Covid-19 Series

Doctors, nurses and health workers in Bihar are working without proper safety measures and run the risk of getting infected themselves. They are making frantic calls to authorities to arrange for protective equipment. This unprecedented crisis has exposed the health system of Bihar as shockingly inadequate, which just ten months ago faced the death of more than hundred children in Muzaffarpur district, writes Anish Ankur.

Strange things are happening in Bihar after the Covid-19 pandemic broke out. Fear, panic and anxiety have gripped almost everyone. Although officially only one person so far has died of this infection, reports of unofficial deaths are coming in from different parts of the state. The state government is not even considering these deaths as Novel Coronavirus (Covid-19) deaths. The cause of death in one case was determined to be a Coronavirus infection after the patient had succumbed, and in another case medical personnel were seen collecting samples from the deceased when their last rites were being performed. Doctors are working without proper safety measures and run the risk of getting infected themselves. They are making frantic calls to authorities to arrange for protective equipment. This unprecedented crisis has exposed the health system of Bihar as shockingly inadequate, which just ten months ago faced the death of more than hundred children in Muzaffarpur district.

The Novel Coronavirus has created a social crisis in Bihar’s society, particularly in rural areas where migrants are not welcome and denied entry into their homes by their own family members. In this crisis, the prices of essential items like vegetables have gone up. Black-marketeers are busy hoarding and making profits off of people’s misery.

According to a press statement issued by the Bihar government health department on March 25, there are four positive cases in Bihar. A total of 275 samples have been collected so far, out of which 268 tested negative. Now the government has issued a helpline number for every district, urging people not to rush to the hospital unless absolutely necessary. A district control room has been formed where doctors and medical personnel have been deputed. Any person who is in need of medical advice has been asked to call the helpline number meant for their district.

But contrary to government claims, news of an increasing number of deaths is continuously coming from different parts of the state. People are giving information about these deaths on Facebook and other social media platforms. A state of confusion prevails everywhere.

Trauma of Saif Ali and his relatives

A 38 year old man, Saif Ali, who had recently travelled to Qatar, was the sixth and youngest Indian to succumb to a Covid-19 infection. He was a resident of Munger and was admitted at the All India Institute of Medical Sciences (AIIMS), Patna, on March 20 and died on March 21. The man, as per available information, arrived at his village on March 13 from Qatar, where he worked as a cook. According to villagers, he had symptoms of the common flu, and was first taken to a private hospital in Munger on March 15 for treatment. Subsequently, he was taken to a private hospital in Patna from where he got admitted to AIIMS, Patna.

Bihar’s principal health secretary, Sanjay Kumar, said in a statement “The deceased had a kidney disease and died on Saturday (21 march) morning before his report came positive for Coronavirus late in the evening.” It raised a lot of questions; for example, why his dead body was handed over to his relatives without following standard operating procedures. One of his relative said

“When Saif died at AIIMS, Patna we told doctors that unless Corona test should be given we will not even touch the body but initially doctors tried to persuade us when we did not budge they threatened us, so at last we had to take the dead body along with us.”

A strange case of death came from Gaya where a patient with respiratory symptoms, admitted to the Anugrah Narayan Medical College and Hospital (ANMCH) in Gaya died without getting tested for the Coronavirus infection. When the deceased family members raised an alarm, the civil surgeon rushed a team to the cremation place and the sample was taken on funeral pyre. However the deceased’s test report came negative.

Government ordered lockdown

After the first casualty and the panic that followed, Nitish Kumar-led NDA government ordered a statewide lockdown till March 31, but soon after that PM  Narendra Modi announced a complete lockdown of the entire country for 21 days starting from 24 March. The police are allegedly behaving rudely to enforce lockdown and at some places have resorted to lathi-charges. Nitish Kumar also announced a slew of relief measures but people were expecting a package similar to the ones announced in Kerala, UP, and Punjab for the daily wagers. The Bihar government has so far refrained from doing so. Daily wage earners are the worst hit in this situation as they are unable to cope with an endemic crisis of such scale. Some commentators like social activist Vinit Rai, anticipating it may lead to a food crisis, said

“A lockdown for twenty-one days is going to be very hard for poor people and labourers. They earn their bread almost daily. How can they cope for three long weeks? Leave Coronavirus, their principal concern is starvation. This situation may lead to a food crisis.”

Migrant workers are not welcome in their villages

In the meanwhile a lot of migrant workers and students from different parts of the country, particularly Mumbai, Pune, Surat, Bengaluru, etc. have started pouring in to Patna. They were coming to Patna in packed trains, without following the recommended safety measures. The bus stand at Mithapur near Patna junction was overfilled with desperate migrants scrambling to get a seat even on the bus rooftops. Appeal to practice social distancing have become a joke in these panic conditions. The plight of migrant workers can be gauged from an unbelievable and astonishing media report in Patna that fourteen labourers, unable to find any transportation facilities due to the curfew-like situation in Jaipur, rushed to their native place in Bihar on foot. According to this report, these labourers were working for a cold storage but after the government lockdown their owner just gave them two thousand rupees and left them in the lurch. Finding no other alternative, they decided to cover the distance of one thousand kilometres by foot. Similar reports of returning by foot are coming from other parts of the country as well.

Migrant workers returning to their villages in Bihar after lockdown in the entire country.

