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The Gujarat Model doesn’t seem to be working during the coronavirus lockdown. Being the fourth highest infected state with 22,562 infections and 22,212 active cases, the reports coming in from Gujarat show that the healthcare system in the state is in shambles. The top three affected cities in the place are Ahmedabad with 15,962 cases, Surat with 2,444 cases and Vadodara with 1,471 cases. According to government figures, in the last one week, the number of new infections has grown by an average of 2 percent every day!
Now, as the lockdown norms have been eased, hospitals in the state will start seeing a surge in trauma and semi-emergency cases. However, the hospitals in Gujarat face multipronged issues – from shortage of blood to shortage of doctors and from protests to the crumbling infrastructure.
Shortage of blood
Ahmedabad Mirror reported that the blood collection in Gujarat has fallen almost 30,000 units from May last year when it was at 75,032 units to May this year at 41,997 units. The state is facing a crippling shortage of blood due to the fear of the coronavirus infection and hospitals are asking family members of patients to find the number of donors needed to either donate blood or replace the blood provided by the hospital so that others can be helped too. Currently, blood banks are only prioritizing the needs of pregnant women and those in trauma situations.
Stating that this situation was unprecedented in the history of the Red Cross Blood Bank, Dr. Vishwas Amin, Medical Director of the Ahmedabad Red Cross Society told Ahmedabad Mirror, “We have not had to seek blood from relatives of ailing patients ever since 2012 when we stopped this system and began relying solely on our benevolent donors and donation camps.” Explaining how they’ve had to hold back in giving blood units due to the scary situation, he said that while before the pandemic 200 units were given off the shelves, now less than 60 units are being disbursed, that too after keeping 25 units for children suffering from thalassemia, adding that the collection of negative blood groups had almost become non-existent.
Officials cited that even regular donors were not responding to requests of blood donations due to the fear of being infected and regular donation camps couldn’t be arranged due to the lockdown. However, the authorities say they will be able to hold small camps in societies and offices if people show interest to donate.
At Ahmedabad Civil Hospital, Dr. Nidhi Bhatnagar, Chairperson of the Gujarat Chapter of the Indian Society o Blood Transfusion and Immune Hematology (ISBTI) said that though blood collection had gone down, they had managed to stay afloat in terms of demand due to the replacements coming in from the patients’ relatives, Ahmedabad Mirror reported.
In Vadodara, however, the situation is bleak with the SSG Civil Hospital completely running out on blood reserves and only relying on replacements by the family members of the patients. The reason for the shortage is the same – the fear of catching the infection. Though Shalini Agarwal, Vadodara Collector told Ahmedabad Mirror that after the lifting of the lockdown permission to hold small donation camps was given.
Surat too has seen a 50 percent drop in blood donation, said Dr. Sumit Bhargava, director of Surat Raktdan Kendra and Research Centre to Mirror. Stating worry, he said that while during normal times, they used to collect 3,000 units per month, the collection during the months of the lockdown from end of March to May 31 had cumulatively only been 2,800 units.
Protests by doctors
75 nurses from the Ahmedabad Municipal Corporation run SVP Hospital which is one of the major Covid-19 hospitals in the state, protested on June 8, 2020, after they received mails from UDF, their employer agency, informing them about a cut in salary and delays in disbursement of the same, Ahmedabad Mirror reported.
Around 350 nurses received the mail on June 2 which stated that with effect from June, those being given a monthly salary of Rs. 30,000 would be given Rs. 22,000 and those receiving Rs. 20,000 will get Rs. 14,000 and that the same would be handed over by the 20th of the month, as opposed to the first week like earlier. UDF Project Head told Mirror that the pay cuts were due to them not being able to afford expenses.
The protests only ended when AMC and SVP officials assured them that their salaries wouldn’t be reduced and presented a notice to UDF and took control of its staff management. Ahmedabad Mirror reported a nurse saying that UDF took the decision of pay cuts saying that it provided PPE kits to the nurses. However, it was found that PPE kits and masks are provided by the AMC and the AMC also bears the cost of the nurses’ quarantine and provides buses for their travel. The AMC also issued a notification stating that the nurses would be considered for direct employment by the AMC.
However, the nurses went back on strike on June 11, stating that the decision of revoking the pay cut had not been sent to them in writing. SVP CEO Ramya Kumar Bhatt told The Indian Express that the protests were motivated, allegedly by five staffers from Rajasthan who were creating trouble. He added that the decision of the pay cut was communicated by the contractual agency, UDF and the decision of the rollback was also communicated by them through e-mail. Bhatt added that the communication of the pay cuts not taking place and an additional 20 percent hike was already done on June 8, the first day of the protest, when it was presented on the hospital’s letterhead.
In light of this, the AMC issued a press note naming the five staffers of “provoking other employees to disrupt functioning” and stated that a police complaint would be filed against them under the IPC and Epidemic Diseases Act, IE reported.
