An investigation by Gaon Connection reveals how several district hospitals, where rural India seeks medicare, have inadequate, faulty or no ventilators at their disposal. There is also a severe shortage of trained technicians to operate them.
Less than 30 kilometres north-east of the state capital Lucknow, where COVID-19 patients and their families scramble for ICU beds, oxygen cylinders or vials of Remdesivir, the mood is sombre at Barabanki. As COVID cases surge in India’s most populous state Uttar Pradesh, doctors and other healthcare staff in the district are worried.
The district hospital at Barabanki does not have a separate COVID-19 ward. It does not have even a single ventilator.
“The Barabanki district hospital has no ventilators, but we are hoping that arrangements will be made very soon to procure them,” RP Singh, district general secretary of the State Employees Joint Council and pharmacist at the district hospital, told Gaon Connection. According to him, senior district officials had assured that efforts were underway to procure ventilators for the district hospital at the earliest.
Meanwhile, COVID-19 cases that come to the district hospital are referred to three private hospitals in Barabanki — Astha Hospital and Diagnostic Centre, Mayo Institute of Medical Sciences and Hind Institute of Medical Sciences. “These private hospitals together have about fifty ventilators. Twenty seven of them are at Hind, twenty at Mayo and we have three at Aastha,” Patel informed Gaon Connection.
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The second wave of COVID-19 is sweeping across India, with over 412,000 fresh cases reported in the past 24 hours. Uttar Pradesh, with its more than 200 million population, is squarely in the line of fire. Half of its corona patients are already from rural areas.
Gaon Connection has been reporting how village after village in the state is in the grip of fever, cold and cough, which are also symptoms of COVID-19. People are reportedly dying too. The insurmountable pressure hospitals in urban India face today is expected to soon trickle down to district hospitals, where the majority of the rural population seeks medicare.
But how prepared are these district hospitals to respond to the challenges thrown by the second wave?
An investigation by Gaon Connection, India’s biggest rural media platform, shows that many of these district hospitals either do not have ventilators or the equipment is dysfunctional. Some hospitals lack trained technicians to operate these ventilators.
The ventilator, a medical equipment in intensive care units of hospitals, is used to help critical patients breathe. As COVID-19 is known to affect the lungs and cause a drop in oxygen levels, some patients need life-saving ventilator support.
Who knows the importance of a ventilator more than Devendra Pandey, a resident of Achalganj in Sadar tehsil of Unnao in Uttar Pradesh? Hooked on to a ventilator at a hospital in Kanpur, Pandey, a COVID-19 patient, is fighting for his life.
In the first week of April this year, Pandey tested COVID positive. Rather than going to a hospital, he self-isolated at home and got himself ‘treated’. When the 65-year-old felt better, he went back to work at the garment store he owned.
Unfortunately, he fell ill again and had to be rushed to a dedicated COVID-19 hospital in Unnao. But, he was refused admission there, allege his family members. After running from pillar to post, Pandey finally found a bed at a private hospital 20 kilometres away in the neighbouring district of Kanpur, where he still is.
It isn’t that the Unnao district, with a population of approximately 3.6 million people, doesn’t have ventilators. Its district hospital — Uma Shankar Dixit Joint District Hospital — has approximately 100 beds and 14 ventilators but they “were not yet fully set up and therefore not available to patients,” informed BB Bhat, Chief Medical Superintendent of the Unnao district hospital.
“There were twenty ventilators in the district hospital, but six of them have been sent to Saraswati Medical College, which is the district’s only Covid L-2 hospital,” Bhat told Gaon Connection.
Saraswati Medical College, the dedicated COVID-19 hospital, has nearly 40 ventilators and all are functional. “But even those are in short supply, because of the huge rise in the number of people needing them due to the fast spread of Corona,” Prem Kumar Singh, a doctor in the Unnao district hospital, told Gaon Connection. He is also state president of the Uttar Pradesh Medical and Public Health Ministerial Association, a doctors’ union.
On being questioned why the district hospital did not have any functional ventilator, Singh said: “District hospitals are not meant to be COVID hospitals.”
Meanwhile, Unnao district has been reporting 250-300 new COVID-19 cases every day. Ventilators aside, testing is also a challenge in the district. “Because of the lack of facilities in the district, RT-PCR test samples are sent to Lucknow’s PGI Hospital [Sanjay Gandhi Post Graduate Institute of Medical Sciences]. It takes anything between seven to ten days for the results to come,” Singh explained, adding that it was another huge hurdle in the way of containing the spread of the coronavirus.
