With inadequate PPE kits, gruelling work hours and threat of infection, ambulance crew find themselves caught in the epicentre of the coronavirus; Stigma and lack of government support have upended their lives
CHENNAI: In December 2019, when the first few cases of the perilous novel coronavirus were reported in Wuhan, China, most of us still didn’t know that it would soon wreak havoc across the world. In the following months, countries began to shut down, borders were sealed and life was interrupted. Meanwhile, India was still bustling, ignorant of the imminent danger, until the evening of March 24 when Prime Minister Narendra Modi announced on national television, “From midnight, this country of 1.3 billion will shut down.
For 21 days, forget what going out means.” On the same evening, huddled in a cramped room, P Vengat and his colleagues were worriedly watching the news unfold as Tamil Nadu chief minister Edappadi Palaniswami announced that the state, like the rest of India, was going into lockdown. “On March 24, when the lockdown was announced, Chennai hardly had a few cases. At the time I didn’t realise the threat of this virus,” says Vengat, an ambulance pilot from Perambur.
In his 15 years of experience, this was the first time Vengat was petrified to be in this field. Staying calm and focussing on the care to be administered have always been the mainstays in his line of work. Dealing with those on the brink of death, taking care of the injured, witnessing blood spattered on bodies or accident sites — Vengat had seen it all. But little did he expect that a tiny virus would unleash its monstrosity, upending his life overnight. Frontline workers like Vengat were now tasked with dealing with COVID-19 patients. With no information, absence of safety gear, and endless work shifts, ambulance pilots found themselves caught in the epicentre of the coronavirus.
Getting a grasp
While awaiting his COVID-19 duty call, Vengat nervously carried on with ferrying non-corona patients to hospitals. On March 30 at 3 pm, he was assigned his first COVID-19 case. Dressed in a PPE suit, wearing a face mask and surgical gloves, along with an ambulance technician, he reached the patient’s house. “The patient had returned from Mumbai on March 27,” he says. After the initial checkup of oxygen level, heart rate and temperature, they suspected that the entire family had been infected. Within the next two weeks, Vengat attended to five COVID-19 positive cases.
Soon the coronavirus hurricane ripped through the entire vulnerable population. Doctors, nurses, paramilitary, police officials, and ambulance drivers were now getting a grasp of what life was like on the front lines. Cheers and jeers, the community faced both, on and off the job. But Thiruvottiyar-based ambulance driver Dinakar M* was unfazed by the threat and the abuses being hurled at Covid warriors. “When soldiers fight to keep us safe, they don’t think about themselves. Everyone gets a time to act; this is our time,” he says, insisting that duty comes first.
As per rules and norms, in a medical crisis, it is the ambulance that is closest to the emergency location. Ambulance drivers do not have the option to reject an assignment. “During the lockdown, we would get a call from the dispatch office to attend to an emergency. Depending on how close we were to the patient, they would assign the call to us. Soon, the government allocated special ambulances to tend to COVID-19 patients. Everyone in the 108 (ambulance) network has to do a special ambulance shift of 12 hours between 8 am and 8 pm. Sometimes, if a regular ambulance is stationed closer to the patient, then that vehicle would be assigned the case,” explains Dinakar, who has been in this line of work for two years. Nearly two months after the corona crisis hit India, Tiruchy-based ambulance technician Dharam* started attending close to 11 cases every day.
“Of those, at least five test positive for corona,” he says. Technicians like Dharam ride along with the pilot to check the patients’ vital signs. In case an anomaly is detected, the patient is rushed to the hospital regardless of him/her being tested or not. “Unfortunately, because of the massive case load now, we have been instructed to accept only genuine cases, where the vital signs are abnormal. Otherwise, we ask the patients to consult their doctor and apply for an ambulance through them,” he elaborates.
No safety kits
While the nature of the job requires them to be detached from pain, the rising number of cases and deaths due to the virus has sent waves of shock among this community. The worry of dealing with infected patients has crippled their confidence. When Dharam received his first call to attend to two suspected corona patients on May 23, he was given the PPE kit, but there were no instructions on how to use it. “The PPE suit is extremely uncomfortable and I was sweating inside. It made me even more scared because one way of contracting the virus was through the exchange of bodily fluids,” he says. Seeing the day-to-day horror faced by the ambulance pilots, the Greater Chennai Corporation organised awareness programmes for onground medical staff between March and June.
They were taught to respond to COVID-19 emergency calls, take precautions, and the criticality of wearing PPE suits. But a month into the lockdown, TNIE reported that PPE kits were in short supply; even doctors were being asked to bring their own cloth masks, increasing their risk of being exposed to the virus. The shortage spelt more danger for ambulance pilots who were instructed to use the PPE kits only when it was confirmed that they were dealing with a COVID-19 case. While the special ambulances were given four kits every day, the regular ambulances had to make do with just masks and gloves. By June, Tamil Nadu recorded cases in four digits.
