‘Low-Quality PPE, Exhaustion, Inhuman Work Conditions’ Led to Death of 98 Bihar Doctors in 2nd Wave, Claim Medicos

New Delhi: With the death of over 98 doctors—second highest in the country—the medical fraternity in Bihar is finding itself short-handed to tackle the disastrous second wave of the Coronavirus outbreak. The devastating scale of the pandemic and government’s mismanagement of the crisis have left the front-line medical responders helpless, scared and demoralised.

Beside the virus, doctors in the state attribute several reasons behind the casualties--public sector healthcare facilities being on ventilator, inadequate number of medical practitioners, exhaustion as a result of stretched working hours for over a year now, sub-standard quality of personal protective equipment (PPE), and lack of other safety gears and unhygienic work place.

The Bihar wing of the Indian Medical Association (IMA) said a whopping 98 doctors have so far succumbed to COVID-19 in the line of duty during the second wave this year. This is in addition to 39 doctors who died of the disease in the first wave last year. In total, 122 doctors in the state have died after contracting the virus on duty since the outbreak last year, the IMA said.

Of the 98 deaths in Bihar, 38 doctors died in the capital city of Patna, while 14 others died in Muzaffarpur, five in Bhagalpur, and three each in Gaya and Siwan. The state has over 30% share of the country’s total death toll, which is over 329.

Bihar’s Healthcare in Shambles

“We should get a quarantine period of at least seven days after working in COVID wards. Ideally, this period is two weeks after five days of duty. But owing to the lesser number of doctors, our turn comes within four-five days. This is one of the primary reasons behind a large number of doctors getting infected,” Dr Ramchandra Kumar, president of the Junior Doctors’ Association (JDA) at the Nalanda Medical College and Hospital (NMCH), one of the three major COVID-designated hospital in Patna, told NewsClick.

He said the hospital also lacks some basic facilities such as an oxygen generation plant, properly functioning ventilators, BiPAP machines, adequate number of paramedics, technicians, and even anaesthetists.

“The ICU is not good in the hospital. If someone needs to be shifted to ventilator support, we have to face a lot of difficulties because of severe shortage of BiPAP machines, anaesthetists and nursing professionals. Against the requirement of at least 50, we have six anaesthetists who are pursuing their post-graduation,” he complained.

If a doctor falls ill, Kumar said, there is no separate arrangements for his or her treatment. “Take for instance the case of Dr Prabhat Kumar, who was tested positive for Covid-19 and being treated at a private hospital in Patna. He was later flown to Hyderabad where he breathed his last. He was a renowned cardiologist of the city,” he concluded.

A senior resident at Darbhanga Medical College also echoed the same. The fewer number of doctors in government hospitals did not get time to take rest for more than a year. And therefore, they were exhausted, which badly affected their immunity. As they got infected, they could not cope with it.

He too holds lack of infrastructure in the state another major reason for deaths of both doctors and patients. “Even doctors could not get ICU beds and oxygen. And therefore, few of them have to be taken to other states,” the senior resident doctor said, suggesting, “Given the thick population in the state, every district should have a multi-specialty hospital and a super-specialty hospital catering for two-three districts apart from district hospitals. It's because all severe patients cannot be accommodated in DMCH, PMCH, IGIMS and Patna-AIIMS.”

Talking about his own hospital (DMCH), he said the government did not learn any lesson from the previous wave. He said during the first wave of the Coronavirus outbreak in the country, Bihar was largely unaffected. The government had enough time to improve the infrastructure, it conveniently ignored to prepare its health facilities.

“We have a newly-constructed, super-specialty hospital, but it is still not equipped to be qualified as one. After failing several deadlines, the hospital was finally made functional without necessary arrangements. The ventilators supplied to the hospital are not installed. Doctors were appointed a year ago even when the facility is not there, and they are already drawing salaries. But we still don’t know who they are, when they come and go. Except us (senior and junior residents), no new face has come to the new facility to treat the patients,” he alleged.

Makeshift arrangements were made during the first wave by using the hostel for nursing students as isolation ward and construction of a small ICU in the administrative building premise.

Despite catering to patients from several neighbouring districts, the DMCH appears to be an insanitary nightmare. Water logging is seen everywhere inside and outside the premises of the hospital. Pigs lying here and there is also a common sight.

A resident doctor from Jawaharlal Nehru Medical College in Bhagalpur also shares the same complaint.

“The only improvement we are witnessing between the two waves is the supply of safety equipment (PPE, gloves, N-95 and surgical masks and gloves, hand sanitisers, etc.) for the doctors. Except for this, nothing seems to have changed. The hospital infrastructure everywhere across the state needs robust improvement. We don’t have well-equipped ICUs where critically ill patients can be treated and provided mechanical life supports. Majority of the hospitals don’t have functional ventilators and sufficient number of technical staff to operate it. There is acute shortage of essential medicines; we only get supply of basic medicines which can be obtained from any ordinary chemist shop situated in even a remote village,” he said on strict condition of anonymity.

