On May 23, Kabir Khatri’s sons spent half the day making frantic calls to Covid-19 hospitals across Mumbai, desperately seeking a bed for their father.
A 69-year-old diabetic, Khatri (name changed to protect privacy) had unexpectedly tested positive for the novel coronavirus the week before, when the private hospital where he was scheduled for a gall bladder surgery demanded a Covid-19 report. Since Khatri was asymptomatic, he was quarantined at home in South Mumbai, where his family monitored his oxygen levels several times a day.
“On Saturday afternoon [on May 23], his oxygen level suddenly fell to 50%, so we knew he needed a hospital,” said Khatri’s younger son, Jameel (name changed), a software engineer.
But a hospital bed was nowhere to be found.
The Khatris registered with the Brihanmumbai Municipal Corporation’s Covid-19 helpline number, only to be told that there were no beds available at Covid hospitals on an urgent basis. They received the same response from almost a dozen other hospitals they called. Finally, late in the evening, a private hospital in Chembur promised them a bed by 9.30 pm.
But now there was a new challenge: getting an ambulance.
“We tried the 108 ambulance helpline, but no one answered. We tried other ambulance services, but no one was available,” said Jameel. “By 8 pm, we finally decided to take our father to the hospital in our car.”
By then, however, Khatri’s oxygen levels had dropped to fatal levels. “He died at home, even before we could get him to the car,” said Jameel. “An ambulance is such a basic thing. If we had found one, maybe he could have been saved.”
A familiar story
Khatri’s story would sound familiar to anyone following Covid-19 headlines in Mumbai. Since recording its first case in mid-March, the city has reported 1,368 coronavirus deaths and 41,986 infections as of Wednesday – more than a fifth of India’s total cases.
The surge of cases has laid bare Mumbai’s poor healthcare infrastructure. Public hospitals have been overwhelmed with more patients than they can handle, and news reports have repeatedly highlighted how the city has “run out of beds” for Covid-19 patients in need of critical care.
A Scroll.in report on May 16 pointed out that Mumbai technically has more beds than the number of critically-ill Covid-19 patients who require them. The municipal corporation, too, claims that shortage of beds is only an occasional problem. Its Covid-19 helpline number, 1916, used to receive updates about bed status from all Covid hospitals two or three times a day, through which it allocated beds. But now, the helpline claims to receive live, real-time updates through a centralised dashboard launched by the municipal corporation on May 27.
“The dashboard is not available to the public – it is only for management purposes for our disaster team,” said Daksha Shah, the spokesperson for the corporation’s health department. “Some times bed shortages do happen, but now private hospitals have also been notified to reserve 80% of their beds for Covid patients, and we are handling it.”
Shah also claimed that there is no shortage of ambulances in the city. “Ambulances are available in plenty – who says they are not?” she said.
But the ground reality for scores of patients like Khatri has been starkly different. In public hospitals, coronavirus patients have been asked to share beds, sleep on the floor, or share wards with corpses that have been left on beds for hours because families refuse to claim them.
People calling the corporation’s Covid-19 helpline are often told there are no beds available. The situation is no better with ambulances – the state’s 108 helpline runs barely 100 ambulances in the city, private ambulance services are expensive and insufficient, and patients are left hight and dry when they need help the most.
These inadequacies ultimately have a human cost. Across the city, people have lost their lives because they could not get a bed or ambulance in time.
The human cost
“Every day, I have been hearing of three to four cases of patients running around between multiple hospitals before getting admission in one,” said Kalpana Gujala, a retired nurse from KEM hospital and the general secretary of the Noble Nursing Union, an association of nurses from across the city.
One such casualty, for instance, was a 55-year-old man from Jogeshwari who died in a wheelchair at KEM Hospital on May 22, after being refused admission by seven other hospitals. A Covid-19 suspect, the man had been experiencing breathlessness and chest pain and was in dire need of intensive care treatment.
He was turned away from six hospitals and placed on oxygen support at the seventh hospital, which eventually discharged him because they had no ventilators available. Finally, the family approached KEM Hospital – one of Mumbai’s largest public hospitals – where he was admitted even though there were no available beds. After a three-hour wait for a bed in a wheelchair, the man eventually died.
On the same day, a woman in suburban Mumbai lost her life because of miscommunication and delays in getting a bed and an ambulance. The woman was already a patient of encephalitis when she tested positive for Covid-19, and the BMC helpline took 24 hours to find her an ICU bed at a hospital in the city.