The flattening of the curve was nowhere in sight. Thyagaraya A*, who had joined duty that month in Chennai, was waiting anxiously for a call from his dispatch officer. Soon, he was summoned to ferry five patients, who had shown symptoms. “At the time, we were only provided with masks. Watching the patients cough worried me. After this, a group of us demanded that we should be given proper protection because we spend 12 hours daily, attending to suspected corona cases,” he shares. Even as the situation became grimmer, ambulance pilots continued with their yeoman service sans PPE kits. In fact, the first systematic survey on the status of personal protective equipment for healthcare workers in India, conducted in June, revealed that almost all components of PPE were found to be either inadequately available or unavailable in most hospitals.
“One of the surprising and important findings is the lack of formal training on PPE. Over half had not received any training and a fifth reported that they selftaught themselves. Also, about 88 per cent did not have the knowledge of appropriate PPE recommended for their work setting,” said Dr Subhashri B of CommonHealth, one of the three researchers behind the survey. While on the one hand, reports said that the virus had spawned a PPE kit industry in India, the ground reality narrated a different story. As recent as July, the dearth was yet to be fixed. The only respite came for the regular ambulance drivers, who were now given the option of transferring COVID-19 assignments to special ambulances.
Stay far, stay safe
In June, K Pal Kannan, secretary of All India 108 Ambulance Union in Chennai, received a call for a patient who had allegedly suffered a heart attack. A pilot for a regular ambulance allocated for non-corona cases, Kannan rushed the patient to the closest government hospital. “An hour later, he passed away. When the postmortem was done, doctors confirmed that the patient was COVIDpositive,” he says. Everyone, who had come in contact with the patient, including Kannan, was put under quarantine for 15 days. While he tested negative, he was asked to selfquarantine. “I was already staying away from my family to avoid the risk of passing on the infection.
A room and bathroom were arranged for me for the first seven days. I was expected to arrange my bedding and food. There was no support provided for my family during those 15 days,” he reveals. Spending days in obscurity, working non-stop shifts, their role in this pandemic is just as important as that of doctors. But this marginalised segment has been left to fend for itself. “At first, it seemed like a brave act to attend to people showing symptoms. But, as the situation got worse, we feared for the health of our families,” says Thyagaraya, (a father of two), who tested positive in July. By then, he had attended to over 50 COVID- positive patients.
Fearing for the safety of his family, he sent them to his hometown near Tamil Nadu border. “I first stayed at a quarantine facility for seven days under intensive care. Then, I quarantined myself in a room with an attached bathroom, provided by the GCC for 15 days,” he adds. Thyagaraya was promised an allowance of `9,000, to support himself and his family while being out of work. “We get our salaries at the beginning of the month and it depends on the number of assignments. We know the exact amount only after the salary is credited to our accounts. But the GCC transferred only `3,000 to my account during my quarantine period. I was given two barrels of water for my daily needs, and a delivery service was organised for my meals. The amount transferred was not enough to support my family, so I sent them to our hometown; at least my parents would support them,” he shares. Despite the assurance, his family didn’t receive any assistance, forcing Thyagaraya to make arrangements even as he was under treatment.
No dignity of labour
As the pandemic raged on, the virus not only affected finances but the psyche too. Thyagaraya and his ilk suffered discrimination and stigma from their friends, neighbours and extended family due to their community contact. “Even before I contracted the virus, my relatives had begun avoiding me. They were aware of my line of work and feared that I was putting them at risk, too. When they beat vessels for essential workers, I don’t think they considered us as one,” shares Kannan, with a hint of sorrow in his voice. It’s unfair, he says, that despite being the first response team, ambulance pilots and technicians are always considered to be at the bottom of the hierarchy in this field.
Thyagaraya shares a similar sentiment. Being the first to throw themselves at risk, they are labelled as ‘untouchables’ by society, he says. “My children have lost friends because their parents have stopped them from playing together. As an ambulance pilot, I feel I owe something to the general public. It is my duty. Yet, on the other hand, I lose motivation after looking at how they treat me at the end of the day,” he opens up. Ten years back, when Dharam had taken up this job, his parents expressed pride, but COVID- 19 has changed it all. “The pandemic has made them anxious.They keep telling me to quit my job and look for something else. My family hasn’t been ostracised by our neighbours, but some friends and relatives have stopped interacting with us because of my job,” he says. It is this worry that is forcing ambulance pilots and technicians to quit at a time when the state continues to record a daily spike in cases, rendering their role as pivotal. Many have been infected, but support and security remain tall promises. “So many people are backing out — technicians and drivers. The industry is recruiting people like never before. The CM bought 500 extra ambulances, but what is the use if no one is there to operate them?” Dharam asks. With the virus sweeping the country, and the focus on preventing deaths, here’s hoping these warriors receive their due — in care and kind.
(*Names changed to protect identity)