Guards armed with rifles escort Dr. Kumar Gaurav as he walks through his hospital on the banks of the Ganges River in Bihar.
The guards are there to protect it from the relatives of patients, adding those with COVID-19, the disease caused by the new coronavirus. Relatives continue to break into services, including in the ICU, to caress and feed their loved ones, without dressing or with the slightest mask as a barrier to the disease.
“If we avoid them, they get angry,” he says. “They need to give homemade food to their patients, and some even need to massage their patients. And they transmit infections from our extensive care teams to other people in society.
He stops to tell a patient’s wife in the ICU that he has to leave. She obeys, only to return after a few minutes of the entrance.
It is the season of monsoons and humidity reaches insufferable levels. But the hospital’s few air conditioners don’t paint, and some parents use hand fans to keep those they enjoy in service-discarded protective equipment cool.
It was not intended to be that way for Dr. Kumar.
Nine years ago, the 42-year-old psychiatrist moved his circle of relatives to his hometown in search of a quieter life and a better pay after 3 years in the Indian capital, New Delhi. He accepted a position as professor of medicine and psychiatrist representative at the 900-bed Jawahar Lal Nehru Hospital and Medical School, named after the Prime Minister of India. With no history but rewarding, he went from the categories to the teachers and visited his psychiatric patients.
But he says he felt compelled to volunteer to work.
“A lot of my colleagues refused,” he says. “I had to take responsibility.”
In April, when the pandemic hit here in Bihar, the hospital was selected as one of the four hospitals committed to COVID for a population of one hundred million more people, at least in theory.
In practice, Kumar says the nearest hospital with adequate extensive care services is about two hundred kilometers (120 miles). And with proper fitness care in the hard-to-find surrounding rural areas, patients generally have nowhere to go through their hospital.
In June, Kumar said, the district administration asked the hospital to also treat unedfected patients. “In an ideal world, there are no patients who don’t have COVID in this hospital,” says Kumar.
Bhagalpur’s fitness system, like many other parts of Bihar, is on the verge of collapse, he said.
They report on a chronic shortage of labor and resources such as blood and medicine. The 37 beds of the ICU are occupied; on the floor next to one of the beds, a relative sits on a brightly colored blanket he brought from home, with a bottle of water on the side.
Kumar says he feels powerless to save him away from COVID patients.
“We don’t know who’s positive and who’s negative,” he says. “We don’t know their prestige and we can’t wait for them to get tested. They just want treatment. We are the most vulnerable population.”
Spokesmen for the Indian federal government and Bihar government, as well as several bureaucrats and ministers guilty of physical care at the federal and state levels, responded to detailed requests for comment. Pranav Kumar, the senior official in Bhagalpur district, also responded to a request for comment.
While infections are slowing in many other countries, India continues to report more than 50,000 cases a day. On Thursday, more than 67,000 cases were reported, setting a one-day record for new infections. Its total of more than two million instances follows only the United States and Brazil, and the instances show no signs of slowing down.
Since the pandemic hit India, more than 46,000 people have been killed.
Although major Indian cities, such as New Delhi and Mumbai, the first hit by the virus, have noticed a decrease in the number of cases, numbers in second-tier cities and rural areas continue to rise.
Bihar is India’s third most populous state; if it were a country, it would be the fourteenth most populous country in the world.
The state has a history, adding the site where the Buddha would have attained enlightenment under the shadow of a Bodhi tree.
But today, Bihar has as one of India’s troubled states.
Based on signs that add child nutrition, Bihar’s point of progression has more in sub-Saharan Africa than in the filthy rich states of southern India. According to federal data, nearly a portion of all young people under the age of five in the state are malnourished, with more than 4 out of 10 young people underweight for their age.
Bihar also has population expansion in India and one of the worst school systems, with poor scores on signs such as adult literacy, the percentage of youth in school and test scores.
The physical care formula was overloaded even before it hit the pandemic. Dr Sunil Kumar, Bihar Secretary of the Indian Medical Association, India’s leading fitness union, said more than part of the medical posts in the state were vacant.
There were about 87,000 cases of the new coronavirus in the state and 465 similar deaths, few compared to other states. Given the low degrees of checking in the state, the numbers can be conservative. However, Bihar’s fitness formula is already close to breaking point, unlike places like New Delhi, which has had many more cases but have greater resources.
The state government’s reaction to the outbreak has led to a public interest dispute calling on India’s federal government, led by Prime Minister Narendra Modi, to take control of the pandemic in that country.
One case, presented through local businessman Aditya Jalan, says “untold” lives will be lost if action is taken quickly, especially with the spread of the pandemic in less evolved and more rural areas.
His petition cites a “total collapse of public fitness infrastructure in Bihar state, adding a lack of COVID-19 hospitals, lack of hospital beds, inadequate testing, unhealthy quarantine centers, failure to comply with social estrangement measures.” lack of supply of PPE to frontline workers.”
The Supreme Court of India is scheduled to hear the case Friday.
State physical fitness disorders are acute in rural Bihar, where government infrastructure is even more rudimentary. In Ismailpur, a village an hour’s drive from Bhagalpur, the lingering annual floods cut off the main road leading to the road. Flooding has reached the threshold for the ramshackle number one fitness centre, which serves more than 52,000 people.
