The second covid wave is hitting India hard and the new case count is averaging over 270,000 over a 7 day period. Lock-downs are in effect in multiple cities which will massively reduce new cases since a majority of people are semi-isolated. I'll share a few more stories here continuing with this series from covid conundrum and covid conundrum continued.
Medical care In India
During my visit to India I was infected with covid late March. Although I was attempting to take precautions against getting infected like double masking and sanitizing hands, it is possible for a breach to happen unless you are isolating completely. Wailing sirens from ambulances had already become a common occurrence and my condition deteriorated enough that I too needed to be moved to a hospital for better care.
I was admitted to Bharati Hospital in Pune which is a combined university and hospital. Bharati can probably be classified as a mid-tier hospital. It is not a top tier private hospital but standard of care and universal treatment protocols are strictly followed as I'll show below.
During late March, there was a strain on hospitals due to an increase in cases. Bharati had been converting beds from normal specialties into covid care zones. Even while I was admitted there, a 100 bed capacity was added. For covid patients, complete isolation of the bed area is needed so that other patients are not infected along with other stricter protocols for care, doctors and visitors. Triaging of cases was done in makeshift OPD (obstructive pulmonary disease) and emergency department extension and doctors were quickly trying to help patients at various stages of infection. For admission all patients needed the Indian identification card called Aadhar. The aadhar card program has been a massive undertaking by itself reaching over a billion citizens.
As the hospital is expanding the facilities, simple extensions above make it possible to scale up. Triaging inside the hospital was time consuming because of the influx of patients and relatives.
Doctors and support staff were wearing medical PPE. This includes the green gown, gloves, face-shield and importantly N95 mask. This is an intermediate protection PPE. A more protective version is an impermeable bodysuit but that makes movement too restrictive for the doctors and staff. The full PPE is a single use one and extremely uncomfortable in Indian weather conditions. They are used in this hospital only in ICU setups where there are aerosol generating procedures. The hospital has not found an increase in HCW (healthcare worker) infection rates due to this policy
Care and facilities at the hospital were great. The doctors and staff were monitoring my health on a regular schedule and making sure that I got the right care. There were multiple visits from the doctors and nurses. With round the clock rotations, help was always at hand. As a covid ward, the room was cleaned multiple times a day. Operations were a bit chaotic at times. Lots of paper was used for managing information like paper charts. I'm not sure how much of this information was digital if any.
Food was served in closed containers with an authentic Maharashtrian menu. Most importantly, the chai was good.
I did require a medicine called Remdesivir (something I have in common with Trump) . I've been considerably lucky since I got infected and was able to get these drugs at the right time. Currently these drugs are barely available for the large number of patients and scaling up production will take time.
Remdesivir is manufactured locally in India and is sold at local prices. It's still expensive for the average Indian and requires hospitalization for administration, but it’s better than alternatives. The government is adding some controls to make sure that pricing remains accessible as well. The biotech industry has been a great success in India along with creation of generic and licensed drugs. India has been able to procure vaccinations since it is a major manufacturer.. otherwise things would have fallen apart.
India has been a destination for medical tourism for many years now. I'm convinced that this will be an area that India will continue to dominate. Care provided is good at very competitive prices. Most importantly the doctors and staff are great.
Heroes
As proud as I am being Indian, there are also many problems. A major social issue is that we do not know how to be thankful.
In the United states, first responders (paramedics, law enforcement, firefighters) and service members (armed forces) are celebrated. During the covid pandemic as well, their service and sacrifice was acknowledged .. although maybe not enough.
In India, we take our first responders for granted. Police and service members are getting some recognition now … but not much for paramedics and doctors. It's even worse than being thankful, when patients do not recover it is common for relatives to abuse or even physically harm doctors and staff. This happens even today again and again.
Let's get a little more personal. The second image in this post is that of my sister, who is a doctor at Bharati Hospital. She has been drafted into working as the primary doctor in a COVID ward for multiple rotations since the outbreak of the pandemic. Doctors from all departments even orthopedicians, radiologists, dermatologists, surgeons, superspecialists have been assigned duties to help the physicians and intensivists. On the most recent rotation she contracted the virus herself. Since she was already vaccinated, her symptoms were mild. However her entire family also got infected causing immense anxiety. This is a similar story for her colleagues and other doctors and health care staff around India and the world. While we are able to isolate at home watching TV and complain about freedoms, these people are at the frontlines trying to treat as many people as possible while being at massive risk. There have been multiple cases of fatalities of healthcare workers all over the world but that has not prevented them from continuing their job. Already at the beginning of the second wave, the team was fatigued with one year of fighting the pandemic.. and now the battle has escalated to a bigger scale.
Staff at hospitals are called by maternal family relationships or maika. Māvshī (मावशी) which is maternal aunt is used to refer to a woman ward helper (member) and Maama for a ward boy. Care for a patient is considered to be similar to what an Indian woman would experience after going back to her family after marriage. Though this model has now changed, especially in the modern urban life in India, the association of that care is extremely powerful and apt. Bharati is not one of the top rated or popular hospitals in the country, but the human element and the little things that matter were outstanding.
Not all heroes wear capes. Some of them wear PPE's. If you get a chance, please do appreciate these people.
Hats off to all covid warriors at Bharati_ dr y.s.kulkarni Bharati Hospital