The thought of Sion Hospital brings back nostalgic memories! It has been a home away from home for all of us as medical students. We join at the young age of seventeen or eighteen. It takes five and a half years to acquire the basic undergraduate MBBS degree. Then, we spend three years doing post-graduation and a few more months or years for experience. So, one is at least 27 or 28 years old by the time our medical education is completed. The 10 to 12 years equal a whole school-life time, hence it is appropriately called the medical school!
The innocent teenager who enters medical school is chiselled, honed, hammered and battered during the decade and emerges with rich experience of life, living, sickness, health…and even death. Young minds cocooned in the care and shelter of their secure upbringing, are suddenly exposed to the harsh realities of life and death.
Sion Hospital is among those that bears the brunt of this trauma, being the first major tertiary care centre as you enter Mumbai. Since it is nearest to Dharavi, one of the five largest slums of the world, it was always crowded – even 40 years ago! The campus was always teeming with patients, their relatives and health personnel busily rushing around the place. Demand always out-stripped supply.
Since our childhood, (we are in our sixties now) we have had four major hospitals viz. the King Edward Memorial Hospital (KEM), the Lokmanya Tilak Municipal General Hospital (LTMGH, better known as Sion Hospital), the Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai (better known as Nair Hospital) and Sir Jamsetjee Jeejebhoy Group of Hospitals (better known as the JJ hospital at Byculla).
With a five-fold population increase in the past 50 years, we ought to have had at least 20 such hospitals for the general public. But we still have only these four. One can only imagine the stress and workload that they bear, further compounded by the lack of space.
Yet, Sion Hospital has risen to every challenge. Whether it is a major railway accident when dozens of patients are wheeled in, or the series of bomb blasts that we lived through for nearly two decades after 1992 or victims of road accidents and other disasters -- all admitted and managed efficiently by the dedicated doctors.
Although medical advances, modern technology, expert medical skills and state-of-the-art facilities are welcome upgrades, the sheer population explosion has made the demands on the hospital supersede its capacity drastically.
Even before the COVID-19 pandemic, Sion Hospital has always been overcrowded, so much so that it was not unusual to have as many as four babies per cradle in the neonatal intensive care; the orthopaedic ward is usually so overflowing with patients that the corridors are converted into ward extensions, and there is even a floor bed between two cots. The casualty is invariably bursting at the seams with patients waiting for a ventilator. That is the reality of public health care, which never came to the attention of the urban middle class, unless caught in an unusual situation. COVID-19 has changed all that.
Young doctors in their early twenties have to deal with this day in and day out. They have to work with what they have, and cannot change the situation. We know who is responsible for improving the healthcare system, but who will tell them? If the poor patient has no voice, neither do the doctors. These patients cannot afford private healthcare and most consider it a boon to get a bed and two free meals a day. They are not the ones who usually complain. They are relieved at being admitted.
My husband (also a doctor in the same institute) often used to give money to poor patients for food and medicines. We knew about this. What we did not know is that he also used to donate blood to patients who had no relative to do so. My sister, who volunteers for Cancer care arranges food, toys, and medicines at Tata Cancer hospital, especially in the paediatric ward.
Children on their death bed can melt the stoniest of hearts! She counsels the parents. She asked one such mother, “Do you have any complaint? Does your child need anything?” to which she promptly replied, “I am not worried about this child. He lies on a bed, gets free food and even toys! I am anxious of my other children at home. Who will feed them?”
Doctors are dealing with this poverty and helplessness in their own way every day.
So in the middle of a global pandemic, when a viral video, which was probably politically motivated, leads to a public backlash against doctors, actively fomented by a part of the media, it is utterly demoralizing to those who are described at ‘corona warriors’.
The pandemic is wreaking havoc by increasing the pressure on an already overstretched system. The number of beds has been further increased. A Fever OPD and a Smart COVID OPD have been installed (the latter to offer a degree of protection through contactless processes). Around 200 to 250 new patients are screened here for fever and associated symptoms. The number of admissions has skyrocketed, with the result that two patients are sometimes put on one cot and there are many more waiting for admission! What can doctors do about this? Incidentally, two patients on a cot during emergencies is not new – it has been going on for decades.
What can doctors do about this, except to continue working round the clock to treat patients? Sion Hospital is not a COVID-19 centre, but has both COVID and non-COVID patients. The surgery department has operated 24 COVID positive emergency patients and conducted 98 COVID positive deliveries. Over 40 COVID positive babies have been treated, over 793 COVID positive medical patients and 210 patients with severe acute respiratory infections have been managed.
The brunt of this is borne by many doctors who turned COVID positive. Doctors from all departments have been put on COVID duty. They have to manage patients at Kasturba and Seven Hills hospitals too. Each time a doctor tests positive, they have to be quarantined along with other support staff. This reduces the number of people available for work but has also been causing a lot of trauma among young minds, who are also dealing with calls from worried parents.
In some departments, all residents and staff members have been absent due to sickness or quarantine, leaving the head of the department to manage the whole department. Such overwork and such trying times are completely unprecedented. In addition to this, these young doctors are deputed to go to a cramped Dharavi, which has been a COVID cauldron, knock on doors and take their throat swabs! This sometimes raises safety concerns.
Very little of these heroic efforts are known to the general public. Instead, a motivated video led to so much of backlash and abuse that it hit the morale of almost everybody working at the hospital. The hasty action against the dean, was a further blow. The doctors looked up to their dean, who was approachable, sensitive, knowledgeable and co-operative and doing his very best in a crumbling health system.
Yes, COVID continued to spread and patients died, but that was not at his door. There were other problems too – the lack of body bags, paucity of employees to shift bodies to the morgue, extra procedures that were mandated due to COVID and finally the fact that relatives unable to collect their dead because of lack of transport or they themselves were quarantined! How was the dean to blame for that? Yet, he was unceremoniously discharged and made a sacrificial lamb!
How has the action solved any problem? Sion Hospital has welcomed the new dean. He too will do his best, when he works in the same situation, he too has the sword of demotion /transfer and public humiliation dangling over his head. Naturally, everyone is on tenterhooks and doctors are demoralized. Is this how the system wants to reward those who are sticking out their necks in trying circumstances?
The lack of medical protective equipment is another huge issue. Thankfully corporates, NGOs and many donors have come forward to help. The doctor is helpless. The budgets for health and education in our country is meagre. We have no idea when our public healthcare system will ever improve.
But doctors and healthcare workers are not responsible for any of this. They are mute workers carrying on their duty to the best of their ability and putting their lives at risk everyday – and that too without pay. Yes, resident doctors have not received their salary for a month and a half even while the government has been showering flowers and praise on them.
Many have not seen their families since the lockdown and cannot go home. They are mostly young doctors in their 20s dealing with an unprecedented situation. They are the sacrificial lambs! Their silence speaks volumes – but does anybody want to lend an ear?
This is the Silence of the Lambs!