Doctors, Ventilators In Short Supply As Covid Moves From Metros To Rest Of India

Mumbai, MAHARASHTRA — When the Shastri Nagar General Hospital in Dombivli received two ventilators soon after the Mumbai floods of 2005, the hospital —run by the local municipality — wondered how to put the life-saving machines to use in a facility that didn’t have an Intensive Care Unit or specialist doctors to operate them.

One of the ventilators was never used, and fell into disrepair. Fifteen years later as Covid-19 rages through this satellite town 40 km from Mumbai, the other ventilator at Shastri Nagar General Hospital is used as part of a six bed ICU. 

The hospital is one of two facilities run by the Kalyan Dombivli Municipal Corporation (KDMC); the Bai Rukminibai Hospital in Kaylan is in similar shape. Both hospitals have 120 beds each, that for years have not graduated from treating minor fever, viral ailments and childbirths. Between them, the two corporation hospitals have one part-time physician, five gynaecologists, four anaesthetists, two paediatricians and one orthopaedic surgeon put together. Two of these anaesthetists are now operating the sole ventilator at Shastri Nagar General Hospital. 

With 24,068 novel coronavirus infections and 487 deaths as of August 6, the KDMC region is the worst hit of Mumbai’s satellite cities, yet medical officials concede that they lack the expertise needed to treat this fatal new illness. 

“We don’t have any general surgeons, chest physicians, intensivists etc,” said KDMC’s medical health officer Dr Suresh Kadam. The lack of specialists, Dr. Kadam said, was a pressing issue. As Covid-19 cases surged in Kalyan-Dombivali, the KDMC placed a desperate advertisement to hire doctors at a generous salary of Rs 2,00,000 per month. When no one came forward, the KDMC raised the salary to Rs 2,50,000 per month in a second advertisement. 

“Yet, not a single candidate came forward,” said Dr Kadam.

Thus far, the efficacy of India’s Covid-19 response has been measured by the acquisition of materials and supplies — test kits, hospital beds, PPE overalls for doctors, and ventilators. Yet, as KDMC’s current predicament reveals, procurement is useless without specialists trained to use these supplies and equipment to save lives. 

Meanwhile, medical officials in Mumbai say the lack of medical facilities in the wider Mumbai Metropolitan Region has put pressure on the capital city’s stretched healthcare system.

“Of the 9,000 Mumbai’s currently occupied Covid beds, 32% are patients from the satellite cities,” Mumbai’s Civic Commissioner Iqbal Singh Chahal told HuffPost India on July 31. He said that over 4,000 Covid deaths that occurred in Mumbai over the past three months were actually of patients from outside the city. 

As India’s Covid-19 pandemic moves from major cities to smaller towns and rural clusters, public health experts warn that the Kalyan-Dombivli’s nightmare scenario is likely to play out again and again in state after state where the public health system has atrophied after decades of negligence and public apathy. 

“Unless urban primary healthcare is upgraded in a big way, not just in big cities but also in suburban satellite towns, we are not going to see well established healthcare,” said Dr K Srinath Reddy, president of the Public Health Foundation of India. 

“In lack of such evolved system, you will only see some private nursing homes and may be a couple of multi-speciality hospitals coming up, but wide availability of primary and secondary services and affordable tertiary care services will not be there,” said Dr Reddy citing the example of Gurgaon that has many private multi-speciality hospitals that offer good tertiary care but affordability remains a challenge. “Therefore, Gurgaon has to upgrade its civil and district hospitals. One cannot depend on the private hospitals which are out of reach for most people. The illusion of availability should not lead to neglect of the public healthcare,” he said.

For now, the KDMC has hurriedly procured 12 additional ventilators that have been installed at a stadium repurposed into an COVID hospital. Private hospitals in the municipality have another 66 ventilators. Bai Rukminibai Hospital still has zero ventilators and has been turned into a non-Covid facility.

KDMC’s public healthcare system

Two weeks ago, Mayur Ghodke an 18-year-old resident of Vithalwadi in Kalyan developed severe stomach ache and had to be rushed to a private hospital, where tests revealed that he had a swollen pancreas. He was admitted to the ICU, but soon developed breathlessness — which was found to be Covid-19.   

