As we enter the third year of the pandemic, there is sobering admission by scientists that humankind will have to learn to continue to live with Covid-19 for the foreseeable future. I write here at this milestone an account about my own personal experience in a general ward of a leading public hospital with the coronavirus infection that was one of the most difficult periods of my life.
I write with some hesitation and this is something that I have struggled to do for this past year. The monumental scale of suffering of literally millions of my countrywomen and men makes my own experience inconsequential by comparison. But I still do so write, only as a direct witness to the disgraceful collapse of even elementary care and everyday humanism that I encountered in the general ward of what is widely considered the finest public hospital in the country.
I had expected to catch the Covid-19 contagion much earlier. The eruption of mass hunger into which homeless people and urban poor people, in general, had been thrust overnight compelled me to descent to the streets of the city I live in, Delhi, from the second day of the first lockdown.
I knew, from two decades of work among them that there are two tenuously fragile strings that alone lift homeless people from hunger every day of their rough lives. One of these is the lowest-end, most casual, most exploitatively reimbursed, most uncertain and most unsafe employment that is unreliably available to them to help fill their bellies each day.
Food solidarity
If this employment at dirt wages does not come their way, their other social security is from religious food charities, in gurudwaras, dargahs, temples and in some cities (not in Delhi, we found) in churches. The punishing lockdown announced in March 2020 with four hours’ notice by Prime Minister Narendra Modi peremptorily and mercilessly snapped both these feeble but still life-saving strings overnight. As I have described at length in my book Locking Down the Poor this unleashed a flood of mass hunger in cities on a scale that I have not witnessed in my lifetime.
There was, therefore, no question: I had to be on the streets, trying to organise food (with dignity and care) to homeless persons and the survivors of the Delhi riots of a few months earlier. So there I was, on the streets, from the second day of the lockdown, helping in a small way in distributing cooked food and ration kits to homeless people who had become like sisters and brothers over the decades of our work together. I caution my reader – this was not a particularly heroic decision: it was an imperative of the heart. I could not do anything else. It was not food charity, it was food solidarity.
And I was not alone in this resolve: many of my young colleagues made the same choice and spent the next months of their lives immersed tirelessly and feverishly in organising food for those thrown by their governments and their employers so thoughtlessly and casually, indeed cruelly into mass hunger.
They were answering distress calls, managing donations that poured in from every corner, making food purchases, assembling thousands of ration kits, organising buses for migrants to return to their homes in safety, protecting homeless people in the shelters we manage, petitioning the courts and reporting the stories.
My young colleagues were aware of the risks they were taking, but for them too there was no choice. Embedded in my heart are the words of one young colleague when I asked him – are you not frightened? He replied, “Yes, I am frightened. But much greater than my fear is their hunger. So I have to be on the streets”. Each made arrangements to try to protect their families. Some moved into the office, some into the homeless shelters for the entire duration of the lockdown.
I moved into a separate bedroom of my house and stopped seeing in person my ageing father and mother-in-law. My colleagues who worked with lynching survivors and homeless people around the country pitched in heroically – in Jharkhand, Bihar, Assam, coastal Karnataka, Mewat, Western Uttar Pradesh, Madhya Pradesh, Bengal and the cities of Jaipur, Patna and Hyderabad. Together my friends distributed ten million meals.
Contracting Covid-19
I had quietly bargained with myself to catch the contagion early. But the virus did not come to me. My epidemiologist friends later explained that we were ironically interacting with the safest populations in these early months because the virus was carried into India mainly by the rich and middle classes who could afford international air tickets.
The destitute homeless were safe because they had no occasion to interact or mingle with the middle classes. It was only after the lockdown ceased, and the classes began to mix again, that the virus spread to the bodies of the poorest denizens of the city.
Dismayed by how total was the denial of testing, quarantine, isolation and treatment of the homeless and the labouring poor, we decided to open our own Covid centre for the homeless, in our homeless shelter on the banks of the Yamuna river in Delhi, and then on the streets in homeless habitations elsewhere. It is in the course of this work that, during the second wave, we lost one of the most selfless and devoted doctors that I have had the privilege of knowing, Dr Pradeep Bijalwan, to who I paid tearful tribute in an article on The India Forum.
It is in this clinic, weeks after we first opened it with Medical Sans Frontiers in our homeless shelter that I caught the Covid-19 virus, along with many of my colleagues.
This was sometime during the month of October 2020. Everyone in our household also tested positive – my wife, my mother-in-law and our domestic helpers. As a precaution, we employed a live-in home nurse for my mother-in-law. Our symptoms were not worrying.
But I have a congenital heart valve defect, and there was a worry that this might render me more vulnerable to complications. I was anxious not to become a problem to my family if my health declined, so I accepted the advice of doctor friends to check into a hospital.
