Sohan Lal died of a COVID infection yesterday. He was 60. I have known him since the '70s when I was working in the textile workers' trade union. His elder brother, Nathu Prasad, a close comrade, was a worker in the Delhi Cloth Mills who was dismissed by the management for his union activities and later started working full-time for the union. The youngest of four brothers, a gentle and quiet teenager when I had first met him, Sohan Lal grew up into a responsible adult working hard as a vegetable seller to look after his family. He had been to the Azadpur Mandi on Friday the 15th. On Tuesday, he developed diarrhea and vomiting. The next day, he had to be hospitalised as his breathing got affected.
Admitted to the ICU in a private hospital in Meera Bagh, West Delhi, he underwent a series of tests including for COVID. A day later, when the results showed he was infected, the hospital management informed the family that he should be shifted to a COVID-designated hospital. He was in critical condition at the time. The family's experience, though individual, is instructive of how the system in Delhi deals with such cases.
There is no protocol for automatic real-time reporting by the private hospital to any government authority if a patient admitted in the hospital tests positive for COVID. The purpose of reports from such hospitals seem to be only to collect statistics, not to help the patient. A patient who may be critical needs care and swift and safe transfer, especially if a ventilator is required. But Sohan Lal had to wait several hours before being moved to a government hospital.
The Delhi Government has a list of designated doctors on duty in different districts. My call to the West District listed number was received immediately and I was directed to another doctor and then finally to a Dr Neeraj Roy who is coordinating the assistance. I gave him the details. He was extremely helpful, assured me that a bed in a COVID-designated hospital would be arranged. But it took two hours before a bed could be confirmed in Safdarjung Hospital. And then formalities in the private hospital took another few hours. This included payment of a quite substantial bill.
The Delhi Government has a list of designated doctors on duty in different districts.
The family were also asked to pay Rs 5,000 for the special ambulance to take Sohan Lal to Safdarjung. Since the lockdown, Sohan Lal's earnings had taken a severe hit. It is a shame that when families have lost their livelihoods, if one of them gets infected, the expenditure has to be born by them, pushing them into debt. Why is treatment for COVID not free in India? Why should the government not requisition a certain number of beds in private hospitals for treatment? Many of these hospitals have got land at subsidised prices and yet, when the entire country is facing such a huge crisis, the central government has not taken such a step and the entire burden is borne by public hospitals starved of funds or by families like Sohan Lal's who can ill-afford it.
They finally reached Safdarjung just before midnight. The staff on duty had not got the information of his admission and so the whole process was delayed. Dr Neeraj, who was following the case, said he had received three calls from the Safdarjung ICU asking where the patient was. He was trying to get through to the doctors but perhaps because of a shift change, there was a communication gap. Caught in this bureaucratic maze, Sohan Lal, struggling hard to breathe, lay unattended in the ambulance outside the building for more than an hour. The staff in the ambulance asked for an oxygen cylinder for the patient. After some time, a cylinder was brought but it was empty. The hospital staff said they were helpless. Ultimately, it was the ambulance staff who took Sohan Lal to the ICU using the ambulance equipment. Even the oxygen mask used was from the ambulance. The staff deputed to the Corona ward were not properly equipped with protective gear according to the ambulance staff.
Unlike many others, Safdarjung Hospital has an ethical policy of "no refusal" for any patient who comes for treatment. In this period of lockdown, it has one of the best records of care and recovery of COVID patients. Medical personnel and staff have had to pay the price with many getting infected. This has depleted the numbers of those on duty. Those working have to put in long and hard hours of work. In Delhi, the number of COVID-infected people is growing, now over 600 new cases in a single day. In addition, with the easing of lockdown restrictions, patients with other ailments who had earlier been denied treatment have been visiting the OPD in large numbers. Thus, the hospital and its infrastructure is under severe pressure.
At the end, even with the best of intentions and efforts of medical personnel, it is the patient who suffers, as Sohan Lal did.
In Delhi, the number of COVID-infected people is growing, now over 600 new cases in a single day.
I called up Dr Neeraj. It was well past 1 am. He took the call and heard what I had to say. I cannot share his comments. But while I was thanking him for his help, he casually said, "I tested positive for COVID today". I could not believe what I had heard and asked him to repeat what he had said. He did in simple terms. "I was running a slight fever. Since I have been at work all these days, I had a test, the results came today, I am COVID positive. Since I do not have severe symptoms and do not need hospitalization, I thought for today, till alternative arrangements are made, I should continue and do whatever I can from my sick bed at home to help those in need." What a hero!
There is no dearth of heroes like Dr. Neeraj in India. There are many like him including in Safdarjung and other government hospitals. It is the current national health policy that has failed them. The thrust of government policy is not to strengthen public health services but to promote insurance-based health schemes that benefit private hospitals and insurance companies. Current expenditure on public health is just 1.28 per cent of the GDP. All over the world, especially in the richest and most advanced countries, it is the privatisation of the health sector and the private insurance-based framework which has proved to be the Achilles heel.
But are we learning any lessons? Even in the 20 lakh crore package announced by the central government, only 15,000 crores was for the health sector. With such a small amount allocated to myriad expenses for the whole country, public hospitals like Safdarjung get left out. What is required is a huge financial package to modernize our hospitals, develop their infrastructure and most importantly, provide much better facilities for doctors, nurses and staff and ensure that in a crisis like this there is no shortage of medical personnel.
It also appears from the experience of this family that there is no attempt from the Delhi Government and health agencies under its jurisdiction to reach out to family members of COVID patients, especially of those patients who have succumbed, and advise them as to what precautions they should take. Doctors in the private hospital advised Sohan Lal's son Rahul to take the test. Rahul had earlier downloaded the Aarogya Setu app. So he filled in the details waiting for a response. Not getting one, he called 100, a police emergency number which quickly responded and took him in a police car to get his test done at Deen Dayal Hospital.
Here he was turned back and told he could come back "another time." 24 hours after his first report through Aarogya Setu, the app is deafeningly silent. A conversation I had with senior functionaries in charge of the Delhi Health Ministry to ask their advice gave a picture quite contrary to the advice given by the doctors. They said there was no need for the family members, even those taking direct care of the deceased patient, to have the test "as it would be negative for the first few days. Only if there are symptoms need the test be done but those in contact should remain in quarantine for at least a week. "I asked if they have a mechanism to contact families of patients. Till now, no official has advised the family. Sohan Lal was in touch with customers on a daily basis. But there is no effort at all to contact them, leave alone advise quarantine. In this case, the Aarogya app has been of little use.
The anxiety to unlock Delhi seems to have pushed protocols to manage COVID to the back-burner. A grieving elder brother, Comrade Nathu said "I told his children, don't weep. A member of our humble family has joined the international roll call of those who died of a common virus, to wake up the world to its infirmities. "
So while a family mourns, one can only hope that the spike of cases in Delhi does not get aggravated due to dilution of government responsibility and the monitoring of protocols.
Brinda Karat is a Politburo member of the CPI(M) and a former Member of the Rajya Sabha.
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