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UP: Story of broken healthcare system

It’s noon on Monday (26 April), and the corridor of the Covid-19 Ward 2 at the government-run Swaroop Rani Nehru Hospital, Prayagraj’s largest district hospital, resembles a railway platform.

Anxious relatives of Covid patients, most of whom have come from small towns and villages across the district, have crowded together at the corridor inside the ward, luggage in tow.

With little adherence to Covid-19 protocols such as social distancing, the relatives have literally just camped on bedsheets — some have lunch while others are waiting to hear from hospital staff about the condition of their loved ones admitted in the Intensive Care Unit .

Among those sitting in the corridor is Pushpendra Dubey, who has come from the nearby town of Naini along with his mother and younger brother. The 18-year-old’s father Ashish, a primary school teacher who is asthmatic, tested positive for Covid and is now battling for his life in one of the wards for the past three days.

“We know it is risky sitting here but where do we go in such a situation? Who will keep us?” he asks. “My father is serious and we do not want to abandon him here. So, we decided to stay put.”

Dubey, a civil engineering diploma student, isn’t alone. On Sunday and Monday, ThePrint met scores of families who are living in the corridor, and keeping vigil on their relatives undergoing treatment.

The corridor is also used by the hospital staff to bring in Covid patients from outside or shift serious Covid patients from one ward to another for treatment.

Dr Ajay Saxena, medical superintendent at the Swaroop Rani Hospital, told ThePrint over the phone that he was aware that the attendants of patients were staying in the corridor.

“These are difficult times. We can’t throw out the families,” he said. “Majority of them have come from nearby towns and villages and have nowhere to go. We are looking at putting some kind of a makeshift shelter outside for the families.”

Dr Saxena, who has also tested positive, added that the Prayagraj district magistrate is also aware of the situation and was trying to address it. “The overwhelming number of patients has put a severe strain on the hospital infrastructure. We have 650 Covid beds and all are full as of now,” Dr Saxena added.

The hospital’s situation is a microcosm of the Covid-19 struggles in Uttar Pradesh, where a devastating surge in cases has exposed the rickety healthcare system in the state.

UP reported 33,574 cases and 249 deaths Monday but the state’s number have been disputed.

In blocks and villages, a rickety health care system
If the bigger government hospitals in UP’s districts are struggling to handle the deluge of cases, healthcare facilities at the blocks and villages are either abysmal or non-existent.

ThePrint visited primary and community health centres in three districts — Prayagraj, Fatehpur and Kaushambi — and found that absentee doctors, shut primary health centres and understaffed community health centres (CHCs) are a common phenomenon in all of them.

At the Shankargarh CHC, which is barely 50 km from Prayagraj, the in-charge, Dr Shailendra Kumar Singh, has opened up a private practice right inside the CHC premises. When ThePrint visited the CHC Sunday, he was busy seeing patients at his house.

The CHC is understaffed, with just three MBBS doctors, including Dr Singh. There are two PHCs in the block but there are no doctors there. “We have limited facilities here. We refer serious cases to the district hospital at Prayagraj,” Dr Singh told ThePrint.

‘Limit RT-PCR tests to just 25’
The Shankargarh CHC is conducting Covid-19 tests but limited infrastructure has meant that on an average, it conducts only 70-100 tests a day.

Singh said that they are mostly conducting rapid antigen tests. “We have been told to limit the number of RT-PCR tests to 25 per day,” he said.

Singh said the reason was that RT PCR samples are sent to the Swaroop Rani Hospital in Prayagraj, which is grappling with a backlog.

“We do not have the facility to analyse the samples here. But currently the district hospital is inundated with test samples and it is difficult to process large numbers of samples,” Dr Singh said.

Singh said that villagers are reluctant to go to PHCs and CHCs when ill and prefer to get treated by ‘jhola chhaap’ doctors (quacks).

“They don’t come to get themselves tested despite showing symptoms. We can’t force them,” he said. “They come when they become serious. By that time, there is little we can do.”

Asked about the protocol being followed if a Covid-19 positive patient is in a serious condition, Dr Singh said, “We do not have a facility to treat Covid patients here. We tell those with mild symptoms to isolate at home while the serious ones are referred to the district hospital at Prayagraj.”

Over 25 km from the Shankargarh CHC is the Lalapur primary health centre .

ThePrint found the PHC shut when it visited Sunday. “The last time a doctor visited the PHC was some six months ago. Now, there is only a pharmacist and a ward boy,” said the ambulance driver, who was present at the PHC. He did not want to be named.

The second PHC in Shankargarh block, which is located in Naribari village, is in an equally dire condition. Both its doctor and pharmacist have been sent on duty to Covid hospitals in Prayagraj.

Vansidhar Dwivedi, a retired government school principal who lives in Lalapur, said that in case of emergency, villagers do not have an option but to go to either Allahabad or Kanpur for treatment. “Sometimes, they die on the way. The PHC here does not have any facility, be it doctors or medicines. It’s the quacks who rule the roost here,” he said.

Sanctioned staff strength 16, working 5
It’s a similar situation at the CHC in Khakhreru village of Fatehpur district.

The sanctioned staff strength at this CHC is 16 but at present, it’s making do with just two doctors and three nurses.

“We have four MBBS doctors here but currently one has been put on Covid duty in Prayagraj and another one is down with Covid,” said Dr Rajoo Rao, in-charge of the CHC.

This CHC, Dr Rao said, has the facility to carry out only rapid antigen tests for Covid.

“On an average, we conduct 26-27 tests per day. We send the mild cases for home isolation while the serious patients are referred to the district hospital,” he said. ThePrint

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