On 27 March, the Mahatma Gandhi Institute of Medical Sciences in Sewagram, in rural Maharashtra, was notified that it would be the nodal centre for the treatment of COVID-19 in the region. As the announcement circulated among the staff, it brought with it a wave of shock. The hospital was unprepared. It had only two ICU beds and was running out of personal protective equipment, or PPE, with only a small stock that they had bought at an inflated price.
A female resident doctor, speaking on condition of anonymity for fear of losing her job, said that she was terrified—she and her husband worked at the hospital, and had a newborn baby at home. Only one of them should risk infection, they decided. Her husband would work on the frontlines, while she stayed home and supported the hospital’s administrative work remotely. She fears that she will not see her husband again. “We are all very scared. I don’t speak just for myself,” she said. “All the resident doctors had similar conversations the minute the notification came in.”
Meanwhile, at the Jhansi Medical College in Uttar Pradesh, the nursing staff has not received their salary for seven months. On 25 March, faced with the looming threat of the COVID-19 pandemic, they boycotted work for the day. In an interview to the media, one nurse said that she met a member of the administration who asked them to “cooperate.” She said she told the administration, “We have been cooperating for seven months now. Corona has just appeared on the scene, a month, or a month and a half ago. It hasn’t been around for seven months, right? Then why are you not paying the salaries? Give it to us after two months, but at least give it.”
“They tell me the budget hasn’t been allocated,” the nurse continued. “Then I said you should let us move forward. But they had already made us sign stamp papers saying that we cannot go on strike, or work anywhere else. If we violate the agreement, we will be expelled from our jobs.” Doctors at the isolation ward at the Jhansi Medical College had not yet been given PPE kits, the nurse said, and hand sanitiser was not being provided either. The staff had been purchasing sanitiser privately, and now it was no longer available in the market.
These grim vignettes are a harbinger of what is to come, as India’s chronically under-resourced healthcare system prepares to confront a wave of COVID-19 cases. India has less than one allopathic doctor per thousand people—the minimum recommended by the World Health Organisation—and only 1.7 nurses per thousand people, again well short of the WHO-recommended three-per-thousand. As of 2016, the Indian Medical Association registered a shortage of tens of thousands of critical-care specialists. The dominant share of India’s doctors and beds are in the private healthcare sector, which has enormous leeway to self-regulate, at the cost of patients and the public.