On 30 January, Shashi Soodan, the head of the microbiology department at the Government Medical College and Hospital Jammu, sent a letter to Sunanda Raina, the principal of college. Soodan requested Raina to arrange for purchasing various items to prepare for the outbreak of COVID-19. The items included 10,000 personal protective equipment. But the hospital did not have PPE tailored for treating COVID-19 till as late as 24 March, Raina said, even though patients with the virus started coming to the hospital on 4 March. Till then, its health workers were using the protective gear required for treating swine flu and HIV, with N95 masks, Raina said.
Raina and a senior official at GMC Jammu, who requested anonymity, told me that the J&K Medical Supplies Corporation Limited, or JKMSCL—a public-sector unit of the Jammu and Kashmir government—was responsible for purchasing and procuring PPE. According to the senior official, the administration had been requesting the corporation for PPE for two months. But the corporation has failed to meeting the hospital’s requirements, the official said, leaving its health workers in the lurch.
By mid-April, two doctors at the hospital had contracted COVID-19. One of them, a 40-year-old microbiologist, was a part of a team that collected samples to test for COVID-19 between 13 March and 19 March. His wife, a dental surgeon, has alleged that the hospital did not provide him with the required PPE. The other doctor who tested positive for the virus is a post-graduate student at GMC. On 8 April, he came in contact with a COVID-19 patient, while he was working in a ward that treated respiratory illnesses. He was wearing a surgical mask and gloves—which do not provide protection from the virus—according to a doctor who was present there.
Health workers at GMC and Sri Maharaja Gulab Singh—a hospital associated with GMC—as well as the microbiologist’s family, told me about the challenges they had faced in the last month. Several of them recounted instances that showed the administration’s lack of concern about their safety. Almost all of them requested anonymity and expressed fear of retribution from the administration. Raina denied that the administration was apathetic at any point of time. She accepted that they were struggling to procure PPE, but blamed the JKMSCL for this. Overall, the situation at GMC has been marked by helplessness, and even confusion.
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The microbiologist’s family was distressed after he tested positive with COVID-19. He lives with his wife, elderly parents and a 15-year-old domestic worker. Three of his relatives spoke about what happened after he had tested positive for COVID-19. They said that the Jammu and Kashmir administration, the media and GMC were insensitive to the family.
The microbiologist began showing symptoms of COVID-19 a few days after 19 March. He soon tested for the virus and the hospital informed him that he had contracted the infection. On 30 March, officials from the government administration and GMC shifted the four of them to a guest house at Ambedkar Chowk. Two days later, they were all tested for the virus. By that evening, the microbiologist’s mother—who suffers from cardiac issues, diabetes and has just one kidney—was feeling unwell. The family had no medical assistance at the guest house. The microbiologist, who was admitted in the hospital, called his family and told them that his wife, father and the domestic help, had tested positive for COVID-19.
The family was distressed by then as it had little information about what would follow and if any assistance would be provided to the microbiologist’s ill mother. At night, a 31-year-old relative of the microbiologist visited the dental surgeon at the guest house. He stood a couple of metres away from her and recorded a video of her talking about the situation. “I don’t understand what is happening,” she said, while sobbing. “An ambulance has come outside asking three of us to come out and sit inside. No one is thinking that a lady for whom we’ve been raising hue and cry for days, she may die of heart attack,” she said, referring to her mother-in-law.
Her husband was admitted because of “hospital negligence, this is all happening because of that,” she said. “We’ve taken so many precautions … My husband is sick because the hospital did not give them PPE. If something happens to anyone, who would I ask for answers?” At around 11 pm, a team of officials from GMC and the administration came to the guest house and announced through a loudspeaker that the three who had been tested positive were to board the vehicle.
Meanwhile, the family was appalled by a report in the Daily Excelsior, a leading daily in Jammu, which created an impression that the doctor was not a part of the teams dealing with COVID-19 samples at GMC. On 31 March, the front-page report stated that Soodan, the microbiology’s department head, had denied that the 40-year-old was a part of the coronavirus testing team. Sanjeev Pargal, the reporter, wrote, “It is being ascertained whether the doctor caught virus within the Medical College or he had come in contact with any person of travel history especially those who have returned from pilgrimage from Saudi Arabia, Iran and Indonesia.” The report also quoted Soodan, who added that she had trifurcated her staff into three teams—collection, testing and infection control and all of them were working “to speed up testing process.”
A 27-year-old—one of the microbiologist’s relatives—was furious at Soodan’s statement and the insinuations made in the report. The relative said that the countries that were mentioned in the report showed that they were trying to link the microbiologist to the Tablighi Jamaat, a Muslim revivalist organisation. The Tablighi Jamaat had organised a conference in Delhi’s Nizamuddin area in March. The conference was criticised for ignoring principles of social distancing when cases of COVID-19 had started to emerge in the country. Sections of the media had taken this as an opportunity to give a communal colour to the virus.
