India's medical workers face infection risk, violence and life-or-death decisions

NEW DELHI • The shifts are long, the wards full and the demand so urgent that medical students and interns have been coaxed into filling in.

Hundreds of healthcare workers have died. Family members at home have fallen ill.

India's doctors and other medical responders find themselves short-handed and underfunded as they battle the world's worst coronavirus outbreak.

Beyond the physical danger they also face, they have been forced by the devastating size of the outbreak and the government's mismanagement of the crisis into cruel routines of helplessness, making decisions day after day that could determine whether a patient lives or dies.

As beds fill up, they have to choose who among the throngs outside the hospital gates to allow inside for treatment.

As the oxygen runs out, they have to choose who gets precious supplies. The emotional toll is mounting.

"All your life you prepare yourself to exhaust every option to save a patient, but imagine when you have to prioritise?" said Dr Mradul Kumar Daga at the largest Covid-19-designated hospital in New Delhi.

"Those are the most heartbreaking decisions you have to make as a doctor.

"And that is what has happened in the last three weeks of my life."

India's second Covid-19 wave is killing thousands a day, and the country's front-line medical workers have shared in the cost.

The Indian Medical Association said more than 1,000 doctors have died from Covid-19 since the pandemic hit last year, with a quarter of those dying since the beginning of last month, said its president J.A. Jayalal.

He estimated at least 40 per cent of doctors have been infected. Recent data on other medical personnel was not available.

The country's healthcare providers work amid an inadequate and deeply unequal medical system.

According to the World Bank, India's healthcare spending - public and out of pocket - totals about 3.5 per cent of its gross domestic product, less than half the global average.

Healthcare workers also face intimidation and violence, with videos circulating of angry family members thrashing medical staff covered in blood in hospital halls, or local strongmen bullying and scolding them.

"Everybody who comes is tense, and even a small issue sparks a big fight and the people are not understanding of the situation," said Dr Jayalal.

"Unfortunately, healthcare professionals have been asked to manage all this."

India was already short-staffed in healthcare. It had about 17 active health workers - doctors, nurses and midwives - per 10,000 people, according to the Indian Institute of Public Health-Delhi and the World Health Organisation (WHO).

That is far below the WHO's threshold of 44.5 trained health workers per 10,000 people.

They are also unequally concentrated in urban centres.

In contrast, about 40 per cent of healthcare providers work in rural areas, where more than 70 per cent of India's population lives.

Bihar, one of India's poorest states, has only 0.24 beds per 1,000 people, less than one-tenth of the world average.

"When I close my eyes, I feel someone needs my help," said Ms Lachhami Kumari, a nurse at a government hospital in the Rohtas district of Bihar. Her 80-bed facility has been overwhelmed by critical Covid-19 patients.

"When I manage to fall asleep, I see people all around, begging for help. That has kept me going."

At another government hospital in Patna, Bihar's capital city, Dr Lokesh Tiwari said almost half of the doctors and paramedic staff have lost family members.

He said the 400 beds in the general wards and the 80 intensive care beds remain full around the clock. Doctors and nurses have broken down so often that the hospital has started providing counselling services to its staff and their families.

"We are sent right into the high of the tornado," said Dr Alisha Akhani, a 22-year-old medical intern who has been doing Covid-19 shifts in Anand district in Gujarat.

"The times are difficult, the times are uncertain. But we will come out as better doctors."

NYTIMES