When the family called for an ambulance, the driver recommended double-checking with the hospital. When they did, the hospital claimed that the bed was not available after all. After several hours of hunting for another bed, a vacancy opened up at the same hospital. But this time, there was no ambulance available immediately. By the time the ambulance arrived and the woman was brought to the hospital, the ICU bed her family had booked was given to another patient. Desperate, her family admitted her in the hospital’s general ward, where she died three hours later.
Mumbai has had a shortage of ambulances for years, and the Covid-19 pandemic has compounded the problem.
With just under 100 vehicles in its fleet in Mumbai, the government’s 108 helpline for free ambulances is of little help for patients who need urgent hospital admission. “Patients have to wait for six to eight hours on an average for a 108 ambulance to show up,” said Gujala.
Private ambulance services are available faster, at two or three hours’ notice, but they are also expensive for most citizens: as much as Rs 10,000 for a trip to a hospital.
Dhaval Panchal, a 32-year-old businessman, claimed that private ambulances were demanding up to Rs 12,000 when he needed to take his Covid-positive father to the hospital last month.
Panchal’s father had been in home quarantine but his family decided to hospitalise him when his oxygen levels began dropping on May 21. Even though he didn’t need intensive care, getting a bed took 11 hours and rejections from six hospitals. Since there were no ambulances available at the 108 helpline, and private ambulances were too expensive, Panchal finally drove his father to Chembur’s SRV Hospital by car.
“We are lucky that he was not critical and because we are privileged,” said Panchal, whose father is now recovering at the private hospital. “For those who are not privileged, it must be so much harder.”
One organisation providing relatively cheaper ambulance services is HelpNow, an initiative by three alumni of the Indian Institute of Technology-Bombay. Started last year on a very small scale, the platform now has 347 private ambulances in its network, which it sends to Covid patients’ homes within an average of 45 minutes. “We received around 1,500 calls in all of April, but in the past week, we are getting around 800 calls a day,” said Aditya Makkar, one of the founders of HelpNow.
The platform is currently providing free ambulance services to the Mumbai Police force, whose staff have been reporting between 25 to 30 coronavirus cases a day, according to Makkar. For others, HelpNow provides ambulances for Rs 5,000 for a minimum distance of 5 km – a “zero margin cost”, according to Makkar. “The amount includes the cost of the PPE [personal protective equipment] and the payment for the ambulance driver and medical worker, as well as the cost of sanitising the vehicle after every trip,” said Makkar.
But this rate of Rs 5,000 is offered only for the handful of ambulances owned directly by HelpNow. For the other ambulances in its network, regular private charges apply.
Treatment in the corridors
While most private ambulances are equipped with first-aid, oxygen supply and defibrillators, ambulances attached to public hospitals are often just plain vehicles with room for a stretcher.
“Our ambulances don’t have doctors or any equipment in them – if anything happens to a patient inside, there is no help,” said a nurse from KEM Hospital who did not wish to be identified. The hospital has been using its ambulances largely to transfer Covid-19 patients without a bed to the BMC’s Seven Hills Hospital, which has a larger bed capacity. “But five or six patients are sent together in one ambulance.”
This is just one small part of the sea of problems plaguing public hospitals in Mumbai. The nurse, as well as the nursing union leader Kalpana Gujala, cited several cases of hospital staff contracting Covid-19 and then struggling to get beds.
“A nurse at one of the big public hospitals died of Covid last month because she did not get a bed,” said Gujala. “At another hospital, a senior management worker took a room for herself for isolation when she got Covid-19, but when junior staff asked for a separate Covid ward for them, they were told it was not available.”
More disturbing is the condition of patients at hospitals like KEM, whose policy is to admit all those who come for Covid tests, whether or not there are beds for them.
“Our emergency wards are overflowing, there are no empty beds, so patients and their relatives are just left lying or sitting in the corridors,” said the anonymous nurse. “Because of this, many patients get tired of waiting for a bed and just leave. The number of such absconding patients is increasing every day, and the task of tracing them falls on us.”
For patients who are critical, this poses an even bigger risk. “The ICU is absolutely full, so if a waiting patient needs a ventilator, we try to clear out other patients’ relatives who form crowds inside the ICU to make space for an extra stretcher,” said the nurse. “Otherwise, if patients need oxygen, we just try to help them as much as possible in the corridors or in their wheelchairs.”