Sarojini Nadimpally: Covid-19 has exposed deep cracks in the Indian healthcare system

Health and healthcare are basic human rights which must be treated as a topmost priority by all governments, writes Sarojini Nadimpally

“Oxygen bed needed urgently!

 “Urgently need an ICU bed in Gurgaon. Oxygen saturation is dropping rapidly! Please DM if you have any leads.”

Have run out of liquid medical oxygen supply. 350 Covid patients admitted in the hospital.”

For many people living Delhi, each day begins with messages like these from friends, family, and colleagues who are in search of hospital beds, oxygen cylinders, oxygen concentrators, reliable doctors, and medicines. Hundreds wait outside hospitals hoping to get admission as soon as a bed is free. Without any luck, many have to take their loved ones back home. Unable to find a bed and in need of oxygen support, many run around town trying to get portable cylinders or refills, sometimes standing in queues for up to 16-18 hours, or buying the oxygen concentrators on the black market by paying 3-4 times more than the original price. Additionally, there are heart-breaking messages— one more person not getting the oxygen bed they need, no admissions in ICU, no oxygen available, one more death, and so on.

Last week, hospitals in Delhi were putting up notices on how many hours their oxygen will last. They too were seeking support for oxygen generators, concentrators, and cylinders. Even crematoriums are unable to take the sheer volume of the number of bodies that are coming in. This is not a scene from a disaster movie; this is in Delhi, the capital city of India. The covid-19 dashboard created by the Delhi government now includes a column to indicate the duration of oxygen that may be available at each hospital. From a cursory look, it seems as though most hospitals have oxygen only for 20 minutes to one hour. The crisis started a few weeks ago, but shows no signs of abating. Like so many other households covid-19 has affected my family too, and the process to isolate the patient while keeping others safe has not been easy. But it seems so small in comparison with the sufferings of so many others. The surge in cases and the lack of life saving oxygen has led to untold trauma, pain, and grief for hundreds of people who have lost their loved ones. One cannot imagine the plight of people in rural areas, with poor health infrastructure, a lockdown, and no opportunity to earn a livelihood. 

Our doctors, medical personnel, and frontline workers are stretched to their limits, but there is no end in sight for either covid -19 or for the virus of callousness and politics. The government’s response is further exposed as it is constantly attempting to shift the onus for the covid-19 surge onto the people rather than on its lack of political will to address the crisis. On the one hand it blames its citizens for not following covid-19 protocols, while on the other it indulges large gatherings such as Kumbh melas and election rallies without caring about the basic protocols. The government has not planned and prepared in advance the strategies needed to proactively prevent the spread of covid-19. It has not prepared the health system for the second wave, even though there have been similar learnings from other countries. The pandemic exposed the deep cracks in the healthcare system across the States, including the capital city Delhi, and the result has been suffering of millions of people.     

The present state of affairs is unacceptable because the central and state governments could do so much more in this situation. Government could divert all resources to deal with this crisis and aid people financially to help them self-isolate and keep them safe. Learning from the experience of 2020, it could take over private hospitals, boost public healthcare, set up more ICUs and ventilators, make vaccination and treatment free, waive bills and production costs, increase access, and fill up vacant posts for medical personnel. It could organise continuous and uninterrupted supply and distribution of medical oxygen to hospitals and nursing homes, in both government and private spaces. It could monitor the outlets for non-institutional purchases and refilling of oxygen cylinders and divert all oxygen towards patient support. It should have, and could have, already have done all this. It is vital, as citizens and organizations, that we remember our experiences and observations from such a time, and ensure that, going forward there is adequate action by the government to look after the right to life and health to all its citizens.

This crisis also brings into focus the exemplary role played by civil society, young volunteers, frontline workers, crematorium workers, sanitation workers, and healthcare professionals in providing support to patients and each other. Their contribution gives immense hope and strength. However, we cannot have a situation where the responsibilities of the government, whether at a central or state level, are shifted onto the citizens. Health and healthcare are basic human rights which must be treated as a topmost priority by all governments. The government must increase public expenditure in healthcare, rapidly expand the public health infrastructure, diagnostics, medicines, vaccines, human resources, and build trust in its citizens that such a horrific disregard for human dignity and life will never happen again.

Sarojini Nadimpally is a public health researcher and social scientist based in Delhi.

Competing interests: none declared.

The author acknowledges Aakriti P, Ranjan De, and Veena Johari for their support.