As the virus strikes Bihar, the state’s poor health infrastructure – considered one of the worst in the country – is simply unable to take the load and is crumbling under pressure. While many are struggling to get tested, the ones who do eventually test positive are finding it difficult to get a bed for treatment. For those who lost the battle to the virus, a new nightmare awaits their family members, as they find it difficult to even arrange a decent burial for their dead ones. A report by Anish Ankur from Patna.

The Covid-19 pandemic situation in Bihar has become critical and it seems the situation is spiralling out of control. Talk of collapse of the health system is growing louder in Bihar. In a telling state of affairs, two Covid-19 positive persons have recently committing suicide, blaming the apathy of the health officials towards them. A boy jumped out of his room in AIIMS Patna, while another person hung himself during home isolation. BJP MLC Sunil Kumar Singh and RJD leader Rajkishore Yadav died of Covid-19. 

Nalanda Medical College and Hospital (NMCH) in Patna, was the first government facility in Bihar to be dedicated as Covid-19 hospital has 447 beds out of which only 166 have oxygen facility, including 80 beds in ICU. Private hospitals are being roped in and the government has fixed a certain quota in prominent private nursing homes in Patna for treatment of corona positive cases. Several private nursing homes have started admitting Covid-19 patients but despite government warning many are still refusing to admit Covid-19 positive patients.

Recently, the death of an undersecretary in the home department created a lot of stir. The senior state government official had to allegedly spend a night on the footpath inside the premises of the All India Institute of Medical Sciences in Patna. He died days later of Covid-19. Even he could not get a hospital bed on time.

The crumbling health system

The story of Manoj Kumar, himself a doctor, is an illustrative example of how the public health system is failing in Bihar. Manoj Kumar is a doctor posted in Arwal referral hospital. He narrated the painful story of death of his elder brother 

“I live along with my brother Arvind Kumar who live in Mitramandal colony, Phulwarisharif. My brother Arvind Kumar is a program officer posted in Begusarai. He had diabetes and blood pressure. For the last two to three days he was suffering from cold, cough and fever. He was taking pills and was taking rest in the home itself. But suddenly his condition started deteriorating. He had breathing problems. We took him to IGIMS (Indira Gandhi Institute of Medical Sciences) hospital by car in the night at 10 pm but they refused to admit him. After that I went to a prominent private nursing home. They said we can’t admit at night. At 12 pm we went to AIIMS. They were asking for reference and test reports then we rushed to PMCH (Patna Medical College and Hospital) but here also nothing happened because PMCH is undergoing a strike of fourth grade employees. In the process of running around my brother died. I introduced myself as a doctor but of no avail. Nobody listened to me. They did not even provide oxygen to my brother. After he died, an ambulance came to carry him to the cremation place.” 

A Facebook live video of Narendra Kumar, a corona positive of West Champaran, went viral in which he is pleading to save his life: 

“I was admitted here last night. I am speaking from Bettiah Covid hospital. I am not getting proper treatment here. Doctor hardly comes. No one is present here to give injection. There is no sanitation, no one comes for nebulisation. There is no system here although the government says that everything is right here. After shouting for fifty times someone listens. Please share this video as much as possible so that my life can be saved. Dogs roam in my ward in the night. I will show the dogs on the next Facebook live.” 

Narendra Kumar during Facebook live. He died without proper treatment.

Narendra Kumar died before he could record the next Facebook live video. 

Doctors and health workers getting infected

Doctors and health workers, who are at the frontline battling the virus, are in a precarious condition. Till now, nine doctors have succumbed to the virus in the state. Dr Mahendra Chaudhry, Dr Mithilesh Kumar Singh, and Senior Dr Awadhesh Kumar Singh are the most recent victims of Covid-19 in the state. While Dr Mahendra Chaudhry was posted in Supaul district hospital, Dr Mithilesh Kumar Singh, former head of PMCH Radiotherapy Department died in AIIMS Patna. Dr Awadhesh, popular for his service to the poor, died in a private nursing home. Civil surgeon of Samastipur, Dr Rati Raman Jha, also died after being infected by the virus. Though this was the first death of a civil surgeon, three more civil surgeons and 40 doctors are currently undergoing treatment for Covid-19 in AIIMS, Patna. 

The entire health department is in a state of panic after the death of doctors and civil surgeons. There are around 400 doctors and healthcare workers who have been infected by Covid-19 so far in the state. Bihar Health Service Association (BHSA) alleged that instead of improving medical infrastructure and investing on human resources, the government was sacrificing medical professionals. It requested the department to post the 1,100 newly appointed specialists and at the same time complete the appointment of 4,000 general duty medical officers at the earliest. Terming the situation as “scary”, BHSA general secretary Dr Ranjit Kumar said, “The state government has not acted on any of our suggestions given to contain the pandemic.” The strike in AIIMS and PMCH, Patna by health workers further aggravated the situation. Doctors are losing confidence in the fight against the virus. At last, Chief Minister Nitish Kumar came forward and tried to restore some confidence by announcing a compensation, pension and job assurance to the family members, in case of the death of frontline doctors fighting Covid-19. 

