Ram Shankar met with a fatal hit-and-run accident in the rural area of Hardoi district of Uttar Pradesh on 16 April 2020 and was referred by the District Hospital to Trauma Centre of King George’s Medical University (KGMU) in Lucknow. He could not be admitted there and was referred to nearby Balrampur Hospital. From there he was referred to Dr Ram Manohar Lohia hospital. He was denied admission at these government facilities as only coronavirus affected patients were being admitted and beds had to be kept free for them. Leaving no choice for them the attendants had to take him to one private hospital after another because either it was too expensive or treatment was unsatisfactory. After going through Almighty, Kamakhya, Charak, Maa and Madocks he finally landed at Galaxy Hospital in Thakurganj where Ram Shankar expired on the morning of 21 April but not before his relatives were made to cough up close to Rs. 2 lakhs in all. The cost of using a ventilator at Madocks was Rs. 11,000 for a day but in the bill double the amount was charged. Ram Shankar belonged to an Other Backward Class with merely half an acre of land in his village.
35 years old Asghar who used to run a small shop from a kiosk in Dubagga, Lucknow, who was riding a motorcycle till a couple of days back, died on 22 April of some undiagnosed illness. The doctors of hospitals where he went were either unwilling or unable to treat him. It is a peculiar situation where some doctors or medical staff are unwilling to deal with patients for the fear of contracting coronavirus.
On 23 April Kiran went to get herself examined at Community Health Centre in Rampur Mathura of District Sitapur. She was asked to get some tests done at a private pathological laboratory at nearby Mehmoodabad. She was diagnosed with tuberculosis, given a strip of medicines and asked to buy more from the market.
Another patient came from Kanpur with a cardiac problem and sought admission to Lari Cardiology of KGMU. But he could not get admitted as every new patient needs to undergo a COVID-19 test to safeguard the essential cardiac care services. It is important to note that Lari Cardiology triages patients in wake of the pandemic so that entire cardiology facility does not face a risk of a shutdown or quarantine, bringing lifesaving services for the region to a halt. Upon arrival, every patient is kept in a designated area with infrastructure and trained healthcare workers for such triaging while COVID-19 tests are done from within the KGMU. Only test reports done from KGMU are accepted here. Tests may take up to two days but turnaround time for the report to come is reducing in every government facility. Upon a negative test report, the patient moves further in the regular cardiology care but only if it is a serious case. However, if the test report is positive, then the patient is triaged to regular care for COVID-19 positive people as per the government guidelines.
It is no doubt paramount to ensure that infection control practices in every healthcare facility are strengthened to prevent transmission of hospital-borne infections. Before COVID-19 too, government hospitals were overburdened with burgeoning demands of healthcare needs. More worrying has been the fact that a significant number of diseases our populations and healthcare system deals with are entirely preventable. The long-standing call from people who care about public health has fallen on deaf ears, to stop privatization of public healthcare, to prioritise preventive healthcare and hold those corporations legally and financially liable who are knowingly selling products that cause diseases (or kill).
COVID-19 has put the entire health system in the spotlight where it is essentially the government-run healthcare services that are struggling to withstand the onslaught of the potentially catastrophic pandemic. COVID-19 has put us in a situation where suddenly profit-making private healthcare industry is in the doldrums. Entire hospitals have had to be shut down for quarantine. It is only the government healthcare services that are still running despite the looming threat of COVID-19.
We need to realize that in this moment of growing crises, we cannot afford that our government healthcare facilities should risk being shut down for quarantine, or healthcare workers face any undue risk of COVID-19.
But equally important is to ensure that while we try our best to prevent COVID-19 pandemic, we are not brewing more pandemics which could have been averted with timely and essential lifesaving care.
On 15 April 2020, Chief Minister of UP had asked authorities to “restart” emergency services in government hospitals, which were earlier suspended on 25 March 2020 to prevent the spread of coronavirus in hospitals.
People living with HIV or Hepatitis C virus or active TB disease need uninterrupted treatment services. But due to lockdown, either health facilities were affected, or people were not able to go to the clinic to get their life-saving medicines. There was some respite for HIV as the National AIDS Control Organization of the Ministry of Health and Family Welfare had relaxed guidelines hours before the imposition of lockdown. These guidelines enabled volunteers among people living with HIV to step forward to home deliver antiretroviral drugs from government-run HIV clinics to over 45,000 people by early April 2020. But India has over 14 lakhs people who are on lifesaving antiretroviral therapy.
Similarly, TB services were affected. State TB officer of UP said that TB field workers were deployed for COVID-19 work. “OPDs in government hospitals are not functioning, private clinics have closed down. Even patients who are symptomatic (for TB) cannot access facilities.” “We have about 4,75,000 active (TB) cases. It is a huge challenge to get medicines to them. We are trying our best to ensure that their treatment is not disrupted.”
Essential services must also mean that we need to ensure uninterrupted medicines are reaching each one of those whose lives depend on it, and everyone who needs healthcare is able to get it. But if we look at the number of deaths due to preventable diseases and avoidable causes, a humbling realization may dawn on us as to how long neglected has health security been.
People do not flock to government hospitals casually, but only when their health needs attention or becomes acute or unbearable. Attending to COVID-19 is a public health emergency globally, but attending to heart diseases, strokes, cancers, diabetes, chronic respiratory diseases, or world’s biggest killer infectious disease (tuberculosis), is also an equal priority.
If patients with serious aliments other than COVID-19 are not given timely lifesaving healthcare, then we need to brace ourselves for a more worrying and unfortunate situation of multiple health and humanitarian crises. This has exposed the inadequacy of our health care system. We should remember that it is the same doctors who are being praised as frontline soldiers against coronavirus today who refuse to go and serve in rural areas in normal times, ask patients to get pathological tests done from private laboratories or buy medicines from private shops.
While we read about stories of brave doctors and medical staff who are putting their lives at risk by exposing themselves to corona affected patients, we also read the unfortunate incidents where medical teams are being attacked when they go to test suspected patients or doctor from Chennai who was even denied a cremation with human dignity. Such medical staff are laudable who have demonstrated an elevated sense of duty and committed themselves to cause of humanity and any attacks on such professionals are definitely condemnable.
We have read news about how railway coaches are being converted into emergency hospital wards. But if there is a lack of availability of infrastructure with the government healthcare system then the best way to add capacity would have been to nationalise the healthcare system. Then it would have at its disposal not only all the private hospitals and their equipment but also the doctors and medical staff associated with it.
After years of relentless privatization and weakening of the public health sector, there is a welcome recognition of the central role public healthcare plays in times of crises. COVID-19 has also exposed in all its ugliness how futile the private sector is in times of healthcare crisis.
Bobby Ramakant, Surabhi Agarwal and Sandeep Pandey
