[More than 1,000 doctors, and an
untold number of medical personnel, have died after coronavirus infections.
Many suffer an emotional toll as they make tough decisions about who gets
treated.]
By Mujib Mashal and Sameer Yasir
India’s doctors and other medical
responders find themselves short-handed and underfunded as they battle the
world’s worst coronavirus outbreak. Beyond the physical danger they also face,
they have been forced by the devastating
size of the outbreak and the government’s mismanagement of
the crisis into cruel routines of helplessness, making decisions day after day
that could determine whether a patient lives or dies.
As beds fill up, they have to
choose who among the throngs outside the hospital gates to allow inside for
treatment. As the oxygen runs out, they have to choose who gets precious
supplies. The emotional toll is mounting.
“All your life you prepare yourself
to exhaust every option to save a patient, but imagine when you have to
prioritize?” said Dr. Mradul Kumar Daga, a professor of medicine at the largest
Covid-designated hospital in New Delhi. “Those are the most heartbreaking decisions
as a doctor you have to make. And that is what has happened in the last three
weeks of my life.”
India’s second coronavirus wave is
killing thousands of people a day, and the country’s frontline medical workers
have shared in the cost. The Indian Medical Association said more than 1,000
doctors have died from Covid since the pandemic hit last year, with one quarter
of those dying since the beginning of April alone, said Dr. J.A. Jayalal, the
organization’s president. He estimated at least 40 percent of doctors have been
infected. Recent data on other medical personnel was not available.
The country’s health care providers
work amid an inadequate and deeply unequal medical system. According to
the World Bank, India’s health care spending, public and out of pocket,
totals about 3.5 percent of its gross domestic product, less than half of the global average.
They also face intimidation and
violence, with videos circulating of angry family members thrashing medical
staff in hospital halls covered in blood, or local strongmen bullying and
scolding them.
“Everybody who comes is tense, and
even a small issue sparks a big fight and the people are not understanding of
the situation,” Dr. Jayalal said. “Unfortunately, health care professionals
have been asked to manage all this.”
Nothing has underscored their
helplessness more than the sometimes avoidable death of their own colleagues in
front of their eyes.
Dr. R.K. Himthani, the head of the
gastroenterology department at the Batra hospital in New Delhi, became one of
12 victims when
the hospital ran out of oxygen for 80 minutes early in May. Dr.
Himthani had treated Covid patients for 14 months before he and his wife were
infected.
As the oxygen ran out, Dr. Shiv
Charan Lal Gupta, the director of the hospital and a friend of Dr. Himthani for
three decades, ran up and down the hallways sending messages to government
officials, media outlets and anybody who might help.
In their masks and gowns, the
hospital staff gathered with teary eyes and folded arms at the main gate to pay
their final respects as Dr. Himthani’s body was wheeled out. Then they went
back to work.
“The oxygen did arrive, but we
couldn’t save those 12 lives, including my friend,” Dr. Gupta said. “We are
feeling so empty and helpless from the inside these days.”
He added, “I have not slept for a
long time.”
India was already short-staffed in
health care. India had about 17 active health workers — doctors, nurses and
midwives — per 10,000 people, according to the Indian Institute of Public
Health-Delhi and the World Health Organization. That is far below the W.H.O.’s
threshold of 44.5 trained health workers per 10,000.
The distribution is unequally
concentrated in urban centers. About 40 percent of health care providers work
in rural
areas, where more than 70 percent of India’s population lives. Bihar, one
of India’s poorest states, has only 0.24 beds per 1,000 people, less than
one-tenth of the world average.
“When I close my eyes, I feel
someone needs my help,” said Lachhami Kumari, a nurse at a government hospital
in the Rohtas district of Bihar, one of India’s poorest states. Her 80-bed
facility has been overwhelmed by critical Covid patients. “When I manage to
fall asleep, I see people all around, begging for help. That has kept me
going.”
At another government hospital in
Patna, Bihar’s capital city, Dr. Lokesh Tiwari said almost half of the doctors
and paramedic staff have lost family members.
He said the 400 beds in the general
ward, and the 80 intensive care beds, remain full around the clock. Doctors and
nurses have broken down so often that the hospital has started providing
counseling services to its staff and their families.
“When you see people walking fine
and suddenly collapsing and dying in one hour, it has an impact on your mental
health,” Dr. Tiwari said.
In a sign of the second wave’s toll
on medical staff, Prime Minister Narendra Modi recently announced extraordinary
measures to address the worker shortage. He called on officials to reach into
the pool of tens of thousands of final year medical students and medical
interns for Covid duty, offering monetary packages and priority treatment in
future government recruitment.
“We are sent right into the high of
the tornado,” said Dr. Alisha Akhani, a 22-year-old medical intern who has been
doing Covid shifts in Anand district, in the state of Gujarat. “The times are
difficult, the times are uncertain. But we will come out as better doctors.”
Dr. Akhani has worked mostly night
shifts in the intensive care unit, which has 40 beds. When the shift ends at 8
a.m., she drives to her hostel, eats a quick breakfast and showers before trying
to get a few hours of sleep. Between shifts, she listens to music and exercises
— a badminton game or a quick run — to clear her head. She also needs to find
time to study for her placement exam after her yearlong internship is over.
Some nights, as many as five
patients die, she said. The deaths that are most difficult for the staff, when
they are the most emotionally drained, happen around dawn.
Sometimes, the loss hits close to
home. Dr. Akhani said one patient, a 50-year-old woman, was a relative. As she
weakened, Dr. Akhani had to call the woman’s husband.
“We were not sure if she was going
to make it through the night,” Dr. Akhani said. “I had to call her husband to
say she might not make it, that it would better if you call your kids and be
with your family during this time.”
Sometimes families ask the doctors
for help to say goodbye.
At a hospital in the eastern city
of Kolkata, one man, Soham Chatterjee, asked the doctors if they could arrange
a final video call with his dying mother, Sanghamitra Chatterjee, a 48-year-old
psychologist and music teacher.
As the doctor held the phone and
nurses gathered around, Soham Chatterjee sang his mother a Bollywood song from
the 1970s, choking on the verses. It’s a song she sang to him when he was
upset, he told The New York Times. Mother and son would also duet at dinners
and family gatherings.
It’s like we knew each other
before,
A heart isn’t won just like that.
Both of us will continue meeting,
That is the promise I make this
evening.
“I just stood there holding the
phone, looking at him looking at his mother and singing,” the doctor, Dipshikha
Ghosh, said on Twitter. “He asked her vitals, thanked me and hung
up.”
Mujib Mashal is The New York Times
correspondent for South Asia. Born in Kabul, he wrote for magazines such
as The Atlantic, Harper’s, Time and others before joining The Times. @MujMash
Sameer Yasir is a reporter for The
New York Times, covering the intersection of identity politics, conflicts and
society. He joined The Times in 2020 and is based in New Delhi. @sameeryasir