Low testing a cause for concern

Bihar has so far reported over 34,000 positive cases for Covid-19. Patna, the state capital, is the hotspot of Covid-19. The total number of infected persons in the city has crossed six thousand, while 51 deaths have been reported from the city, so far. Observers claim that the real numbers are much higher. The state has so far tested the fewest number of people (3,423 persons) per million in the whole of the country which is far below the national average of over 10,000 persons per million. Currently Bihar is testing around 10,000 people on an average every day, significantly lower than states with comparable populations. Also, a large chunk of these are rapid antigen tests, which tend to throw up a large number of false negatives. Despite ICMR guidelines, these tests are not followed up by a confirmatory RT-PCR test. Government health officials say that the daily capacity of the state’s government-run labs is less than 6,000 for RT-PCR tests, the most reliable diagnostic tests for Covid-19. 

The state health minister Mangal Pandey said, “Bihar, in two lots, has received 2, 80, 000 rapid antigen testing kits, besides the 20,000 kits it already got from the central government a week ago.” He assured that testing capacity will now be significantly enhanced. 

The lack of testing and tracing of contacts seems to be in part dictated by political compulsions. The state is scheduled to go to polls later this year and Nitish Kumar is underplaying the situation for as long as he can. Aggressive testing will result in more positive cases being detected and will put more burden on the already crumbling heath infrastructure.

The dead are not being properly cremated 

Meanwhile, in Patna, both the rich and poor are suffering the same fate after their death. Dead bodies of Covid-19 persons are being cremated in haste and without following proper funeral procedure. If a Covid-19 patient dies, his family will have to pay Rs. 14,000 to perform his last rites. This is the rate in Patna, while in Bhagalpur, where a bank official recently died, his family had to pay Rs. 50,000, before his dead body could be consigned to the flames.

A video of a young man, screaming with agony before the camera, went viral on social media, in which he is describing the trauma he had to undergo:

 “Just like we wrap bread with paper, dead bodies are being wrapped in NMCH, Patna. I wandered from pillar to post along with my sick father at midnight around 2 am and found [the] staff in drunken condition. I requested doctors with my folded hands that please attend to my father but no doctors came as they were busy in filling the forms. I requested them again and again as my father’s condition was fast deteriorating, but no one cared. Even my ambulance driver requested the doctors. At last they came after three and half hours to declare my father was dead.” 

He continued: 

“Every private hospital of Patna is referring any critical patient to NMCH, AIIMS and IGMC. They will stamp out that this is Covid patient and get rid of their responsibilities. I had to pay fifteen thousand rupee for an ambulance just to cover a distance of 4-5 km to ‘Bans Ghat’ (Cremation place) to cremate my father. Everybody there was drunk and refused to perform the last rites of my father. According to them, the dead body was not properly wrapped. When I asked the ambulance to take the dead body again to NMCH for proper wrapping, the ambulance driver started dilly-dallying even though I had paid him five thousand rupee.”

 This young man was shouting in utter frustration not only at government and private nursing homes but on those who are responsible for cremation of bodies. He alleged: 

“They poured petrol over my father’s corpse so that the body is burnt as soon as possible. Dead body exploded like a bomb because no wood was placed on his pyre. I could not perform my father’s last rites properly.” 

In another incident, a 50 year old man in Chowk Thana of Harmandir Gali, Patna city, was found Corona positive and was in home isolation. He died in the early morning around 4 a.m. His family and neighbours kept pleading with the administration and health department to help them dispose of his body but their request went unheard. Nobody came. In the meantime, the corpse started stinking. At last the two sons of the dead person, themselves, arranged the funeral, wearing a PPE kit. One of the brothers said in a very sad and depressed voice 

“There should be at least four people to give shoulder to the dead body, but we are only two brothers at this time. We don’t have any idea how to dispose of the corona positive dead person. But what can be done? We are heading towards cremation ghat.”

Two brother with PPE kit carrying the dead body of their father as no one came forward to shoulder their father’s dead body.

In another video from NMCH (Nalanda Medical College and Hospital), a family is seen carrying a dead body in an auto rickshaw, as no ambulance was available. The patient was Covid-19 positive and died during treatment. In the same hospital, a dead body of a Covid-19 patient was left in the ward covered with just a thin ‘Gumcha’ (Cotton towel) with a large part of it exposed, causing anxiety among other patients undergoing treatment in the same ward. An attendant of a Covid-19 patient, who shot those pictures, claimed the body had been lying there for hours. 

PMCH principal Dr Vidyapati Chaudhry defended the situation and said there were only six cabinets in the mortuary of the forensic medicine department to keep dead bodies. “Sometimes, we are forced to keep dead bodies outside,” he said. NMCH principal Dr Hiralal Mahto’s comment was “There’s an established protocol for disposal of bodies of Covid-19 patients. One day five deaths had taken place and we had left the bodies there (on beds in wards) for disposal in the evening, as the crematorium at Bans Ghat receives these bodies only after 8 p.m.” He further added “We have two body handlers and a mortuary for four bodies, which is not sufficient. The hospital has already given a proposal to the department for setting up a new mortuary to accommodate a minimum of six more bodies.” But the file is moving from one desk to another for official approval.

Fortunately, the case fatality rate in Bihar, till now, is only 0.69 percent while the recovery rate is around 66 to 68 percent. But the increasing number of daily cases in Patna, and the experience of Delhi, Mumbai and other cities shows there is no place for any complacency with this virus. With elections to the state coming soon, the unchecked pandemic can cause political disaster for Nitish. Before the situation further spins out of control, he has to act and act very fast.

• Anish Ankur is a freelance journalist based in Patna.