On April 25 when 25-year-old Syed Ali’s oxygen levels dipped perilously low to 78 percent, his family in Indarwa Abdullah, a village in Bihar’s Gopalganj district, rushed him to the district hospital. He was put on oxygen therapy, but it was not helping. He needed a ventilator, the doctors said.

The Gopalganj district hospital has three ventilators that it received from the Central government last September. But seven months later, as Bihar battles a deadly surge of Covid-19, with daily caseload this week increasing to more than three times the peak seen last year, these life-saving devices are little more than furniture here.

“We do not have an anaesthetist to operate them,” said a district health official.

After much effort, Ali’s family managed to arrange an ambulance to ferry him to Patna, but not enough oxygen to last the four-hour journey. Consequently, his condition deteriorated even further on the way. He died soon after in a private hospital in Patna.

Two days later, in adjoining Siwan, when Mangal Kumar Sah’s wife Savita Kumari was struggling to breathe at a government-run Covid facility in the district’s Maharajganj town, the doctors said they could not help despite there being enough oxygen in the hospital. She needed a ventilator support, they said, and the facility did not have any.

Barely half an hour away, though, was the Siwan district hospital where four ventilators have been lying idle since last summer. “We do not have doctors and technicians to operate them,” said Vishwa Mohan, Siwan’s district program manager in the health department.

Forty-year-old Savita Devi died hours later, gasping for breath.

Then on Thursday, Pramod Kumar Mandal, a politician belonging to the Rashtriya Janata Dal, Bihar’s main opposition party, died reportedly because he could not get access to a ventilator in the district hospital in north east Bihar’s Araria district hospital. Yet again, it is not like Araria has no ventilators. There are as many as six, all delivered last year – but all of them are non-operational till date.

“Ventilators are installed, but not functional,” said MP Gupta, the district’s civil surgeon. “We need trained manpower for it. We have been told by the government to recruit locally, but it is proving difficult to hire trained hands.”

After the coronavirus pandemic struck India in March 2020, the Central government procured around 60,000 “Made In India” ventilators. The outlay for 50,000 of them, amounting to around Rs 2,000 crore, came through the PM Cares fund. Of these, 17,100 ventilators were distributed to the states. The state-wise distribution is not in the public domain, but an official in Bihar confirmed that all district hospitals in the state had received them. Interviews with district health officials corroborated that the ventilators had arrived in the hospitals between July and September.

But most of these ventilators in Bihar are still not operational, an investigation by Scroll.in revealed. We called district hospitals in all 38 districts in the state. While we were unable to speak to officials in five districts, as many as 33 district hospitals confirmed that they had received ventilators last year. In 25 of them, however, the ventilators are still not up and running.

This was largely because of a lack of doctors and trained technicians, said officials. In some cases, the district hospitals did not have supporting infrastructure like on-site oxygen plants, pipelines, and uninterrupted power supply devices required for ventilators to function optimally.

Even in district hospitals where the ventilators are functional, officials said they are being operated without adequate manpower.

Staff shortages

In Champaran (East) district hospital, for instance, doctors operate the ventilators without technicians when there is an emergency, said civil surgeon Akhileshwar Prasad Singh. “It would be helpful if we got technicians.”

Indeed, doctors say that full-time technicians are important when it comes to safe operation of these devices. “These devices are prone to malfunctioning so a technician who is always keeping a watch is a must,” said Sunil Kumar Jha, the chief surgeon of Madhubani.

In the Madhubani district hospital, none of the six ventilators it received are operational. “We have just one doctor, that is not enough,” said Jha. “For six ventilators we need at least four. If not four, give us three at least.”

Scarcity of health workers is a chronic problem in Bihar. According to government data, one doctor in the state caters to more than 28,000 people, the worst ratio in the country. According to the state government’s submissions in the court last year, as many as 8,768 of the 11,645 sanctioned posts of doctors in the state were vacant. Nearly 5,600 of these posts were in rural areas.

A senior health official of the state told Scroll.in that the state had recruited not “less than 2,000-3,000 doctors” since the pandemic began. “But not everyone joined, of course, because some don’t want to go to rural areas,” said the official, who did not want to be identified.

No pipelines, no UPS machines

Yet, the lack of health care workers is not the only reason behind the non-functionality of the ventilators in the district hospitals. Some of them do not have the required physical infrastructure either. In Sheohar and Sitamarhi, officials said the district hospitals did not have on-site oxygen plants and pipes to transport oxygen that are necessary for the optimal functioning of ventilators.

In Madhubani, chief surgeon Jha said there were no uninterrupted power supply devices. “Ventilators need round the clock power supply, but we do not have UPS,” he said. “They gave ventilators but no UPS machines.”

What makes the situation particularly egregious is that except for Darbhanga and Gaya which also have medical colleges, none of the 25 districts have higher government facilities with ventilators. In many of these 25 districts, there are no private hospitals which have ventilators either. This means patients, already critical, are forced to travel long distances to bigger centres like Patna or Bhagalpur.

Consider Kaimur district in south west Bihar. Patients from the district have to travel to Patna, located almost six hours away, to avail of critical care facilities. This, despite the Kaimur district hospital having six ventilators of its own, again delivered last year by the Centre but non-functional so far.

These delays can often be catastrophic as in the case of Gopalganj’s Syed Ali. “If there is a ventilator in the district, why is it not being used?” asked his distraught uncle, Syed Sirur Ali. “What is the point of these district hospitals if they have to keep referring us to Patna?”

Experts said this trend of referring critical patients to Patna was unsustainable in any case in times like these. “People who live in Patna are struggling to get ICU beds despite all their connections,” said a development professional who works in the health sector in North Bihar, requesting anonymity since she worked closely with the state government. “What chance do people from villages have in a situation like this?”