A tragedy goes viral!

With their local health systems broken and unable to provide specialised care, many like the Rajbhars brave the challenge of travelling to a big, alien, expensive city with hope. They sleep on the streets or in the corridors of hospitals, tending to their loved ones with amazing resilience.

Sanjay Nagral
May 15, 2020, Mumbai Mirror

Sandhya and Pannelal Rajbhar set out from Varanasi in November last year, with hope of getting their just born baby, ambitiously named Prince, cured of a congenital heart disease. Like thousands of ordinary Indians who travel long distances, they sought care at Mumbai’s public hospitals. With their local health systems broken and unable to provide specialised care, many like the Rajbhars brave the challenge of travelling to a big, alien, expensive city with hope. They sleep on the streets or in the corridors of hospitals, tending to their loved ones with amazing resilience.

And many get successfully treated at almost no cost.

Prince was hospitalised at KEM Hospital, well known for its expertise in cardiac surgery. He was connected to a simple device called a multipara monitor in the ICU. This is a daily use device and has had no major safety concerns. In what was an unintentional and rare accident, the electrodes from the device caught fire, charring a part of Prince’s diminutive body. This set off an unfortunate chain of events. The resultant burns caused infection, necessitating amputation of one arm. However, the infection persisted and soon Prince was battling organ failure. Despite intense efforts, he succumbed to deadly resistant bacteria lurking in our hospitals. This tragedy unfolded in full public glare due to relentless coverage by the media. On the day he left Mumbai, Pannelal was interviewed on TV. He said, “I couldn’t take my son to a private hospital as I couldn’t afford it. I will always regret it. Now, I will be scared to take my family to a government hospital.”

A perfectly understandable guilt laden response of a grieving father who has just lost his newborn. But for the rest of us it throws up a disturbing conundrum.

This week, videos emerged out of two large Mumbai public hospitals at the forefront of treating Covid, showing dead bodies waiting to be disposed lying amongst patients. WhatsApp forwards by trigger-happy citizens soon made them ‘viral’. Their macabre nature perhaps fuelled the voyeurism more than the usual. There was predictable, shock, outrage and denouncement. Most likely by next week we would have forgotten the incident.

But shouldn’t we call out our public hospitals for the unhygienic and insensitive atmosphere? To make the authorities take notice, shouldn’t the media highlight the conditions that violate basic human dignity? Just because they offer free treatment should they be allowed to get away with callous behaviour? All very valid questions.

Wait. Remember Pannelal Rajbhar. Will bad news from public hospitals lead to people choosing the private sector? Will this push them into spending large sums of money and suffer huge collateral financial damage? In other words, are we doing a disservice to the poor who access public hospitals by lowering their image? What will happen to the morale of Sion Hospital, which in non-Covid times has Mumbai’s largest trauma care facility? These are also equally valid questions.

We have a vexing contradiction with no easy answers. But one step forward may be to recognise the dangers of lurching too much on either side. People like us, who have largely abandoned public hospitals and secured ourselves through a parallel system, have the breathing space and clout to influence the way ahead. If we wait for automatic deliverance from the government, we are deluding ourselves. A senior state minister was successfully treated for Covid in a large private hospital’s ICU after being on the ventilator for a prolonged period. Indeed good for him, and in a way it is his choice. But note that he didn’t trust his own government hospitals.

As I have repeatedly said in this column, this epidemic is urging us to rethink health policy as never before. As I pen this, I see an announcement of Rs 2,000 crore being allotted from PMCARES fund for ventilators. Though we need them, just buying more ventilators is unlikely to help. They need an ecosystem to deliver. Without that they will become just exhibits of good intentions. Anecdotally, a large proportion of Covid patients ventilated in Mumbai’s speciality private sector ICUs have recovered. This is mainly due to trained doctors called intensivists and specialist ICU nurses, which is a deficit in public hospitals. We need to harness this experience for everyone. This will need decisive steps from the state, which are still not to be seen.

We are well into the belly of this beast of an epidemic.

Here we are, faced with the bizarre situation of viral videos of dead bodies in public hospitals alongside forwards of astronomical bills of lakhs of rupees from modern private ICUs and refusal by insurance companies to pay PPE costs. We have everyday news of patients moving from hospital to hospital begging for abed and dying.

We forward all these with equal alacrity from our phones. But given the nature of this epidemic, this pincer of a neglected public system, an unaffordable private sector, poor coordination and even denial of care can close in on any of us.

While we may soon have to get used to the coronavirus, one hopes we don’t get used to this.