He said medical facilities in the third most populous state of the country are dying a slow death, but there is no one to take a stock of it. “Sometimes we go into depression seeing patients collapsing before us and our helplessness to revive them. But the government is unfazed and busy in its image makeover by shamelessly making false claims of doing enough,” he added.

Poor PPE Quality, Exhaustion Leading to Deaths

The IMA-Bihar, the apex body of doctors, alleged that the PPE supplied to the state is of inferior quality that causes extreme dehydration among doctors who have to don it for four-six hours at a length. The apex body considers PPE quality as one of the major reason behind large number of casualties among doctors in the state. The second reason it cites is middle and older age doctors working at government hospitals.

“The national doctor-patients ratio stands at 1.4 doctor for 1,000 patients, but Bihar has one doctor for 2,400 people. A strength of around 17,000 is required in the state with a population of 12.5 crores, but we have only 8,000 permanent doctors in government hospitals. Our medical colleges have around 2,000 doctors against the sanctioned posts of 4,200,” IMA Bihar Secretary Dr Sunil Kumar told NewsClick. The sanctioned strength of doctors in referral hospitals and primary health centres is supposed to be 13,500, but the current number is merely 6,500, Kumar said.

“The state roughly has 30,000 registered doctors, of whom 18,000 work in government facilities. Over 10,000 of them work on contract basis whom I am not counting while giving the figure of the present strength. The remaining 12,000 of the total registered doctors in the state are engaged in private practice,” he added.

Kumar added that the fewer number of doctors in government hospitals did not get proper rest for over a year despite handling the first wave of the pandemic very successfully. Their exhaustion adversely affected their immunity, leading to severity of their comorbidity triggered by the virus and they succumbed to the diseases.

“The fatalities among doctors in medical colleges are comparatively less because institutionalised facilities mostly have young junior and senior residents, who have strong immunity and can cope up with the virus in case of mild and moderate illness,” he added.

Asked about the health department's claim of hiring 1,000 doctors on contract basis only through interviews, Kumar said, “The state government is recruiting very less doctors against the vacant seats and that too on contractual basis for three months or six months.”

However, the Bihar government claims it has 1,19,000 doctors for 12 crore population. “...the state has 12 crore population and to meet the WHO norms, the state should have 1.20 lakh doctors in the state to fulfil the criteria. But there are 1.19 lakh doctors in the state at present,” Bihar Health Minister Mangal Pandey had told the Assembly on March 13.

According to him, there are 40,200 allopathic doctors, 33,922 Ayush doctors, 34,257 homeopathic doctors, 5,203 Unani doctors and 6,130 dentists. As per WHO norms, there should be one doctor for every 1,000 people.

Dr Kumar also said that the state still has short supply of oxygen. “Of 200 hospitals (both government and private) in Patna, only 90 got oxygen supply during the crisis. More than 100 did not get supply but still kept treating patients by managing oxygen in the name of humanity,” he said.

HIGHEST DEATH, BUT NO COMPENSATION

Chief Minister Nitish Kumar-led National Democratic Alliance (NDA) government in the state on May 1 announced ex-gratia amount of Rs 4 lakh for the kins of doctors and other medical staff, who died of COVID-19. The government also announced that their salaries for the remaining period of their service will be paid to the surviving family in the form of a “special family pension”. As another option, a government job has also been promised to one member of the victim’s family.

However, contrary to these tall promises, the survivor’s families still await the compensations. “Of the 98 doctors who died of COVID-19 while being on duty, only one doctor’s kin has received Rs 50 lakh as compensation announced last year by the Centre for the frontline workers who lose their life in the line of duty. There is no one to answer why the doctors’ families have not benefited from the Centre’s health insurance scheme. The state government is yet to pay even a single family,” said Dr Kumar.

He demanded an ex-gratia amount of Rs 50 lakh be given by the government. Further, he said the IMA has decided to give Rs 10 lakh each from its side to families of poor doctors. “We are going to give Rs 10 lakh to the family of three poor doctors in Bihar,” he said.

A total of 513 doctors lost their lives in India after contracting the virus in the second wave, which began around March-April, 2021, the central body of the IMA had said on May 25.

Releasing revised figures on COVID-related fatalities among doctors, it stated that with 103 casualties, Delhi recorded highest deaths, followed by Bihar (96), Uttar Pradesh (41), Rajasthan (39), Gujarat (31), Andhra Pradesh (29) and Jharkhand (29).

The voluntary organisation of doctors said as many as 747 doctors had died due to COVID-19 during the first wave of the pandemic. With 91 death, Tamil Nadu had topped the list. It was followed by Maharashtra (81), West Bengal (71), Andhra Pradesh (70), Karnataka (68) and Uttar Pradesh (65).