About 180 kilometres north of Unnao is the District Hospital Shahjahanpur in Uttar Pradesh. The district hospital has 20 ventilators, but “there is a shortage of trained people to operate the ventilators. Not everyone can operate it”, Rohtash Kumar, Additional Chief Medical Officer of the Pandit Ram Prasad Bismil district hospital, Shahjahanpur, Uttar Pradesh, told Gaon Connection.
A tube is inserted into the windpipe of the patient and the other end is attached to the ventilator that pumps in oxygen, he explained. “A person who is trained in operating ventilators can handle three to four of them at a time, as long as they are in the same room,” he said.
But, ventilating a patient is not everyone’s cup of tea. “When patients experience difficulty in breathing, they are given oxygen. But, despite that, if they continue to struggle to breathe, they have to be put on ventilator support in the intensive care units of hospitals,” Sutapa Pal, consultant general practitioner at Kolkata, West Bengal, who has worked for 21 years, told Gaon Connection.
“There is a problem of not having trained people to operate the ventilators. I cannot ventilate a patient, I need trained staff to do it,” Pal added. “The need of the hour is to have well-equipped primary health centres in rural India with more beds, ICUs and ventilators in district hospitals. But these machines are no good if we do not have many more trained healthcare workers in the villages and districts,” said Pal.
Both Rohtash Kumar as well as UP Sinha, Chief Medical Superintendent of Shahjahanpur, told Gaon Connection there was a shortage of trained individuals who could operate and monitor ventilators at the Shahjahanpur district hospital.
The district, with a population of three million, has more than 2,300 villages. On May 4, the district hospital had 115 COVID patients admitted — six on ventilators.
About 500 kilometres from Shahjahanpur, across the state border, lies the Sardar Vallabhbhai Patel District Hospital Satna in Madhya Pradesh. “Our hospital has a total of nine ventilators,” an hospital official told Gaon Connection.
One was damaged in a short circuit two years ago, and of the remaining eight, only two are in working condition, he informed on condition of anonymity. “But we have no technician to operate it, and our doctor who knows how to operate it has tested positive,” he added.
There are 13 private COVID-dedicated hospitals in Satna. But only one of them — the M.P. Birla Hospital & Priyamvada Birla Cancer Research Institute — has a single ventilator. The only other private hospital in the district that has a ventilator is a children’s hospital, which is not for COVID-19 patients.
The district, with a population of over 2.2 million, reported 272 fresh cases on May 3 and three deaths due to COVID-19. Predictably, lack of sufficient emergency care services means critical patients from Satna are referred to the adjoining Rewa district, about 56 kilometres away.
In sharp contrast to these district hospitals which face either a shortage of ventilators or lack technicians to operate them, the divisional hospital Mirzapur boasts 28 ventilators and technicians too.
At the Barrister Yusuf Emam Divisional Hospital, Mirzapur, which caters to Mirzapur, Bhadohi and Sonbhadra districts of Uttar Pradesh, doctors claimed they had state-of-the-art ventilators. “The L2 hospital has twenty eight ventilators,” Kamal Kumar, superintendent-in-chief, told Gaon Connection. But he added that there were only three technicians to work those ventilators.
Vikas Singh, a doctor at the divisional hospital Mirzapur, clarified: “We have modern ventilators that do not need expert operators.” Unlike the traditional ventilators more commonly used, modern ventilators do not require the patient to be intubated, he explained, adding that a single technician could easily handle 10 to 12 ventilators simultaneously.
“Ventilators, injections and medicines are all available at our divisional hospital. It is just the frightening spectre of the pandemic that is causing a problem,” he said. On May 4, of the 50 beds at the L2 hospital, 18 were occupied by COVID-19 patients.
According to the Uttar Pradesh government, efforts are underway to respond to the second wave challenge in its rural areas.
“We have initiated an early identification drive where our teams are going house to house in each village,” Amit Mohan Prasad, Additional Health Secretary to the state government, told Gaon Connection. The teams are talking to the villagers about their symptoms and distributing medical kits, even before they are being tested, he said.
“Meanwhile, COVID testing teams have also moved into the villages. They are conducting rapid antigen tests. Two community halls in each district are being converted into COVID hospitals, with fifty beds each,” Prasad informed.
According to him, some beds in these community centres would have oxygen support but no ventilators. “Patients who need critical care will be referred to the district or divisional hospitals or medical colleges or the other higher centres,” he told Gaon Connection.
Reported by Virendra Singh, Barabanki; Ramji Mishra, Shahjahanpur; Sumit Yadav, Unnao; Brijendra Dubey, Mirzapur; and Sachin Tulsa Tripathi, Satna. Written and edited by Pankaja Srinivasan.