Hirra Azmat from Srinagar has had a hard time making her grandmother, Hajra Begum, understand social distancing. “She can’t come to terms with this new form of imprisonment called quarantine,” said 26-year-old Azmat. Begum, 80, gets so annoyed that she even threatens to retaliate. “Nani suffers from dementia and heart blockage,” said Azmat. “She missed her monthly follow-ups. Her body aches have increased and she needs a change of medication for symptomatic relief.”
Getting care for non-Covid-19 ailments has been a nightmare in India in the last three months. With the focus on tackling Covid-19, the rising burden of non-communicable diseases is being neglected. Those with acute and life-threatening problems like snake bites and pneumonia also find it difficult to get treated.
At All India Institute of Medical Sciences, the OPDs remain closed. “Even now, they are not planning to open the OPDs,” said a senior AIIMS doctor who wished to remain anonymous. “So, no new patient can come in. Even the old ones cannot come. If liquor shops and malls can be opened, why not OPDs?” Currently, only trauma and cancer surgeries are being done in the hospital, and chemotherapy and radiotherapy are not being offered to all patients, said the doctor. A 200-bed trauma centre in AIIMS has been converted into a Covid-19 hospital. “Nowhere in the world has a tertiary centre been converted into a Covid-19 hospital. It just shows how rotten our health care system is,” he said.
As arrangements were not made for existing patients in hospitals that were converted to Covid-19 centres, the health care system took a hit. Kamal Shah, cofounder and director of guest services at the dialysis care provider NephroPlus in Hyderabad, said: “They don’t take into account what happens to the dialysis patients. Where will they go?” Shah, 44, has been on dialysis for 23 years. “We have figured out alternatives in some cases but those centres are farther off than their regular centres,” he said. “Because of this, some of our patients could not get to the dialysis centre and they died.” The health system has turned a blind eye to such deaths and they seem to be less significant than the Covid-19 deaths.
Dr Yogesh Jain, cofounder of the Jan Swasthya Sahyog, which offers highly subsidised health care services to villages in Chhattisgarh, says it is important to have specific non-Covid-19 hospitals as well. “Maternal and infant deaths are happening because of lack of access to health care. If I want to admit a patient with severe pneumonia, I don’t have a place to send him. If you set aside all your resources for Covid-19 care, where do people go for treatment of communicable diseases?” he said.
In Chhattisgarh, one wing of each district hospital has been converted into a Covid-19 hospital. “Ideally, private hospitals should be made Covid-19 hospitals operating under the government, and a district hospital should be the designated non-Covid-19 hospital,” said Jain.
Shah says that the lack of public transport is a big problem as patients below the poverty line depend on it. But even those with vehicles avoid hospitals if the illness is not life threatening. They see hospitals as vectors of Covid-19 and follow-up visits have declined remarkably in hospitals.
As Hyderabad sees a surge in cases, non-Covid-19 hospitals and clinics are faced with an ethical dilemma. If the hospital accepts a patient without a Covid-19 test, it puts existing patients at risk. But it is hard to get the test done in many places, unless one has strong symptoms.
Many private hospitals in Chhattisgarh have remained closed. “I have no doubt that the deaths and disabilities arising out of the lack of care given to non-Covid-19 problems will be far more than those caused by Covid-19,” said Jain. “Be it TB patients not getting a refill of their medication, women not getting their C-section on time or diabetics who have stopped treatment as the doctor is not available in the OPD... they are going to suffer hugely,” he said.
Puja Bhattacharjee from Kolkata, who suffers from psoriasis and psoriatic arthritis, agrees. “Since last winter, my psoriasis has flared up, and now, I have large patches on my skin,” said the 32-year-old. “I really need to go to the dermatologist to get medicines. My old medicines are not working anymore.” Bhattacharjee had set an appointment for mid-May, which did not happen. The clinic is closed now and she is making do with the old medicines.
Amid all the chaos, telemedicine has been a boon for some. Unlike Begum, who did not benefit much from it, Bhattacharjee has been able to avail mental health care online. She made an appointment with her psychiatrist through HealthPlix, an app. “I used to go to his clinic before. During the lockdown, we had a video session and he gave me some directions,” she said.
Technology has been a lifesaver for Ruchi Dwivedi too, who was in her final month of pregnancy when the lockdown was announced. “We restricted hospital visits to only one mandatory scan and all other consultations with my gynaecologist were done over the phone,” she said. “Even after the delivery, my visits to the paediatrician were limited to getting vaccines, which were again clubbed together.”
But the lockdown has been a testing time for her mother-in-law, Ajitha S., a rheumatoid arthritis patient, who has been on HCQS 300 for two years. With the increased use of hydroxychloroquine for Covid-19 treatment, the drug is hard to come by in medical stores, even with a prescription. “It was a nightmare as I normally do not hoard medicines,” says Ajitha, 62. “I wish the government had either given us a heads up or made some alternate arrangements.”
“There is a difference between fear and caution,” said the doctor from AIIMS. “The government has instilled fear in the minds of people at the cost of treatment for non-communicable diseases, instead of inducing caution.”