Since March 2020, Indian healthcare system has grappled hard to contain the COVID-19 surge. An exorbitant cost of this fight is being borne by the non-COVID-19 patients. The onset of the second wave, once again disrupted OPD and non-emergency services in several hospitals as majority of them diverted the resources at their disposal to combat COVID-19 tsunami. The Voices explores the crisis.
Shadows of an Epidemic
Diversion of medical infrastructure to curb the COVID-19 onslaught, has amplified the curve of distress deaths. For a populated country like India, where daily mortality rate for various Non communicable diseases (NCDs) has always been recorded high, COVID-19 has further aggravated the crisis. Tedros Adhanom Ghebreyesus, director-general, World Health Organization (WHO) says “Many people who need treatment for diseases such as cancer, cardiovascular disease, and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began.”
Unintended compromise with concerns of non-COVID-19 patients is no less than a potential epidemic of its own kind. A 2021 Apollo Hospital study confirms “In dealing with the Covid-19 pandemic, the data from our Health of the Nation report made it clear that we have let another epidemic slip, the epidemic of NCDs – the impact of which we are already beginning to see around us.”
As per a WHO report, 2000 cancer patients die in India every day. A health ministry release confirms the death of 216 patients daily from Tuberculosis in 2019. Lancet study says 7000 people died daily from cardiovascular disease in 2016. In this case, forced to wait and live outside hospitals would prove to be fatal for many. NCD patients have nowhere to go but wait in vain, for the pandemic to get over. Hence COVID-19 may prove to be a blow for the attempts to realise the resolution of UN’s Agenda for Sustainable Development to reduce premature NCD deaths to 1/3rd by 2030.
Reflections from the ground
Krishna Devi, 82, a resident of Patel Nagar, Delhi, scheduled for a tail bone surgery, was turned back from Sir Ganga Ram Hospital after it was converted into a COVID facility. While sharing her plight with The Voices she says “I am old, and it is very difficult for me to travel, given the condition I am in. While COVID-19 treatment is a priority, it is not like other people’s pain is of no concern.”
A conservative approach is gradually overtaking the urge to secure immediate medical intervention. While hospitals are working out on innovation and strategies to avoid in-facility treatment of relatively non critical patients, patient psychology too is leading to hospital hesitancy. Kuldip Sharma, 62, a diabetic patient, says, “my blood sugar levels are really high. My doctor refuses to see me properly. I was supposed to undergo a few tests, but now I won’t go because I’m worried that I’ll be exposed to the virus. I have no options as of now but to rely on insulin and my older medications.”
Although systemised reporting of data is hindered by the lockdown, news reports show that patients suffering from non-COVID-19 diseases, patients with scheduled surgical procedures and follow-up visits are undergoing an unimaginable crisis – the impact of which is compounded for patients needing hospitalisation. In a country with 5.5 government beds for 10,000 population, even a marginal increase in hospitalisation adds pressure on the system exponentially.
“I’ve been waiting outside the hospital for days now. I don’t know when will I get any treatment, or attention from the authorities”, says a distressed patient outside Sir Ganga Ram hospital.
A source from Safdarjung Hospital, New Delhi, says, “Initially, the whole focus went on COVID-19. We immediately turned non-COVID-19 facilities into COVID-19 facilities. But after sometime we had so many patients, that we had to completely close the OPDs and elective surgeries. Patients were asked to come after 2 or 3 months. Nobody was prepared for this situation, and no one expected that so many people would become sick in so little time. We have not been able to take care of all the patients. We tried our best to do some justice to them through online OPDs, but we succeeded only partially.”
India has 37.6 health workers for every 10000 people as compared to the WHO benchmark of a minimum 44.5. This lack of adequate medical staff, makes the patients and even the doctors vulnerable to COVID infection, especially in those departments where treatment is time sensitive.
Dr. Swasti Chaudhary, a Gynecologist from District Hospital, Jalpaiguri, West Bengal, says, “In my department, we have been continuously treating emergency deliveries, C-sec patients. We can’t expect them to wait. There are separate buildings in our hospital where non-infected people are being treated. But if there is a call for emergency assistance or a patient goes into labour in a COVID ward, we immediately rush there. It involves a huge risk of cross-contamination as we can’t even isolate ourselves post that because there is no other team.”
On being asked if there have been any changes in patient behaviours, Dr. Swasti adds, “There is serious fear in people. Earlier, mothers used to come around their due date, stay in the hospital for a week. Now, even if their due-date arrives, they don’t come to the hospital till they go into labour. This puts both the mother and child under the risk of complications and mortality.”
While private hospitals have been able to handle non-COVID-19 issues better than last year by ensuring a range of innovation such as online OPDs, app-based assistance and dedicated admission facilities, it is the government hospitals that are still under a lot of pressure due to a shortage of trained medical staff. Geographical proximity and affordability make government run healthcare infrastructure a first choice for common folk. This in turn puts immense pressure on the doctors and medical staff there. They too have matured in handling of non-COVID-19 patients.
“This year, we have not closed the OPDs completely, but curtailed them by limiting the number of hours and consultations in a day. There is a dedicated team of physicians and surgeons whose numbers were circulated so that people can take online or telephonic consultations. With maximum manpower switched over to COVID wards we are able to cater to 500 people each day through these online OPDs. Earlier, on an average 8000 patients visited Safdarjung hospital in OPDs”, confirms the source from Safdarjung Hospital.
Experts believe healthcare system can no longer afford to focus exclusively on COVID-19, oblivious to the fact that their response to the pandemic may jeopardise the well-being and life of others who need medical assistance. WHO DG says “It is vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19.”
Story Edited By NK Jha