As the Adyar river in Chennai breached its banks in the first week of December, everything from houses and schools to colleges and hospitals went under water. The roads caved in, houses collapsed and communication networks failed. Many hospitals and medical centres, too, collapsed. The floods exposed the ill-preparedness of most government and private hospitals in handling such disasters.
Most unfortunate were the patients of Madras Institute of Orthopaedics and Traumatology International at Manapakkam in Chennai, where the flood water entered even the intensive care unit. In the absence of power backup, 18 people who were on ventilator support died within 20 minutes of the power supply going off.
The daughter of a patient in the cardiac ward of the hospital said her mother survived on a cup of oats and a piece of bread for three days. As soon as it became evident that the building would be flooded, the doctors left. The nursing staff, however, stayed put, helping the patients in whatever way possible. “The ICU was totally dark. The ventilators went off on the very first day itself. It was a nightmare,” said the patient’s daughter, who herself survived on a few bars of chocolate she had in her bag.
Global Hospitals at Perumabakkam was cut off by the flood waters. “There was no power and we had to switch off the generator because of excessive water in the hospital premises,” says Ashwin Sridhar, chief neurosurgeon at the hospital. “Some areas of the hospital had water as high as 12 feet. Our nurses and doctors worked overnight in the ICU and provided manual ventilation to patients on ventilator. But soon we realised that we needed to evacuate 400 people. Thankfully, we could do so with the help of five motorised boats.”
Lack of foresight and a support mechanism proved costly for these two tertiary care centres. Why were the generators in these two hospitals kept on the ground floor? In the case of MIOT, the ICU, too, was on the ground floor.
In 2013, when the river Jhelum breached its banks, the Lal Ded Maternity Hospital in Srinagar was flooded. “The electricity went off and we had to perform a caesarean section. We did it under candlelight,” said Dr Mushtaq Ahmed Rather, the hospital’s medical superintendent. “We didn’t even have candles, but we managed to get some from a nearby shop. Though we had many backup plans, everything failed as our generators were on the ground floor. We have redesigned our backup plans after the floods.”
According to experts, the best way a state could prepare itself for calamities is by making a checklist of all natural and man-made disasters that could affect it, evaluate the intensity and work on building a system to tackle them.
In Chennai, for instance, the system collapsed because the government ignored the flaws in the hospital safety standards. Considered to be one of the best cities for medical tourism in India, Chennai failed to meet the basic safety standards. The Tamil Nadu Private Clinical Establishments (Regulation) Act, 1997—which prescribes minimum standards to be followed by all private hospitals—came into force 17 years ago, but the rules are yet to be notified. “We are in the final stages of preparing the rules for the state act. We have already had several rounds of meetings. The act will soon be in place. It will be notified shortly,” says J. Radhakrishnan, health secretary, Tamil Nadu. The Clinical Establishments (Registration and Regulation) Act, which was introduced by the Central government in 2010, too, awaits notification.
In December 2011, a fire broke out in the basement of the Advanced Medical Research Institute in Kolkata, which claimed 90 lives. A few months before the fire, Kavita Narayan, a disaster management expert trained by the Federal Emergency Management Agency in the US, along with health care experts, structural engineers, doctors and specialists in hospital design had prepared a detailed document on the way the hospital staff should behave in times of an emergency, particularly a calamity.
The document provides guidelines on how to evacuate patients and their families, avoid flooding of critical units and where to store which equipment. It also provides safety instructions that the hospital staff should follow during an emergency. The document was submitted to the National Disaster Management Authority in December 2013, but nothing came out of it.
Like Chennai, Mumbai is no stranger to heavy rains. In a report by Intergovernmental Panel on Climate Change, Mumbai was second in a list of 50 cities across the world that are susceptible to coastal flooding. On July 26, 2005, the city received a record rainfall of 944mm in a single day. It was flooded and more than 600 people lost their lives. But, unfortunately, health care authorities haven’t learnt any lessons. “Most hospitals in Mumbai have a disaster management mechanism ready, but hardly any staff trained to respond during disasters,” said Dr P.M. Bhujang, president of Association of Hospitals.
Both medical and non-medical staff must be given training. “Most hospitals fail to respond well to disasters not because of lack of facilities, but because of the response of its team,” said S. Narayani, director of Fortis Hospital, Mumbai, which has a disaster management plan in place.
Apart from ensuring power backup and a supply of clean water, a standard procedure code must be prepared for the staff to follow, such as the activities that should be continued or suspended in case of power outage, a mechanism to stock food and water, and when and how to evacuate people. It is important to conduct mock drills every six months.
The government needs to take a look at the existing systems. “There isn’t a single disaster management plan. Every time there is a crisis, we take a relook at our existing plans,” said Sujata Saunik, principal secretary, public health and family welfare department, Maharashtra.
In Kolkata, fire is a major cause for concern. In fact, last year around 15 fire-related incidents were reported in the city. Yet, authorities admit that they are yet to work out a plan to prevent loss of life and property. “We don’t have trained people in the health sector to deal with big disasters,” says Javed Khan, West Bengal disaster management minister. “We have just begun training our doctors, nurses and other health care officials.”
In Assam, every year from May to October, the threat of floods looms large. Last year, floods affected more than 18 lakh people in the state. “We have been holding mock drills to train the staff to handle cases of fire, floods and earthquake,” said Nandita Hazarika, project officer, Assam State Disaster Management Authority.
In case of fire, the primary focus should be on vacating the hospital and ensuring ventilation to let out smoke to avoid death by choking. In case of earthquake, there is the threat of the building collapsing, so the main focus remains on evacuation as well as setting up of a makeshift field hospital. Ideally, a hospital should have at least three days of power backup.
Conducting mock drills helps in assessing the readiness. “In one tertiary hospital, we found that they had their operation theatres in one building and the intensive care unit in another. We advised them to make each building self-sufficient so that the system doesn’t collapse if something happens to one of them,” said Hazarika.
Technology can help in such situations. “Our cellphone lines were dead during the Chennai floods. But, thankfully, all our employees were connected on WhatsApp for the initial two days when we needed to coordinate with them,” said Subbiah Viswanathan, chief operating officer, Apollo Hospital, Chennai. “We were also equipped with walkie-talkies, which run on batteries.”
To be able to handle a disaster efficiently, it is important that the government, private institutions and voluntary agencies work in tandem. “At the time of a disaster, internal resources may not be adequate in dealing with the situation. It is important to designate the roles in advance,” said Dr Ravikant Singh, president, Doctors For You, a voluntary organisation which provides medical expertise to areas affected by disasters.
Every state is supposed to have a disaster response force, but unfortunately none of the seven Union Territories have it. Some states have roped in other forces that are not equipped to rescue and help victims of a disaster. “These forces have doctors, equipment and instruments to deal with specific needs,” said Major General Anurag Gupta, joint secretary and adviser, operations, National Disaster Management Authority. “It is the responsibility of the state government to make arrangements for disaster management during peace time.”
WITH LAKSHMI SUBRAMANIAN, SWAGATA YADAVAR AND RABI BANERJEE