Shortages of doctors
A Comptroller and Auditor General (CAG) report from the period of 2010 – 2015 about the healthcare system in Gujarat had said that the government run healthcare system in Gujarat has deteriorated to an alarming extent with up to 77% specialist doctors and 69% general doctors not in position, shortage of nurses up to 72%, and paramedical staff up to 41%, shortage of beds in hospitals up to 73%, funds for buying medicines lying unutilised, essential drugs in short supply, patients being given medicines that are already declared Not of Standard Quality (NSQ) and accident and emergency services either not available or partially available. Over a 100 doctors have tested positive for the virus in the last two months cite various media reports.
Now during the lockdown, the situation had exacerbated, with most critical care specialists and anaesthesiologists, catering to Covid-19 patients, leaving a gap in the space of doctors needed when non-Covid patients could start trickling in, reported Ahmedabad Mirror. A senior doctor of Ahmedabad Civil Hospital told Mirror that almost 50 percent, most of the 36 anaesthesiologists were stationed in the ICU, with 30 percent helping out with non-Covid surgeries.
The situation in GMERS Sola Ahmedabad and the Covid ICU at the Institute of Kidney Disease and Research Centre, is the same too, with over 75 percent and 80 percent of the anesthesia specialists and intensivists being on Covid-19 duty.
Apart from this, at any given time, 20 percent of the doctors are in isolation with them being home for a week after 10 days of duty. This period has been reduced from 14 days, yet hospitals are feeling the strain even after having full strength of doctors. A doctor at GMERS Sola told Mirror, “If any healthcare worker in isolation post Covid-19 duty does not show symptoms, they are back on non-Covid duty even after five days due to workload.”
To battle this shortage, hospitals are now planning to invite consultants and prioritize surgeries, reported Mirror. They are also looking to employ doctors – critical care specialists, anesthetists, pulmonologists and infectious disease specialists on a contractual basis. The appalling shortage of doctors can be understood from an advertisement by the Gujarat health commissioner who sought 686 Class I and Class II doctors for civil hospitals in Ahmedabad, Rajkot, Bhavnagar, Jamnagar, Vadodara and Surat.
Ahmedabad Civil Hospital can’t shake away controversies
Late last month, after a young whistle blower had brought forth the ugly plight of the Ahmedabad Civil Hospital to the fore stating that doctors were not given PPEs and were criticized of undergoing Covid-19 tests, the Gujarat High Court also lambasted the Gujarat administration over its mismanagement of the burgeoning health crisis in the state amidst the Covid-19 pandemic.
Calling the Ahmedabad Civil Hospital a “dungeon”, the HC in its order on May 22 had stated, “We are very sorry to state that the Civil Hospital, Ahmedabad, as on date, appears to be in an extremely bad shape. Ordinarily, the citizens hailing from a poor strata of society are being treated at the Civil Hospital. This does not mean that human life is not to be protected. Human life is extremely precious and it should not be allowed to be lost at a place like the Civil Hospital at Ahmedabad,” asking whether the state government was aware that patients at the Civil Hospital were dying due to lack of adequate number of ventilators.
Gujarat has been mired in controversy during the lockdown after reports of theft emerged from various hospitals. News of personal belongings like cash, watches and mobile phones being stolen from Ahmedabad Civil Hospital made the news recently. The hospital also came under fire for mismanagement and apathy after it failed to inform relatives of deaths of their family members.
The state was also embroiled in a fake ventilator controversy when the so-called ventilator machines, called Dhaman-1 developed by a company called Jyoti CNC were tested only on one patient before 900 were installed in government hospitals across the state! The machines hadn’t even received a license from the Drug Controller General of India (DGCI).
In mid-May, Sabrang India reported how as many as 25 out of 30 private hospitals refused to become Covid centers on grounds that the capping of the cost of treatment was way lower than the actual cost of treatment. The Ahmedabad Hospitals and Nursing Homes Association (AHNA) estimated that on an average, a private hospital incurs between Rs 20,000-22,000 for the general ward per day, while for ICU the running cost is between Rs 30,000-40,000 per patient per day. However, it cited that the Government Resolution, hospitals would be reimbursed by the state government – Rs. 200 per patient for OPD and Rs. 200 for X-rays, blood test and other tests. Expenses like staff salary, electricity bill etc. are not to be paid to the designated hospitals.
The Gujarat government has increasingly tried to downplay the faults in its healthcare system. The Indian Express reported that in the application moved before the court on May 25, which was incidentally a holiday on account of Eid, the Gujarat government has allegedly said that Ahmedabad’s Covid-19 situation was at least better than Italy or France. The government application reportedly said, “…the rise in the number of Covid-19 cases has been substantially slow in the state as compared to the said countries.” It added, “Similarly, the number of deaths has been substantially less in Gujarat as compared to Italy and France.” However, these comparisons were only made based on population. Sabrang India debunked this claim by studying the statistics that actually mattered – the number of people tested.
When more people are tested, more incidences of the disease can be diagnosed and treated. Often people who are asymptomatic could carry the virus and while they may not succumb to it, they can easily pass the disease to others who may be more vulnerable on account of reduced immunity, age or comorbidity factors.
Therefore, comparing Gujarat or Ahmedabad to Italy and France is not only an example of comparing apples to oranges, but also suggests that the administration is more interested in image management than actually improving healthcare infrastructure.
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