KOLKATA: Covid-19 has brought sheer chaos to India’s under-resourced health provision systems, and for many frontline workers that is right where the problem begins. “In India, where we need 5 doctors we have 1. As doctors it’s not on us to create more positions for doctors; it’s governments’ responsibility. If as doctors we remain overworked the quality of care does down,” says Dr Arjun Talapatra, an anesthesiology postgraduate at the Manipal Institute of Technology.

There is 1 public hospital for every 56,000 people in India, and one hospital bed per 1,844 people. Each doctor must serve 1,456 Indians on average – but the bigger problem is the inequity in distribution, with physicians and medical facilities disproportionately located in wealthy, urban areas.

The Indian government’s expenditure on health is a scant and declining 3.6% of GDP, as opposed to a world average of 10%. Over the past few years moreover, a large chunk of these funds has been diverted from financing primary healthcare under the National (Rural) Health Mission to Aayushman Bharat, an insurance scheme where public money is used to subsidise private insurers and hospital businesses.

With the Covid pandemic these faultline are revealed to us clearer than ever before.

Dr Atia Rahman, who works as a medical administrator at one of Kolkata’s renowned hospitals, says “India’s healthcare is severely overworked, there’s no doubt about it. A hospital is not just a structure; it requires hundreds of staff including doctors and nurses, and what India needs is more of them.”

Even basic equipment is limited in the current outbreak. “We get a call from the neighbouring hospital, or we call them, saying ‘As of tonight ventilators are over’ or ‘As of tonight we are at peak capacity of patients’, asking other hospitals to take over when the burden becomes too much,” says Dr Anujeet Paul, a practising ophthalmologist in Pondicherry.

However, according to Dr Paul, of the large numbers of people coming in with symptoms and ailments, some come for “mere assurances. Uninformed patients add to the bulk of patients visiting the hospital, and they too have the moral right to be attended to, even though it costs medical professionals their time.”

It is well known that doctors handling Covid patients require PPE kits and necessary equipment, with stories of shortages coming in from all over the country. But the need for equipment does not exist for Covid alone. ICU beds, general wards, ventilators, etc. are also required for non-Covid patients. Many of these people are already being denied medical care: as the monsoon winds bring dengue, malaria and flu, how will hospitals keep their heads above the water?

“Just because Covid is now the latest pandemic it doesn’t mean that people will not have accidents, or heart attacks or strokes – 20 to 30% of our beds and services are reserved for such patients and for those who are critical and need 2 to 6 hours of intervention time,” says Dr Paul.

Dr Rahman adds that “we’re already anticipating the enormous volume of patients that will come up with monsoons. We know it’s going to happen and we are already preparing for it. It’s not possible to stop the rise of new infections: you have to deal it as the new normal.”

Chronic treatments like dialysis, or emergencies like cardiac dysfunction, also need constant attention. “Our hospital between 3 am and 6 am receives 60 to 80 patients who need dialysis. They cannot be ignored just because Covid happened,” says Dr Paul.

This raises the problem of hospitals becoming hotbeds of Covid transmission, as many reports have documented. As Dr Mausumi Das, who works at the Gandhi Hospital in Hyderabad, tells The Citizen:

“For two weeks we had wards and ICUs kept aside for non-Covid cases or cases we were unsure of, because they hadn’t been tested yet but needed admitting. The issue is that we cannot take care of such patients and ensure their safety from Covid. Once stabilised, they were immediately transferred to other facilities.”

Recent events at the Gandhi Hospital, where two junior doctors were assaulted by the relatives of a deceased Covid patient, moved several junior doctors to strike work. Questions were raised about the immense load of Covid patients thrust upon the sole Covid designated hospital for the 4 crore people in Telangana.

In Delhi NDMC hospital doctors had to threaten resignation or a “pens down” strike if they were not paid their salaries pending for the past three months. Doctors of the Kasturba Hospital had to threaten a mass resignation for the same reasons.

Given the continued under-availability of protective equipment and testing kits, Covid patients who are pre- or asymptomatic are adding to doctors’ challenges.

“Ideally we should be wearing protective equipment for every patient we come across – anyone can have the virus – but that’s not possible because we don’t have equipment in that capacity. We just hope they don’t have the virus, or won’t transmit it, or if they do, you just hope that you won’t transmit it to the other patients,” says Dr Arjun Talapatra.

He adds, “My roommate is also a practising anesthesiologist; we often have to try and put a tube in the patient’s airway. One of his patients later tested positive and since my roommate might have been exposed to the virus, he was quarantined.”

Dr Rahman underscores the problem: “Initially so many healthcare workers were testing positive. A few hospitals I know had to be shut down for few weeks because all the staff had to be quarantined.”

“Nobody was prepared for this,” Dr Paul believes.

“With the lockdown restrictions easing, I feel India is sitting on a ticking time bomb. We do not know the actual number of cases. People need to be tested and for a huge population like India’s, experts have already projected alarming rates of patients in the country by December this year. Our healthcare system is being overburdened and the country is losing lives that could be saved,” he tells The Citizen.

Dr Rahman offers a flip side. “Cases are increasing, but on the bright side we are also getting better at management, in terms of how to deal with the huge numbers using whatever we have. How messy things were at the start of the pandemic, and how it is now – there’s a lot of difference.”

It is often said that all great things are preceded by chaos. With governments slow on the uptake, corrupted by commercial interests and politicking, it is all India’s doctors can do to hold on.

All the doctors interviewed in this story are associated with Doctors For A Cause, a social welfare organisation and a community of doctors, medical and non-medical individuals.

Aniba Junaid is an undergraduate student at the Loreto College, Kolkata