Covid-19 is creating social crisis

When these migrant labourers and students reach their villages they encounter an unexpected situation. Their relatives are not allowing them to enter their own homes unless they go through a proper check up at a local hospital. They become vulnerable because they can be easily identified by villagers. At some places, villagers simply inform police and government officials about these migrants and when police come, few of them flee and hide for the fear of the police. To address this social crisis, the general administration department issued a letter to all DMs to make temporary arrangements for these migrants in schools, panchayat and other government buildings.

Hoarding and black marketeering on the rise

At this time of distress, the price of all essential items skyrocketed over the span of just a few days. Vegetables, particularly potatoes and onions, have been particularly hit. Potatoes and onions are being sold at two to three times higher than their normal price. Hoarders are making money and profit off of people’s misery. A photojournalist, working for a national magazine, said on the condition of anonymity that “I have heard that vehicles carrying potatoes were not coming in [the] Digha area so I went there to enquire about it in the very early morning, and found that sixteen trucks loaded with potatoes were in the process of being unloaded into a local BJP MLA’s cold storage. Since there was darkness I could not take a photo.” He further asked “He is our representative. He knows the standard price for potatoes, then why has the price gone up? In these times our own leaders are busy looting us”. Black marketeering and hoarding is rampant everywhere. Political parties have started raising demands to take stringent action against hoarders and black marketeers.

At last the government awakened to the seriousness of the situation and issued a helpline number to address the black marketeering but people doubt the effectiveness of these formal measures.

Carona virus exposed government system

The Covid-19 crisis has exposed the weaknesses of the government healthcare system badly. Bihar has only two virology research and diagnostic laboratories (VRDL) equipped to undertake ‘Real-Time Polymerase Chain Reaction’ (RT-PCR) tests which are required to test for the novel Coronavirus (Covid-19). The first is Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Agamakuan, listed by the Indian Council of Medical Research (ICMR) as an approved laboratory, while Indira Gandhi Institute of Medical Sciences (IGIMS) is the second laboratory meant for conducting tests. Although the ICMR has approved two more centres, namely Patna Medical College and Hospital (PMCH) and Darbhanga Medical College and Hospital (DMCH), they won’t have equipment and testing kits until March 25. Some days ago, DMCH doctors refused to work without protective equipment. Doctors have warned in several places that unless the situation improves within forty-eight hours they will not resume their services.

The Bihar government has converted the 850-bed Nalanda Medical College and Hospital (NMCH), in Patna into a Coronavirus treatment center. All wards in this hospital will be converted into isolation wards. But here, 83 of its postgraduate medicos have developed Covid-19 like symptoms in the course of  examining patients and have therefore requested a leave of 15 days for home quarantine. They have submitted this request to the superintendent of NMCH who then forwarded their letter to the principal secretary for further action.

Testing kits, labs, masks, sanitizer, and other personal protective equipment (PPE) are not available even for doctors, let alone the common citizen. A health department circular for Bhagalpur districts has gone viral, which says that the doctors working in OPD and emergency wards do not require safety measures like N-95 masks and that simple masks and gloves are sufficient.

Health Department circular stating N-95 mask, PPE etc not needed by doctors to treat covid-19 patients.

Government hospitals are deprived of funds, lack of doctors, nurses, etc. Groundxero’ readers must remember how last year in April-May, the death of more than a hundred children exposed the dismal healthcare scenario of the state. It seems the government did not learn a lesson from that tragedy. Giving the prevailing strength in Bihar government hospital, activist Santosh Kumar said

“Bihar is among the lowest on every health indicator in the country. Against the sanctioned strength, sixty seven percent posts are vacant for years. Even the contractual posts are not filled. Out of 4,957 posts, [the] current strength is only 566.”

Most of the private nursing homes have shut down their OPDs and other services. But in this difficult situation, ‘Poly Clinic’, a medical centre of left-oriented doctors based in Patna, is running and helping people despite the lockdown. Dr Shakeel,  apart from running ‘Poly Clinic’, is  also the National General Secretary of IDPD (Indian Doctors for Peace and Development), and he said

“Lockdown will not help too much. Lockdown is only the first step and it should be followed by other measures otherwise gains achieved by it can be lost.  Once the lockdown is lifted there will be a surge and boom of infected people. To fight the coronavirus, the government will have to follow the full cycle which consists of “isolate, test, treat and trace”. This is the standard international procedure. Other stages are totally missing here. The new guideline is that all pneumonia patients should be tested but given the lack of facilities it is not being followed.”

What can the Bihar government do in this situation? Dr Shakeel suggested

“A proactive role is required. There is a shortage of health service providers and frontline health workers like ASHA workers who are engaged in counselling but they don’t possess ‘Personal Protective Equipment’ (PPE). Government should also lift the ban on alcohol by amending the act so that sanitizers can be made immediately.”

How ill equipped are our  health departments in this extremely serious scenario can be gauged from the Facebook post of Bineeta Chaudhry, a PMCH doctor, in which she compared the situations of doctors with a “suicde squad”, writing

“Suicide squad working in emergency at Patna Medical College and Hospital, Bihar. We are being given HIV kits instead of PPE. This is how we are supposed to fight against corona and this is how we are going to treat patients. This is actually a suicide that we have chosen for our self. Once we are infected, we will be infecting others too. No facilities, no equipment, no management, moreover no sanitizer, just empty bottles as you can see in [the] picture. Where medical superintendent is more worried for his lunch with CM of Bihar then thinking about us and we are being threatened for FIR if we deny to do duty in this situation, lets suicide happily while doing our job sir Narendra Modi @ World Health Organization (WHO) “.

Anish Ankur is a freelance journalist from Patna.