I need to explain why I chose the general ward of a public hospital. I do have health insurance – in fact, we bought health (and life) insurance paid from the office for all staff, as they were putting their health and lives at risk.
I could have easily checked into a private hospital – beds were available at that time. And it is not as though I have in the past not used the services of private hospitals: I had on two recent occasions checked into one of the less ostentatious of private hospitals for some minor surgeries. But this moment was different.
I was reading, alternating between anguish and wrath, of Union ministers, chief ministers and health ministers of states, all almost without exception admitting themselves after testing positive for Covid-19 into the most expensive private hospitals of their cities. The rage was because they clearly had no faith in the public services they were responsible for building and managing. The anguish was that they had no qualms in abandoning the poor who could not afford to enter the gates of a private hospital to these services.
Public hospital
I, therefore, decided that when Covid-19 got to me, I would only go to a public hospital. But then the question arose: where within a public hospital? I had friends in the Union health ministry from my years in the Indian Administrative Service, including my trainees. A phone call would have been enough at that time to get a single private room in the All India Institute of Medical Sciences or Safdarjang Hospital. However, that seemed to be a cop-out, because I would use my privilege to simply escape the fate of lakhs of my countrywomen and men in this time of the greatest health emergency of the century. So I made my decision: I would check myself into the general Covid-19 ward of a public hospital.
My daughter, who had recovered from Covid-19 a month earlier drove me to the hospital. The formalities took some time. I was then asked to walk into an ambulance with some other patients. My daughter was not allowed to travel with me beyond this point. We hugged, and from the ambulance, I waved. From here on, I was on my own.
Another patient and I were driven through the traffic for some minutes to the designated Covid centre of the hospital, lodged in an entirely separate building on the opposite side of the highway. We were shown to the lift. I had carried with me a book to read, a toothbrush and paste, and my phone. The lift took us to the top floor. I walked into a general ward with around 50 beds. Most of them were occupied.
I was uncertain about what I was expected to do. I looked around for a nurse. She said, find an empty bed and lie down there. I was confused: “will you not give me some hospital clothes to wear?” I asked her. “We do not have any,” she replied brusquely. “Find a bed, and lie down in the clothes that you are wearing.”
A little bemused, I did as I was told. I then began to size up my situation. What hit me first was the high-decibel piercing noise levels that incessantly pervaded the ward 24x7, never relenting, which became one dominant memory of the days and nights that followed. Even past midnight, the noise would not cease.
Hopeless grief
One part of the clamour was of the voices of the nurses and ward boys who seemed always to shout at each other, at any time of the day or night. The second was the screams of the monitors. The monitor attached to my bed was also gutsy in its wailing. The only catch was that it was not connected to me. This meant that no one was checking my vitals.
At home, at least we had an oximeter that helped monitor our oxygen levels. Here in the hospital, it was apparent that even if my oxygen levels plummeted, no one would be the wiser. And then, there was the piteous wailing of patients. At any point of time, I counted at least half a dozen patients who were convinced that they were about to die. But no family was allowed at their bedside, and none of the ward staff tried to counsel or comfort them in any way.
Between the bedlam and the hopeless grief of the wails, I tried to sleep, but this became difficult even late into the night. I thought I would chat with the ward boys, whose faces of course I could not see. They all looked like spacemen, but it was apparent that they were young men.
As one spoke to me, I learnt to my shock that most of them were untrained. “The regular ward boys of the hospital refused to work in the Covid ward”, he said. “Before the lockdown, I was a room boy in a hotel. The hotel retrenched us. My family was starving. The hospital offered work to anyone willing to work in a Covid ward. I was terrified. But when you see hunger in your home, tell me what choice do you have?”
No doctor came once to see us even once in the days that I spent in the ward. And I was trapped: I now did not have the option to leave.
Some days passed, maybe two, I cannot remember clearly. I begged the staff: you do not have clothes for me, but I am feeling sweaty and dirty. Can I at least have a bath? After some confabulations and some more pleading, they agreed. They led me to a bathroom. This much I remember. After this, I lost my memory entirely for around ten days.
I picked up the details of some of what followed from my wife and daughter later. My wife worried because I stopped answering my phone. She called by phone the nurses: they said I was okay, but maybe I had slipped into a depression.
My wife was very sceptical: even if I had just slipped into depression, she said, which was unlikely, I would not just suddenly just switch off, stop speaking altogether. I had after all spoken to her at length just a couple of hours earlier. But the nurses were insistent: I was okay, my Covid was under control, I may be in depression but there was nothing to worry about.