There are no beds or oxygen bottles, and a dog and its disorder rest on PPE equipment lying in the corner of the coronavirus room.
“It’s a long-overdue area,” says one of the center’s two doctors, Dr. Rakesh Ranjan. “People are even afraid to get tested. Sometimes we have to ask the police to control other people.”
Psychiatrist Kumar’s hospital is subsidized through the Ganges, India’s holiest and swollen gang during the summer monsoon. Next to the water buffaloes that bathe on the banks, personal paramedics wash their cars with buckets to break.
On the way to the hospital, there is a huge pothole and the cars leading the patients are blocked there. Outside the main gates, family members sit with the bodies of their loved ones as they wait for personal ambulances to take them for burial or cremation.
Workers who push carts with patients entering general emergency departments do not know the history of newcomers, most of whom have not yet been screened for the virus. Often dressed only in gloves as protective equipment, staff take them inside, take their oxygen grades and leave them in carts in the hallway, where other people are treated until they can find a bed.
In the hallway, an exhausted one rests her head on a wall while taking her husband’s blood pattern while he is a liar on a stretcher next to her. In one of the emergency services, she drags her husband from a stretcher to his bed while his parents hold an intravenous bottle.
“If I stand in front of a COVID patient for two minutes and see 20 patients, I am exposed for 40 minutes,” he says.
Complaints from beginner doctors are constant. In an assembly on the lack of drugs, Kumar promised them that he would convince them that more resources were needed. He later admits it will be difficult.
Kumar cries as he describes his worst moment since taking office, when a friend of his father, who wanted normal blood transfusions, asked for help.
“I had to say no because we don’t have enough blood in the bank. We only have a minimum for emergencies,” he said. Discover those painful rejections. “I don’t know how to say no to a patient.”
Born in Bhagalpur, Kumar moved to the northern city of Chandigarh for medical training, where he met his wife, Mili Jaswal, a psychologist.
After their marriage, the couple moved to New Delhi, where they followed a stray dog, Faith.
Kumar worked in a personal hospital, but he may only handle the culture.
“Your is the amount you can pay them back financially,” he says. “It’s hard for a doctor to paint on that.
And so, in 2011, Kumar, Mili and Faith approached an exercise in Bihar. “Financial security is a vital factor, and I had my circle of relatives here,” Says Kumar.
His daughter Iti Swara, now six, was born a few years later. He loves her.
Recently, he had his two-room government bungalow painted pink at his request. But those days, the hugs she gives her daughter every morning before she went to paint have changed. Now he has concern in mind, not love.
Mili fears that Kumar’s long hours of work and pictorial tension will take her away from her daughter. “When he’s home, she needs to communicate with him, but he can’t, ” he said. “She needs to divide her mind and play with him, but he can’t.”
Kumar saw cases in the district slowly accumulate for several months, but the call to resume hospital control last month came suddenly.
The director of the previous hospital had tested the virus and, to Kumar’s surprise, said some of the more experienced doctors turned down the job.
Attempts to download a commentary from doctors failed, the hospital’s lower-ranking doctors showed Kumar’s account, and an official letter from the former director cited one of the negatives.
He thought of his extended family, which he stopped visiting when the virus began to spread throughout the neighborhood. Who would run the hospital if they were admitted, if not him?
“For the other people in Bhagalpur and the neighboring districts, it’s my responsibility,” he says. “That’s why I raised my hand.”
Fear of the virus, and anger at lack of resources, haunts patients and their loved ones.
On a Sunday in July, Parsada Sah, a 67-year-old emaciated shopkeeper, was tested for the coronavirus in a village 50 km from Bhagalpur. Sah, along with his wife, Vimla Devi, and son Manoj, arrived at the hospital by ambulance this afternoon.
Manoj showed his father’s positive check to the on-call doctor. He says he was told there were no beds in COVID and asked him to place a bed in a 20-bed general emergency room that was already over crowded.
“We’ve been told it’s the only position we can have right now, because there’s no room,” Manoj says. “We beg them a lot. They told me everyone was looking for a bed.”
Even though they know he’s infected, the family circle enters the room to feed Sah.
“The staff just puts the food in bed, doesn’t feed anyone,” Manoj says. “If the patient can’t eat alone, he’ll have to call someone to help him.”
Kumar says their concerns are genuine.
“We don’t have separately to take patients to the bathroom or feed them,” he says. “The challenge is that we don’t have enough human resources from behind.”
Finally, almost a day later, a bed for Sah is discovered in solitary confinement. When he was transferred, Sameer, a 22-year-old doctor who lent a hand sent to assist in the transfer, put on his plastic suit. Instead of glasses, wear a pair of reasonable sunglasses.
He’s waving to his suit.
“We get them when we transfer HIV patients from the general ward to a COVID ward. Otherwise, he says, “we are the first to get a patient when they enter, but we have no protection.”
After recovering an oxygen bottle to move it and tin with the bottle for a few minutes, Sameer and his colleague notice it is defective. They take a new one, but the rusty cart on which they ride it moves slightly. He screams as the men retreat to drag him down the hospital corridors.
The stump tube of Sah’s oxygen mask as Sameer tries to maintain speed with the stretcher, with the man’s wife and the son’s mendacity behind.
Finally, the wheels of the carriage prevent it from spinning completely. So Sameer lifts the big box over his shoulders and bears the weight himself.