Later, in a statement to another local daily, Early Times, Soodan said that the microbiologist “is a very dedicated doctor” and that he was, in fact, on duty. She reiterated the same to me, and said he must have been in the collection or infection control team. But she added, “Many healthcare professionals in India and all over the world have acquired infection. How can we know from where one contracts infection?” When I asked if she would be giving a clarification to the Daily Excelsior, she replied that her team was overworked. “How can I write responses to them, I am tied to so many other things at present.”
During the conversation, on 7 April, Soodan dismissed the idea that there was a shortage of PPE kits. “Well in advance we had the PPE kits in our stock for collection of samples and testing because we also test influenza, so we use PPEs,” she said. “But I can’t say anything what would happen in the days to come.” However, on 24 April, Raina, the principal of GMC, confirmed that procuring protective gear for COVID-19 was a struggle for the hospital.
The second doctor who contracted COVID-19 had unexpectedly come into contact with a patient who was at the time suspected to have the virus. The doctor, in his twenties, was a post-graduate student at GMC. On the afternoon of 8 April, he was deputed in the hospital’s Ward Number Three, then designated for patients with respiratory problems. A health worker at GMC who was present in the hospital at that time—and was involved in the matter—told me about the events that unfolded that day. That afternoon, a woman came to the ward who seemed “critical.” The post-graduate student, who was wearing surgical gloves and a mask at the time, checked her pulse. He then looked in her file and found that the hospital had taken her sample to test her for COVID-19. The woman died minutes later. “She was a suspected case,” the health worker who narrated the incident to me said, “but perhaps did not know where to go and landed up in Ward Three.”
That evening, the woman’s test result returned positive. The administration asked the post-graduate student to go to his hostel and “self-quarantine” himself there. The next day, he was shifted to a hotel. Four days later, he tested positive for COVID-19 and was shifted to the Government Chest Diseases and Tuberculosis Hospital Jammu, an associated hospital of GMC that has been designated as a COVID-19 hospital.
When asked about this incident, Raina’s account differed in details from that of the health worker who was involved in the matter. She said that the patient was not sent to the respiratory ward, but was actually being taken to the isolation ward and she died on the way in the hospital. According to Raina, that the doctor who contracted the virus tried to save her life and gave her a heart massage. “He was not working in COVID area, that’s why he was not provided with a PPE kit,” she said.
At SMGS, the only maternity hospital in Jammu that provides tertiary care, at least thirteen doctors as well as other nurses and staff had to be quarantined as they came into contact with a COVID-19 patient. Two doctors who treated the patient recounted how it happened and the administration’s haphazard response. The patient needed emergency help and there was no time to determine whether she could be a carrier of COVID-19, the doctors said.
The patient was a pregnant woman from Akhnoor who came to SMGS’s emergency department on 9 April. She required a caesarean. “She had a previous caesarean, so we operated on her since it was her term and she was complaining of pain,” one of the doctors who treated her said. As the patient came with a “bad chest,” her sample was also collected for a COVID-19 test. On 11 April, her test results returned positive.
At the time of duty, “we had the normal HIV kit’s gowns, those plastic gowns, and some of us were not wearing it because, honestly, we weren’t exposed to such threat,” the doctor said. “We were having N95 masks, some had plastic gowns, some were wearing scrubs, some were not wearing gowns—everyone was wearing gloves and N95 masks. But we were not fully protected against that patient,” the doctor said. “Even the PPE kits don’t 100 percent protect you from the corona strain, but it is, obviously, far more better than what we had.”
The doctor told me that it was unclear to her what protective gear they should have been wearing. The union ministry of health had released a set of guidelines for the rationale use of PPE for healthcare workers dealing with COVID-19 on 24 March. According to the guidelines, in the emergency department, if one is attending a case which could require aerosol generating procedures, they should wear a N95 mask and gloves. But in the same department, while attending to “severely ill patients of SARI”—severe acute respiratory infection—“full complement of PPE” is required. Components of this PPE are “goggles, face-shield, mask, gloves, coverall/gowns (with or without aprons), head cover and shoe cover.”
But according to the doctor who treated the patient at SMGS, in emergency situations, “we cannot practically wait” to engage with a patient and decide what equipment they should use. The emergency staff had not demanded full PPE kits till then as “I know from the administration these kits are not available so easily,” the doctor said. “Only those healthcare workers working with the corona patients are getting those equipment.” The administration as well as the staff also did not anticipate this situation wherein a person coming for a delivery would have COVID-19, the doctor said. “We didn’t know that those without a travel history will turn out to be positive, because it wasn’t a community spread,” the doctor told me.
After the patient tested positive, the administration did not immediately quarantine the healthcare workers who had come into contact with her. In fact, administration members were rude to the health workers who demanded solutions. “I think the administration wasn’t prepared for such a situation, for such a mass quarantine,” the doctor said. Those who were working with COVID-19 patients were getting quarantine facilities, “but this wasn’t expected, it came out of syllabus,” according to the doctor.