“Doctors told us that swelling induced by an infection combined with Covid could make his situation worse. We were immediately told to look for a Covid hospital with a ventilator backup,” said his father Ashok Ghodke.

But none of the six Covid hospitals in Kalyan — public or private — had a vacant bed with ventilator support. Eventually, they moved Mayur to Mumbai’s SevenHills Hospital, about 42 kilometres away from their home.

“We had shifted from Mumbai to Kalyan in 1989 but every time there is a medical emergency, we have to rush there,” Ghodke said.

The Ghodke family is one of hundreds of thousands of former Mumbaikars to be gradually priced out of Mumbai’s dizzying property market. In 2011, Kalyan-Dombivli had a population of 1.2 million people. Today, city officials estimate the population has risen to over 1.8 million, most of whom have found jobs and livelihoods in the Mumbai metropolitan region’s ever-growing sprawl. 

KDMC reported its first Covid-19 case on March 13. It took almost four months to hit 10,000 cases on July 5; but eight days later the number of cases had crossed 15,000.

As the Covid-19 pandemic quickly overwhelmed KDMC’s civic-run medical facilities, the municipal corporation took over three private hospitals, the civic-run Shastri Nagar Hospital opened a six bed ICU in June, a first for KDMC, and a sports complex, Savlaram Maharaj Krida Sankul, with 185 beds, including 30 ICU beds, was opened as a jumbo facility only on July 6. Even so, patients with severe symptoms still had to make the 40 km journey to Mumbai.

Some patients did not survive the journey.

On June 21, Dr Parag Patil, a 52-year-old gynaecologist, succumbed to the infection after undergoing treatment in three hospitals. Dr. Patil had volunteered to work at the fever clinics started by the corporation, when he caught Covid-19 himself. He was initially admitted to Meera Hospital in Kalyan and subsequently shifted to Horizon Hospital, Thane. 

“But all this while, his family was trying for a bed in a Mumbai hospital for better nursing care,” said Dr Prashant Patil, secretary of Indian Medical Association, Kalyan, who knew him well. The family finally secured a bed at Mumbai’s Jaslok Hospital, where he battled for life for two weeks before succumbing to the infection. 

“For years, we have been demanding better and affordable facilities at the public hospitals but all our pleas have fallen on deaf ears,” said local activist Shrinivas Ghanekar. Ghanekar himself was looking for a hospital bed after his 80-year-old father, suffering from cancer, contracted Covid-19.

“Doctors in one of the hospitals taken over by the KDMC told us that they were not equipped to handle such patients during the pandemic,” said Ghanekar. His father died at home on July 18.     

KDMC commissioner Dr Vijay Suryawanshi refused to comment on the state of KDMC’s public healthcare system, saying he only took over the post in February.  

“Since the crisis hit, I began aggressive preparations. Our situation is under control now. The numbers have fallen and the doubling time of cases has increased from 15 days to 36 days,” he said. 

He said that another large hall and a school have also been converted into Covid health centres. The functioning of these jumbo facilities has been outsourced to a private health agency. “We are also working towards creating at least two permanent facilities that would last in KDMC for the next 15-20 years”.

Burden on Mumbai

For a suburb with no real Covid-19 facilities, KDMC has a surprisingly low fatality rate of 2% — compared to a national average of about 2.2%.  Thane, which has recorded 21,757 cases and 755 deaths has a death rate of 3.47% while Mumbai city has the highest fatality rate of 5.54%.

“Bodies of Covid patients from MMR who die in Mumbai hospitals are not sent back. They are cremated here in Mumbai. Thus, as per the law, the death certificates are also issued from here,” said Chahal adding that while the Covid-19 fatality rate may not get affected, the overall death rate of Mumbai is getting altered.

The high infection rate in the rest of MMR has also stopped Mumbai from resuming the city’s vital transport links. 

“Unless the infections in MMR come down, we can’t start local trains because all the trains emanate from areas like Kalyan, Kasara, Vasai, Virar etc. We cannot take the risk of importing lakhs of people every day who may be carrying the infection,” said Chahal.

Public health analyst Ravi Duggal said that whatever little healthcare exists in the MMR is due to the private sector. “Maharashtra spends barely Rs 1300 per capita on healthcare, much less than the national average of Rs 1600-1700. “Covid has exposed this weakness,” he said.