A year ago on April 13, when Bijnor saw its first Covid-19 diagnosis, the district hospital did not have a single ventilator. Over the course of the next few months, the Uttar Pradesh government sent 24 ventilators to Bijnor to help severe Covid patients, but the officials sitting in Lucknow forgot that anesthesiologists are needed to hook up patients to these ventilators. District authorities were not even asked if there were enough specialist doctors available to operate them.There have been 7,735 Covid cases in Bijnor till April 25 this year but until this weekend none of them could benefit from these ventilators. Over the past year, doctors here were forced to refer hundreds of serious Covid patients to the Teerthanker Mahaveer University (TMU) Hospital in Moradabad, more than 80 km away.Now, with Bijnor one of the worst affected districts in UP and the increase in the number of patients in TMU, it is feared that getting admissions there will become difficult. Nearly half of the total number of cases reported in the district were diagnosed since the beginning of April. The positivity rate has increased by 73 times since April 1 when only 5 out of the 1,916 tested emerged positive, while 495 positive cases emerged out of the 2,584 tested on April 24.
Resources lying in waste
The district hospital in Bijnor has a dedicated L-2 Covid ward in operation since last year (to deal with complicated and critical cases), but despite the availability of resources, it is only able to admit either asymptomatic patients or those with mild symptoms. There are 98 beds available in the facility out of which 10 beds have pipeline supply of oxygen, and 40-45 beds can be equipped with oxygen cylinders.So the hospital does have the infrastructure to be able to admit serious patients.According to hospital sources, in June 2020, four ventilators were sent by the state government and later a few more were sent in batches until the hospital had 24 ventilators in total.Of these, 14 had been kept in the storeroom and 10 have been set up in the L-2 Covid ward. But until this weekend, they were nothing more than display pieces because there were no anaesthesiologists working here who could operate them.In Covid-19 care, the anesthesiologist has one of the riskiest jobs. When a patient is no longer able to breathe on their own, an anesthesiologist is called on to intubate them. They insert a breathing tube, or an endotracheal tube, through the mouth and into their air passage. The patients need to be anaesthetized during this process so that they don't feel like they are choking. The tube is connected to a ventilator, which pushes air into the lungs to help patients breathe.Until April 25, not a single anesthesiologist was working at this L2 Covid ward. At least three anesthesiologists must on the hospital's roll so that they can each work 8-hour shifts and ensure the ventilator is continually in operation for 24 hours. Additional specialist doctors are needed to relieve these doctors after a few days in order to give them a break. Last year, after demands from the district authorities, a specialist doctor was sent by the government, but he was only here temporarily and wasn't of help anyway because he didn't have enough anesthesiologists to support him.There isn't even a ventilator technician available on hand for maintenance and repair of the machines. Apart from this, there is no cardiologist where at least one is required, there is only one physician handling the duties of three, there is no chest doctor and no medical officers though at least two are required.
'My father could have been saved'
Waseem Ahmad, 32, son of the deceased Azimuddin (he goes by one name only) told us that his father tested positive for Covid on July 19 last year. His situation turned serious but he couldn't be treated at the district hospital and was referred to TMU Moradabad the same day. Unfortunately, the 60-year-old Azimuddin, a retired nazir (registrar) at Bijnor tehsil, could not make it to Moradabad and died on-route. Waseem believes that if the facilities available at the district hospital's L2 ward could have been properly utilised, his father could have been saved.Officially, 72 Covid patients have died in the district since the start of the pandemic. According to government data, there have only been 7 deaths in the second wave but this number is highly suspect.People familiar with the matter were of the view that if the government cannot afford the staff to operate the ventilators, the machines should at least be sent to places where they can be used. At a time when there is a huge shortage of resources, two dozen ventilators sitting idle makes no sense. Maybe these could be used to save the lives of people in some other hospital.Dr Gyan Chand, the Chief Medical Superintendent at Bijnor district hospital, admits that until recently they did not have a single anesthesiologist to operate the 10 ventilators that have been set up. "Last year, one Dr Radheshyam Swamy was sent by the government, but to run the ventilator continuously for 24 hours, at least three anesthesiologists are required to work in three shifts. Also, we have no ventilator technician. Therefore, it is our compulsion to refer serious patients to TMU Moradabad."Ramakant Pandey, District Magistrate, Bijnor, told us that they know two anesthesiologists who can take up duty but that is still not enough. "Because once you start the ventilators, they cannot be stopped. All efforts have been made to recruit another expert anesthesiologist. We are also willing to hire a private anesthesiologist at any cost," he said."Lucknow has its own needs," he said when asked why the government can't appoint the appropriate doctors to Bijnor on an emergency basis. "After the beds go full at TMU Moradabad, arrangements will be made at Pulkit Memorial for serious patients," he said. It is worth noting that Pulkit Memorial, a private hospital in Bijnor that was designated an L-2 COVID-19 hospital last year, has not admitted a single coronavirus patient since the pandemic began.The latest update from Bijnor is that 10 of these ventilators have been shipped to Moradabad on April 25, according to the DM, and some "private staff" were finally roped in to start the ventilators at the L2 facility this weekend.