The administration was “taking quite a long time to come to a decision” about whether they would quarantine us, the doctor said. The health workers were apprehensive as they could not go home after being exposed to a patient with the coronavirus. “Through lots of communication again and again we convinced them that we cannot go home, so we had an emergency meeting,” the doctor said. “We were quarantined on Sunday early morning hours.”
Some of the health workers were then taken to a hotel at Prem Nagar in Jammu, “where at least two to three dozen people had gathered and were literally raising slogans, ‘Inko nikaalo, yeh bimaari leke aaye hai humaare paas’”—remove them, they have brought the disease to us—the doctor told me. “We had to change our accommodation due to this hostile environment.” After this case, the doctors demanded that the emergency staff should get PPE kits “or something close to that,” the doctor said. “Because we don’t know any person walking into the hospital is corona positive or not.” The doctor said she had heard that the emergency staff was getting more protection now.
When asked about the communication gap in this case, Raina admitted that there were some issues. “I won’t say they were in PPE kits for corona code, but they had the protection they need for surgery,” she said. “But even when you are conducting a surgery or delivery, you use protection against splashes … we are giving N95 mask to every healthcare worker whether they are in emergency or screening areas, respiratory clinics or COVID areas.” It is then unclear why the second doctor who contracted the virus—the post-graduate student—was working in a ward for respiratory illnesses wearing a normal surgical mask.
At least one post-graduate student who was interning at SMGS hospital had also come in contact with the patient from Akhnoor. The intern spoke to me about the administration’s lack of concern about the situation about this. “I had checked the blood pressure of the patient one or two times. I was just wearing surgical masks and gloves,” the intern said. The administration did not inform the intern that the patient had contracted COVID-19, according to the intern. “I got to know by some other colleague. [The administration] said stay at the hostel,” the intern said. A hostel inmate “brings food to me” every day, the intern said. “The medical staff didn’t show any concern, they didn’t even call me.”
A senior official at GMC told me the JKMSCL—the corporation responsible to procure PPE—was “inefficient and insensitive.” The official said, “I fail to understand why we have this corporation when Jammu and Kashmir has become a union territory and it comes under the direct administrative control of the central government.” According to the official, the corporation has Rs 4.5 crore from the GMC to facilitate procurement this year. “We have to attend the patients. We can’t wait,” the official said.
On 24 April, I called, messaged and dropped an email to Shiv Kumar Gupta, the then managing director of the corporation, for a comment on these allegations. The next day, the government of Jammu and Kashmir posted Dr Yash Pal Sharma as the managing director of the corporation. Priyanka Bhat, the general manager of JKMSCL for Jammu region, told me that she is not the “authority to comment on it.” On 26 April, I spoke to Sharma, who was taking charge as the managing director the next day. “As of now I am not aware of the shortages,” Sharma said. He said it would be his priority to look into these issues.
The principal admitted that initially, she did not have clarity about the equipment the staff would need for COVID-19. “First, we started using HIV PPEs and then we decided that those working in COVID areas would use the specific PPEs,” Raina said. “We tried to manage, kahin kahin se karke shuru, ki dekhe toh sahi hote hai kaise hai, TV pe dekha”—We started managing from somewhere, thought let’s have a look what they are like, saw it on TV.
Between 22 March and 4 April, the hospital received around four hundred fifty PPE kits for COVID-19. On 23 April, the hospital received another set of 750 kits. “But I have to manage five hospitals,” Raina said, referring to facilities that had been turned into “COVID-19 hospitals.” She, as well as the senior official, mentioned that the administration had been “arranging” PPEs on their own.
On 22 April, Kashmiri Times, a local daily, published an article which alleged that the hospital had bought PPEs at an overpriced cost from a private company by withdrawing money from the hospital’s Students’ Welfare Fund. Raina said that the allegations were unfair. “When we got to know that corporation is not able to provide us the COVID kits, we received orders from the government that you make the arrangements. What arrangements can we make, we will search market only?” she said.
The order was placed as a back-up option, Raina said, as they did not know when the corporation would be able to provide the kits. She said that the decision to place the order was made after consulting all stakeholders. According to Raina, several officials in the hospital were also consulted before withdrawing Rs 50 lakh from the Students’ Welfare Fund. Right from sanitisers, everything required to combat COVID-19 is being sold at exorbitant prices everywhere, she added. “I had first cancelled the purchase order then Atal Duloo, the finance commissioner health told me not to take media reports seriously,” she said. Raina claimed that the hospital had followed the right procedures. “We contributed at our own or requested people to arrange PPE kits and made things work at the hospital for a few days,” she said. “But you can’t beg for long.”
“Forty-eight patients have been admitted in my ward. Sixteen cases successfully discharged out of them,” Raina told me on 24 April. By then, GMC and the centres in its jurisdiction had conducted 2,850 tests for COVID-19. As of 4 pm on 26 April, 66,977 people were enlisted for observation for surveillance of COVID-19 in Jammu and Kashmir. A doctor, another post-graduate student who had come into contact with the COVID-positive patient at SMGS, told me he was scared for his safety. “We have not been trained to embrace death like soldiers,” the student said. “We need protection equipment … We can also spread it.”