After another day, my wife put her foot down. She decided to insist on my discharge. It was a decision that probably saved my life. The hospital staff said it was unorthodox to let someone go who is still testing positive for Covid, but they were willing to let me go. My discharge slip reported nothing untoward.
Loss of memory
I am told that back at home, I could not recognise my wife and daughter. When asked, I apparently said that they were nurses. I would not speak or eat, complaining all the time of a headache and nausea. A couple of more days passed when blue marks appeared on my forehead. My family and friends conferred and decided that this was possibly something serious. They took me to another hospital, where they conducted many tests. They then grimly spoke to my wife and daughter. It is not Covid.
They did not know how, but I had developed very serious brain injuries, and there was heavy bleeding in the cranium. The public hospital earlier had recommended that I take Aspirin, which had further stimulated bleeding in my brain. All of this was imminently life-threatening. I would probably need immediate surgery if my life was to be saved. But that hospital did not have the expertise for this. I needed to be taken to yet another hospital.
Family and friends zeroed in on a hospital in Gurugram that was covered with my Central Government Health Scheme card (as I am a retired civil servant). The young neurologist took me in, and after another battery of tests, said he would like to try a few days with medicines, not surgery. I went into another Covid-19 intensive care unit, even larger than the Covid ward in the public hospital.
It took a few more days for my memory to, bit by bit, return. I recall the first vivid hallucinations. I imagined that I was cured of Covid and that people who loved me were happy and wanted me with them.
In my hallucinations, I chose to first visit the people who had been released from the detention centres in Assam after our intervention in the Supreme Court. I still can recall vividly the faces of the people, the children prancing around, and my conversations with them, as if all of this was real. Slowly a part of my mind recognised that I was still in a Covid ward. I was not even permitted to go to the bathroom. How could I have travelled all the way to Assam? I struggled to take a hold of myself, and from then my memory was slowly restored.
More tragedy
More tragedy was in store after I returned home. My father, nearly 95 years old, was intensely, inextricably tied to me. Every day, wherever I was, I must speak to him. After Covid, he had got used to meeting me on Skype. For many years, our mutual routine had been that a day would not pass without my speaking to him. And now, ten days had passed and I had not talked to him. He was convinced that some great harm had fallen on me. In his worry, he got a stroke, and in hours passed away. Heartbroken with the news, I pulled myself out of bed and organised his funeral, difficult in Covid times.
In the coming months, friends insisted that I meet a succession of leading neurologists. They all looked at my scans and said that how my brain was so severely injured was a mystery, more so because the hospital insisted that nothing at all had happened to me, and I had no external injuries. The doctors also all agreed that my survival, and eventual healing without changes in my personality, were nothing less than a miracle. A little longer in the public hospital, and the bleeding in my brain would surely have led to my death.
The story did not end there. My health improved a little, and I insisted on returning to the people I worked with. The crisis in their lives was too acute for me to stay away. I was back on the streets, in the shelters, and travelled to Assam, Mewat, Western Uttar Pradesh, Hyderabad and Bangalore. But I took sick again, this time with raging undiagnosed fevers.
I was in hospital once more, and in some time my entire body broke out in red rashes. The doctors diagnosed one of my fevers to be adult measles. Again after my discharge, I returned once more to my work and travels.
One more time, I suddenly started losing weight with alarming rapidity – 8 kg in two weeks. I could also barely breathe or swallow. Again hospital, another battery of tests to rule out cancer and tuberculosis. The diagnosis this time was that a fungus had almost completely colonised my lungs, probably from steroids when I was being treated for my brain injury.
Strong medicines and some hill air in our cottage near Bhimtaal, with my family including my three-year-old grandson, again restored me slowly back to health. At the time I write this, I realise that my body is still ravaged, I am still to regain the fitness I had taken for granted all my adult life.
Through all of this, I am also battling wild charges against me by the government, including insurrection, hate-mongering and high financial crime. I remained determined to continue to speak out against the savaging of the Constitution and of freedoms, justice and fraternity. My body will take time to be restored, I realise that. But I am determined that I will not allow my voice, my spirit, my solidarity and my love – for whatever these are worth – to be vanquished by the virus, and far more dangerously by an uncaring, malign state.
As I said, I have struggled to write this dire eye-witness account for over a year. Its troubling reminders continue to haunt my memory and my conscience, of what the public good of healthcare had been reduced to in India, of the hell into which people who could not afford the extortions of for-private healthcare had been thrown into. And of the wages of electing a state led by people who are singularly, pathologically bereft of compassion. I still felt that, however difficult, I must create this personal record for one reason, for the hope that we will not allow this to ever happen to our people again.
Harsh Mander is a human rights and peace worker, writer, columnist, researcher and teacher who works with survivors of mass violence, hunger, homeless persons and street children. His Twitter handle is @harsh_mander.