CNS: When the health system became the cause of death

Well known Hindustani classical singer Padma Vibhushan Channulal Mishra, chosen as one of the proposers of Narendra Modi in Lok Sabha elections, lost his wife and elder daughter to Covid in private hospitals in Varanasi. Younger daughter has accused Medwin Hospital of charging Rs. 1.5 lakhs for treatement of her sister and not being able to explain the cause of death. Pandit Channulal Mishra has asked for a probe into his daughter’s death from the Chief Minister. The family has also asked for the CCTV footage of the ward where deceased daughter was admitted for a week. Madhurima Kundu, a Ph.D. student at Jawaharlal Nehru University was admitted for four days at Sultanpuri Government Isolation Centre for Covid patients in Delhi and has described the pathetic conditions related to availability and behavior of doctors, medical and para-medical staff, sanitation, food, medicines, linen and monitoring of oxygen in a petition filed in High Court. The ill patients had to go down to the reception to ask for every basic thing and stand in queues in scorching sun to get medicines.

True to the spirit of Atmanirbhar Bharat, 90% of the patients who chose to treat themselves at their homes, even without a trained medical staff available at hand, survived mainly because of better patient care at home. Most who was because of negligence of hospitals more than the disease. Question is why were family members as attendants, with Personal Protective Equipment and proper precautions, not allowed in hospitals? How many government-run and private hospitals do we know in India where attendant-less care is possible? Caring and supporting have an important role to play in the healing process. But our healthcare system is, barring rare exceptions, built in a way that we need a battery of attendants to support a hospitalized person. Given this grave reality, was it not a disaster to force-execute Covid isolation and quarantine based on an attendant-less approach? During the last 17 months since the global public health emergency was declared, the government has miserably failed to prepare the health system for attendant-less care for Covid patients. Moreover, rights-based access to care still remains a mirage for majority of our population.

Number of people hid their Covid condition at home for the fear of being dragged to hospital by the administration as they had more faith in their family members and local doctors. Most who availed the services of hospitals were middle and upper middle class as only they could manage a bed there. Why were people from slums, which are densely populated and hence should have been more prone to spread of disease, not there in hospitals? Surprisingly, the per capita cases were less in slums and lower income group localities. The government response has failed to acknowledge the mistrust its top-down decisions propel among communities, such as the idea of a highly centralized command control centres. Profiling of Covid positive people or criminalizing them or harassing whistleblowers who raised important concerns on Covid response (such as shortage of oxygen) are measures that will dissuade people to come forward.

Another reason for deaths in hospitals was that bureaucrats were taking decisions, including the nature of treatment, instead of people from the medical field. For example, in U.P. the command control centres were taking decision about the hospital to which patient should be admitted depending on availability of beds. A simple system where relatives of patients could find out even before leaving their home which was the nearest hospital with an available bed was not put in place in spite of all the hullabaloo about digital India. Number of patients died on way from one hospital to another. Member of Parliament Kaushal Kishore exposed how ventilators and BiPAP in Balrampur Hospital were lying unused for want of technically trained personnel who could operate them and over hundred beds with Oxygen in Respiratory Medicine wards, including ICU, of King George Medical University were not being utilized. The failure of health care system was criminal.

Even when doctors knew that Remdisivir was not a cure for Covid, at best it shortened the period of stay in hospital, and Plasma therapy was not effective against the new variant of corona virus (except for very few studies that show its possible role in very initial days since the beginning of infection), patients were being made to run from pillar to post to arrange for these ‘prescribed’ treatments. Government was chest thumping on largest ‘plasma bank’ while there was no concrete evidence to back its claim. Finally, Plasma therapy was dropped from treatment protocol by Covid Naitonal Task Force on 18 May, 2021.

Despite knowing fully well that there is no cure for novel corona virus and emerging science and data is very limited on its clinical management, government has failed to prioritise prevention. Breaking the chain of transmission of the infectious virus should have been centrestage to Covid response right from the very beginning of the epidemic. We failed to protect our frontline healthcare workers who not only contracted Covid but also an alarming number of them died in spite of having been vaccinated. How can we forget those nurses, doctors and other healthcare workers who had raised their voice against acute shortage of PPE or masks when the pandemic began? Why was 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 essentialness of the values and rights enshrined in our Constitution for every human being. Instead of ensuring social support security for every human being and people-centric agenda takes centrestage in governance for delivering on the promise of ‘Health For All’, the government is allowing select companies to mint profits, blackmarketing and hoarding to plague our ailing system, and worst of all, profiteering from illness and death to continue to take deeper roots. The Union and State government now seem to be competing to announce relief measures for children orphaned due to Covid. Did we need a Covid to remind us of the society’s responsibility towards orphans? And even now government is talking about only children orphaned due to Covid, not all orphans! Considering there is underreporting of Covid related deaths how many orphans or their well wishers will be able to prove that the parent(s) died of Covid in order to avail the ‘benefits’ from our labyrinthine bureaucracy? Will this government move away from event management approach and rather focus on serving its duty towards all our people? We should not have to use our class-caste connections to secure a bed in a hospital or a place in a crematorium. When will the system become sensitive and responsive to every citizen of this country?

Dr Sandeep Pandey, Bobby Ramakant

(Dr Sandeep Pandey, a Ramon Magsaysay Awardee, and Bobby Ramakant are part of Socialist Party (India). Follow them on Twitter @Sandeep4Justice, @BobbyRamakant)

5 June 2021