battle. The hospital drivers are running day and night to fetch oxygen. Sometimes, the hospital staff are in touch with the drivers, minute-to-minute by mobile phones, to check the drivers’ location so they can calibrate oxygen supplies. The decision to hospitalize patients is based not only on the need for hospitalization but also on the availability of oxygen stocks and beds. Other resources are limited in supply too. I have been waiting for the injection remdesivir for four patients; it is so difficult to get that it’s being sold on the black market.
Media coverage for major cities in India is widespread, but now COVID-19 is hitting the peripheral districts and its villages hard without much media attention. Shortage of COVID-19 diagnostic tests, delayed diagnosis and hospitalization, poor health infrastructure, shortages of medicine and supplies, and compromised, untrained workers are making the situation go from worse to worst. Hospitals like Bel-Air can manage with what they have, but destiny decides who receives a bed in a hospital and whether they can survive with the available resources.
The situation in metro cities like Delhi, Mumbai, Bangalore, and others is deteriorating with each day. The people, not the “system,” are responsible for their own access to healthcare and are running from pillar to post for medications and hospital beds.
This situation has been a long time coming — a health system does not collapse in a day or a month. Poor long-term investments and a lack of sustained efforts to maintain quality healthcare over the years result in absolute disaster when pandemics like COVID-19 strike.
“Health” has never been a priority in India, but political insensitivity in recent times — demonstrated by huge gatherings at election rallies and religious gatherings without ensuring any safety measures — are mistakes we can hopefully learn from.
Large, multispecialty private hospitals in metropolitan cities provide advanced healthcare services paid through private insurance, but this is not how most Indians receive healthcare. Around 70% of the Indian population still lives in rural areas, and a large proportion of the population has no health insurance. Unless the quality of care is improved and maintained at primary or secondary health facilities, there’s no way to protect the health of the majority of Indian society.
COVID-19 has exposed the reality of healthcare systems all over India. I can just hope that the lessons of this catastrophe will be used as an opportunity to reinvigorate healthcare systems in India before we are attacked by another COVID-19.
Anwar Parvez Sayed, MBBS, MPH, is Executive Director of the International Training and Education Center for Health (I-TECH) India, based in the University of Washington’s Department of Global Health.