Falling at the frontline: When health workers find themselves ‘on the other side’

Nandana James | Updated on August 29, 2020

Healthcare workers walk to the Covid-19 care ward at the Rajiv Gandhi Government General Hospital in Chennai.   -  THE HINDU

Healthcare professionals are falling victim to Covid even as they help patients fight it. Steps to protect their health and ensure their financial security are the need of the hour

Suraj Singh watched in horror as Covid-19 patients around him gasped for breath, their faces contorted with the sheer effort. The 26-year-old doctor recalled how patients would sometimes quietly pass away — separated as they are from their loved ones even in death — to be discovered only a while later by doctors. They would then be moved to a corner of the room, their faces shrouded to accord them remnants of dignity. “It was haunting in the initial days,” Suraj admits in a quiet voice.

Just as he was becoming numb to this, in a sense, he too tested positive. “I found myself on the other side then,” he says.

As the coronavirus pandemic raged across India, scores of healthcare workers like Suraj Singh had to cope with the double whammy of falling victim to the novel coronavirus even as they pulled out all stops to fight it.

When Suraj, a resident doctor at Mumbai’s KEM hospital, was posted in the emergency Covid-19 ward, he was rattled at the prospect of seeing daily occurrences of illness and death. If not for the coronavirus outbreak that overburdened hospitals, a psychiatry resident doctor like him would probably have never been in such an environment.

What aggravates matters is that, despite being hailed as ‘frontline warriors’ — with comparisons to soldiers protecting the borders — the reality is marred by delayed salaries, abrupt terminations and other unfavourable factors. And now, they are succumbing to the virus.

IMA voices concern

Pointing to the worrying situation doctors are facing, the Indian Medical Association (IMA), representing 3.5 lakh doctors across the country, said in a letter to Prime Minister Modi, “(An) increasing number of doctors are getting infected and losing lives due to Covid. Substantial number of them are general practitioners. Disturbing reports have appeared about doctors and their families not getting beds for admission and also lack of drugs in many cases. Death among doctors due to Covid is reaching (an) alarming proportion.” About 196 doctors have lost their lives while tackling the pandemic, the letter said.

Abhiman Chauhan, a senior resident doctor at Kasturba Hospital, Delhi, who got infected with the coronavirus — and transmitted the infection to his wife and child too — was marked absent when he was away from work due to the virus. This meant a deduction of salary if he was away from the hospital beyond the number of days he is allowed.

This is made worse by salary delays of 2-3 months, he alleges, and many others vouch for the same. At Hindu Rao Hospital, which also faces issues with delayed salaries, Abhimanyu Sardana, the president of its resident doctors association (RDA), says the number of healthcare workers infected with Covid-19 was over 130, up to July.

In a court order dated June 12, 2020, the Delhi High Court directed Kasturba Hospital and Hindu Rao Hospital to pay salaries that had not been paid for three months.

It took court battles and threats to resign en masse for them to be paid their salaries, says Sunil Kumar Prasad, president of Kasturba Hospital’s RDA. “How is wanting our salaries on time against the government?” he asks, of accusations made against him and his colleagues. “There is a PM-CARES fund…, which was precisely made for such situations. Give us our salaries from the PM-CARES funds if you don’t have funds,” says Sunil, dismissing the authorities’ claims about lack of funds.

Financial constraints

Increasing instances of healthcare workers getting infected with Covid-19 and dying due to it highlight how this exacerbates an already overburdened and poorly funded healthcare system. India’s public health spending is less than 1 per cent of the country’s Gross Domestic Product (GDP).

“The cost of a poorly funded, poorly managed public health system is being borne by patients and healthcare workers,” says Inayat Singh Kakar, a health activist at Jan Swasthya Abhiyan.

Harjit Singh Bhatti, national president, Progressive Medicos and Scientists Forum (PMSF), a non-profit organisation of doctors and scientists, who is also a former president of RDA, AIIMS (Delhi), says that healthcare workers are increasingly getting infected possibly because of long working hours — which involves getting exposed to the virus for a longer period of time — as well as a shortage of healthcare workers. The guidelines for quarantine after duty are also not strictly followed in many hospitals, whilst there is also the issue of quarantine period considered as leave instead of “on duty”, he says.

