Mumbai’s health infrastructure falls short as patients go after private medical care

The spread of Covid-19 disease among the city’s wealthier residents of high rises — at least 799 buildings are now sealed by the Brihanmumbai Municipal Corporation as of April 12 — is driving the shortage of private hospital beds in Mumbai

The spread of Covid-19 disease among the city’s wealthier residents of high rises — at least 799 buildings are now sealed by the Brihanmumbai Municipal Corporation as of April 12 — is driving the shortage of private hospital beds in Mumbai. This shift in the socio-economic pattern of the pandemic has once again left Mumbai struggling to cope, as it did during the first wave.

New Covid Care Centre, at Nehru Science Centre, Worli. (Anshuman Poyrekar/HT Photo)

Bandra’s tony Lilavati Hospital in Bandra added 25 beds in the lobby of its Covid-19 floor last month, but it’s still not enough, chief executive officer Dr V Ravishankhar said. “Patients know that once they are in, their treatment will start and they will be moved to a bed as soon as someone is discharged,” Ravishankar said. “It gets tough when patients have specific demands of private beds or deluxe rooms.” At any given point, at least eight Covid-19 patients are being treated in the triage area – the first point of contact with a patient. After the last peak settled down in November, many beds were reassigned for non-Covid care. But as soon as the cases surged, they went back to the Covid-19 arrangement. Currently, the hospital has 142 regular beds and 48 Intensive Care Unit beds for Covid-19 cases.

According to Brihanmumbai Municipal Corporation’s additional municipal commissioner Suresh Kakani, a shortage of beds is being felt in the private sector particularly as “a large number of patients are now coming from housing complexes and high rises.”

The situation in public-run hospitals isn’t as yet dire, but the number of vacant beds is fast reducing. As of April 12, as many as 15,451 beds were occupied out of the 19,329 Covid-19 beds under the BMC’s command (13,512 in public hospitals and 5817 in private hospitals). Of the vacant beds, only 588 were in private hospitals. The city has 89 ICU beds available (out of a total of 2,529) and 32 ventilators available (out of a total of 1302).

Mumbai has recorded over 5,20,214 cases and 12,017 deaths to date. Last year, the city’s highest single-day surge during the first wave was 2848 cases on October 7, 2020. This year, the highest single-day count touched 11,302 on April 4. A serological prevalence study carried out by the Tata Institute of Fundamental Research along with the BMC in July 2020 had revealed that 57% of the slum population and 16% of the non-slum population were infected by the coronaviruS. A second round of the study in August also showed a higher prevalence of 44.9% in slums and 17.5% prevalence in the non-slum population. The surveys marked an important trend—those living in high rises had escaped the first wave of the pandemic.

SHORTAGE OF BEDS

Last year, as the pandemic raged, the civic body created additional health infrastructure in the form of jumbo Covid-19 facilities in large areas. The first such facility opened inside the dome stadium of the National Sports Club of India in Worli in March 2020. Other such jumbo facilities were started in Bandra Kurla Complex, Byculla, Goregaon, Dahisar, and Mulund, at a breakneck speed. When the cases started declining in November, these big facilities were mostly lying vacant but the infrastructure was retained for vaccination drives and a second wave which was anticipated in December-January. The facility at Mahalaxmi was dismantled, and now the corporation wants to put that facility back up.

“We retained all new infrastructure that was developed for Covid-19, which is why we have been able to cater to a large number of patients in the second wave,” Kakani said. According to him, the number of hospital beds, including ICU and oxygenated beds is 1.5 times more than what the city had during the first wave.

“In the jumbo facilities too, the number of beds has been increased. For example, the BKC facility has upgraded to 2000 beds from the earlier 1000, and Goregaon facility has gone up to 1600 from 1100 beds,” he said. The civic body also plans to open three more jumbo facilities with 300 beds each. “We have identified larges spaces in the western and eastern suburbs and one in the city. We will start with 300 beds and increase the capacity as per the need,” Kakani said. The possible locations earmarked are Malad, Kanjurmarg, and Sion.

GOVT SHORTSIGHTEDNESS

The high demand for private beds stems from multiple reasons like the lack of hygiene, upkeep, and the overall negative perception about the public-run healthcare facilities, experts said. Civic commissioner Iqbal Chahal has appealed to the citizens to not be picky while choosing beds but the civic body definitely needs to do much more to instill confidence in their facilities.

“The second wave was almost two months later than we anticipated. The government had enough and more time to work various aspects on hygiene and upkeep of these facilities and upgrade them based on the feedback or complaints of patients,” said health activist Dr Abhijit More.

In the first wave, social media was replete with accounts of people who had faced a difficult time accessing civic facilities, whether of beds or ambulances that arrived on time. Recently, a 38-year-old academician who was admitted to the BKC jumbo facility shared his experience on Twitter last week, and wrote about the dirty sheets, unclean toilets, and the high summer temperatures which made his recovery period difficult.

In another instance, a 59-year-old social worker from South Mumbai was unable to find an oxygen bed for his 56-year-old wife last week. Eventually he found one in the civic-run Nair hospital. But when he received a call from Bombay Hospital, a private facility, about the availability of a bed, he decided to shift his wife within an hour of admission. “There was no doctor to communicate with us. When we reached there, I took my wife on a stretcher all the way to the fifth-floor ward. Once there, I had to chase a nurse to shift her on the bed and connect her oxygen. Then I was asked to get an X-Ray done and I had to again shift her on a stretcher and take her to the diagnostics sections. There was no help available. It was simply impossible to believe that my wife would get any treatment or attention,” the social worker who did not wish to be named said. “When I got a call from Bombay Hospital, I immediately decided to shift her out,” he said adding his wife’s condition has now improved and her oxygen saturation has gone up to 93%.

Nair Hospital’s dean Dr Ramesh Bharmal, however, said that they had enough staff members. “We have recruited 150 multi-purpose workers and are also in the process of recruiting more AYUSH doctors. Our hospital also has vacant oxygen beds. Only the ICU beds are currently full. Some doctors were away for their examinations, but they have joined back work from April 1,” he said.

According to More, Mumbai is facing a shortage of healthcare workers because those hired on contract during the first wave were not given renewals. “A lot of doctors who were hired on the contract were let go after the cases decreased. A good healthcare system cannot run on short contracts. One had to have a good number of doctors and an additional reserve as a backup. Need-based hiring of doctors puts lives at risk. I have heard the Mumbai and Pune corporations have let go of anywhere between 200 to 300 doctors,” he said. It is as yet unclear how many doctors were hired by the civic body, during the first wave, on contract, as well as during the current second wave.