Amidst the raging second wave of the Covid-19 pandemic, a healthcare system that was already crumbling under the incremental load is gasping for breath, not just due to a lack of oxygen (pun intended) but severe shortfalls in all the basic medical amenities required for preservation and sustenance of life. The second wave was a rude shock to a society that had been preoccupied by state elections in the weeks when it crept up on us. The general public is now getting a taste of a differently morbid flavour of news every day morning. The news of numbers, pyres, chaos and propaganda. For healthcare workers, it’s a nightmare morphing into reality
Where do we start investigating this sickness befalling the healthcare services in this country? Getting to the basics—allocation of funds for health infrastructure, which has improved over years but still falls short by more than a mile. For a country that is obsessed with the idea of becoming a superpower in the near future, India spends a miserly 1.6% of its GDP on healthcare, a far cry from the at least 5% recommended by the WHO to meet the demands of the burgeoning population. After about 75 years since gaining Independence, the general callousness and short-sightedness of successive governments at the helm (irrespective of political colour) have left people dying on roads, under the trees and inside their vehicles due to lack of medical attention. With every disconsolate cry and the piercing gasp of anguish that emanates out of the mouths of the helpless and the dying, a sliver of human spirit is chipped off.
To have an idea of what kind of treatment is being given to the general population, we have to know how the essential healthcare providers are being treated. As happens during wartime, where soldiers are herded together and left to fend for themselves, doctors along with nurses and attendants are being treated as fodder for the cannons during this Covid war. Soldiers are at least provided with arms and ammunition for their battles, whereas these frontline warriors are short of essential tools like antivirals and oxygen in this fight. To make it worse, if they fall ill in the line of duty, they won’t be able to arrange a bed or an oxygen cylinder for themselves. How cruel is this irony!
According to the Indian Medical Association (IMA), about 800 doctors have been martyred in this long-drawn battle against the pandemic. Physicians are working in truly abominable conditions—overcrowded hospitals doused in fear and panic, inhumane working hours, sleepless nights and days, public scrutiny, political and administrative pressure, risk of getting infected, to identify a few. They are not allowed any leaves, even to take care of their own near and dear ones or even to quit their jobs if they simply don’t feel up to it. Work policies are inflexible. In various parts of the country, resident doctors and nursing staff aren’t being paid their regular salaries and are being held responsible for various situations out of their control. The ensuing period has witnessed them struggling with serious physical and mental issues. There are various studies on healthcare workers showing an alarming increase in depression, anxiety, sleep problems and even suicidal tendencies. Recently a resident doctor in Delhi committed suicide after a prolonged posting in a Covid ICU where he witnessed deaths of many patients despite him giving it his all to save them. This is a desperate wake-up call for all the stakeholders before it’s too late to stem this rot. Mental health issues have assumed an impetus during this pandemic, something that was long due. What about the emotional and social problems of one of the most vulnerable sections?
To add to this already agonising situation, the administration is still struggling to rein in the rampant black-marketing and stockpiling of drugs such as Remdesivir injections and even oxygen cylinders. These essential medications are being auctioned off and sold to the highest bidder. Remdesivir injections, which generally cost around `800-1,000 per vial, are being sold at around `20,000- 40,000 per vial, which challenges health and purses at the same time. Surely, no price is too high to pay for your or your loved one’s life. To add insult to injury, there are some pathologically evil rackets flagrantly manufacturing and supplying fake drugs to add to their corpus. So, even after shelling out all your savings, you may end up with an ineffectual injection.
The Indian Medical Service (IMS) could have been conceived along the lines of IAS, IPS, IES and IFS. The medical and healthcare delivery system needs to be placed in the hands of those who understand it best. There have been repeated requests from various doctor’s associations and bodies for the government to consider this proposition, but to no avail. This pandemic has exposed the Centre-state divide, with a lack of homogenisation in matters of healthcare delivery, and laid bare the ineptitude of bureaucracy in dealing with the matters of prevention and treatment of the corona invasion. This failing system requires an in-depth cleansing and an overhaul of its long-neglected healthcare infrastructure. And setting up the IMS would be the first of many steps required to mitigate this impending cataclysm and others to come.
We totally agree that the administration and governance are trying their best at all levels. They are also panic-stricken due to this unprecedented crisis. We also agree that when there is a war, the army needs to fight, period. However, when the enemy is unknown, fatalities are high and the battle is prolonged, the army needs a bit of extra care! That’s all we have to say as physicians.
This is no complaint, no grudge, no blame game, no finger-pointing. The frustration-filled lines above are a mere appeal to be listened to while we strive to protect others at the frontline. We may have chosen this profession out of our own will, but that does not necessarily grant us immunity from the sufferings and losses of humankind. Some of you may ignorantly argue, “You need to be stronger!” Trust me, we have been so for more than a year. Now we are at the brink of our sanity.
Desperate times call for desperate measures and while digging a well when the fire’s raging isn’t exactly foresight, there might still be something left worth saving.
Dr Mayank Rai (Psychiatrist, AIIMS, Rishikesh)
Dr Debanjan Banerjee (Psychiatrist, NIMHANS, Bengaluru)
(rai.mayank0@gmail.com, dr.djan88@gmail.com)