Mitali Chauhan, a senior resident doctor at Hindu Rao, also was infected with the coronavirus whilst grappling with financial uncertainties from delayed salaries. “I have the luxury to ask my parents for money …It’s very distressing, however, to seek help from them at this age, when you are in your thirties. A colleague had to borrow money from friends for his wife’s surgery since his salary had not been paid,” she says.

At Delhi’s Hakeem Abdul Hameed Centenary Hospital, two nurses got infected with the coronavirus while treating patients. They were among 84 staff nurses — who were working on a contractual basis — whose jobs were terminated, according to a writ petition filed by Anjum Jahan Sheikh and others in July. HACH is a 470-bed hospital, out of which 200 beds have been dedicated to treating Covid-19 patients.

“The petitioners (the terminated nurses) have been regularly raising issues faced by the nursing staff in fighting Covid-19, with regard to not providing personal protective equipment (PPE) kits, N-95 masks, treating Covid-19 patients in ICU at a ratio of 1:6, etc,” the petition states.

Cases of violence against doctors also abound, and the impunity with they occur is more shocking. “It just shows that clapping and praising alone will do no good,” Mitali notes.

No monetary relief

In late July, 27-year-old Dr Joginder Choudhary, who worked at Dr Baba Saheb Ambedkar Hospital, died of Covid-19. He was initially admitted to a government-run hospital but, as his condition worsened, he was taken to Sir Ganga Ram Hospital, where his family was given a bill for ₹3.4 lakh. The doctors association at the hospital raised about ₹2.8 lakh for the treatment. His father reportedly wrote to the hospital administration seeking help. The doctors association also wrote to Delhi Chief Minister Arvind Kejriwal. Finally the hospital accepted the father’s request and bore the cost of treatment, according to reports.

Joginder’s younger brother told NDTV that their father, a 51-year-old farmer, had sold their house so that Joginder could become a doctor and support their dream of setting up a hospital. “But we have lost Joginder bhaiya and the dream is shattered now.”

Delhi’s Health Minister Satyendar Jain said that his family will be compensated by about ₹1 crore, according to reports. “The focus of the government, overall, is more towards compensating the deaths of healthcare workers, rather than protecting them from infections,” says Harjit. This is also an eerie reminder of a point raised by Kasturba Hospital’s Sunil — after doctors die of Covid-19, the Delhi government gives ₹1 crore to the family. “But for the living doctors, there are no salaries even.”

According to a survey by Behanbox (a digital media platform for gender journalism) of 52 ASHA workers and ASHA union leaders across 16 States in India, it found that “69 per cent had not (been) paid their honorariums yet...”

The survey quotes Sunita, an ASHA worker from Bihar, as saying that of the eight deaths among ASHA workers that she has heard of, none received any insurance benefits. “I am not sure if they were actually coronavirus-positive, but they died while on duty. Even if they were not coronavirus infected, their families should get some monetary relief,” she says in the survey.

Recently, an FIR was registered by the Delhi Police against a hundred members of The Delhi ASHA Workers Union for protesting at Jantar Mantar regarding their wage structures.

Steps to protect healthcare workers

Experts suggest various ways to curb the rising cases of coronavirus infections among healthcare workersas well as to ensure better treatment of the infected workers.

Regular duty hours, recruitment of more healthcare workers to ease the burden, as well as the provision of timely and proper quarantine facilities, and ensuring that the infected healthcare workers get the best available treatment — like politicians and celebrities are given — are some of the measures the government can undertake, says Harjit. The families of those who succumb to the virus should be compensated quickly.

The government should have recruited more healthcare workers, and followed the guidelines for isolation and quarantine post their duty, says Harjit. A special strategy to tackle the rising cases among healthcare workers should have been implemented over four months back, but even if it is done now it can be helpful, he adds.

Meanwhile, Abhiman, who has recovered from Covid, puts it plainly. “We just want our salary. There is no other issue. We can’t work without our salary.” It’s as simple as that.

Published on August 29, 2020

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