Nurses leave at the end of their shift at King Edward Memorial (KEM) hospital in Mumbai. — AFP

In Mumbai, Covid-19 patients are dying as they wait for ambulances and hospital beds

The human cost of broken health infrastructure is rising every day.

Updated Jun 04, 2020 01:32pm

On May 23, Kabir Khatri’s sons spent half the day making frantic calls to Covid-19 hospitals across Mumbai, desperately seeking a bed for their father.

A 69-year-old diabetic, Khatri (name changed to protect privacy) had unexpectedly tested positive for the novel coronavirus the week before, when the private hospital where he was scheduled for a gall bladder surgery demanded a Covid-19 report. Since Khatri was asymptomatic, he was quarantined at home in South Mumbai, where his family monitored his oxygen levels several times a day.

"On Saturday afternoon [on May 23], his oxygen level suddenly fell to 50%, so we knew he needed a hospital," said Khatri’s younger son, Jameel (name changed), a software engineer.

But a hospital bed was nowhere to be found.

The Khatris registered with the Brihanmumbai Municipal Corporation's Covid-19 helpline number, only to be told that there were no beds available at Covid hospitals on an urgent basis. They received the same response from almost a dozen other hospitals they called. Finally, late in the evening, a private hospital in Chembur promised them a bed by 9.30 pm.

But now there was a new challenge: getting an ambulance.

"We tried the 108 ambulance helpline, but no one answered. We tried other ambulance services, but no one was available," said Jameel. "By 8 pm, we finally decided to take our father to the hospital in our car."

By then, however, Khatri’s oxygen levels had dropped to fatal levels. "He died at home, even before we could get him to the car," said Jameel. "An ambulance is such a basic thing. If we had found one, maybe he could have been saved."

A familiar story

Khatri’s story would sound familiar to anyone following Covid-19 headlines in Mumbai. Since recording its first case in mid-March, the city has reported 1,368 coronavirus deaths and 41,986 infections as of Wednesday — more than a fifth of India’s total cases.

The surge of cases has laid bare Mumbai’s poor healthcare infrastructure. Public hospitals have been overwhelmed with more patients than they can handle, and news reports have repeatedly highlighted how the city has "run out of beds" for Covid-19 patients in need of critical care.

A Scroll.in report on May 16 pointed out that Mumbai technically has more beds than the number of critically-ill Covid-19 patients who require them. The municipal corporation, too, claims that shortage of beds is only an occasional problem. Its Covid-19 helpline number, 1916, used to receive updates about bed status from all Covid hospitals two or three times a day, through which it allocated beds. But now, the helpline claims to receive live, real-time updates through a centralised dashboard launched by the municipal corporation on May 27.

"The dashboard is not available to the public — it is only for management purposes for our disaster team," said Daksha Shah, the spokesperson for the corporation’s health department. "Some times bed shortages do happen, but now private hospitals have also been notified to reserve 80% of their beds for Covid patients, and we are handling it."

Shah also claimed that there is no shortage of ambulances in the city. "Ambulances are available in plenty — who says they are not?" she said.

A temporary hospital for non-critical Covid-19 patients under construction. — AFP
A temporary hospital for non-critical Covid-19 patients under construction. — AFP

But the ground reality for scores of patients like Khatri has been starkly different. In public hospitals, coronavirus patients have been asked to share beds, sleep on the floor, or share wards with corpses that have been left on beds for hours because families refuse to claim them.

People calling the corporation’s Covid-19 helpline are often told there are no beds available. The situation is no better with ambulances — the state’s 108 helpline runs barely 100 ambulances in the city, private ambulance services are expensive and insufficient, and patients are left high and dry when they need help the most.

These inadequacies ultimately have a human cost. Across the city, people have lost their lives because they could not get a bed or ambulance in time.

The human cost

"Every day, I have been hearing of three to four cases of patients running around between multiple hospitals before getting admission in one," said Kalpana Gujala, a retired nurse from KEM hospital and the general secretary of the Noble Nursing Union, an association of nurses from across the city.

One such casualty, for instance, was a 55-year-old man from Jogeshwari who died in a wheelchair at KEM Hospital on May 22, after being refused admission by seven other hospitals. A Covid-19 suspect, the man had been experiencing breathlessness and chest pain and was in dire need of intensive care treatment.

He was turned away from six hospitals and placed on oxygen support at the seventh hospital, which eventually discharged him because they had no ventilators available. Finally, the family approached KEM Hospital — one of Mumbai’s largest public hospitals — where he was admitted even though there were no available beds. After a three-hour wait for a bed in a wheelchair, the man eventually died.

On the same day, a woman in suburban Mumbai lost her life because of miscommunication and delays in getting a bed and an ambulance. The woman was already a patient of encephalitis when she tested positive for Covid-19, and the BMC helpline took 24 hours to find her an ICU bed at a hospital in the city.

When the family called for an ambulance, the driver recommended double-checking with the hospital. When they did, the hospital claimed that the bed was not available after all. After several hours of hunting for another bed, a vacancy opened up at the same hospital. But this time, there was no ambulance available immediately. By the time the ambulance arrived and the woman was brought to the hospital, the ICU bed her family had booked was given to another patient. Desperate, her family admitted her in the hospital’s general ward, where she died three hours later.

Ambulance woes

Mumbai has had a shortage of ambulances for years, and the Covid-19 pandemic has compounded the problem.

With just under 100 vehicles in its fleet in Mumbai, the government’s 108 helpline for free ambulances is of little help for patients who need urgent hospital admission. "Patients have to wait for six to eight hours on an average for a 108 ambulance to show up," said Gujala.

Private ambulance services are available faster, at two or three hours’ notice, but they are also expensive for most citizens: as much as Rs 10,000 for a trip to a hospital.

Dhaval Panchal, a 32-year-old businessman, claimed that private ambulances were demanding up to Rs 12,000 when he needed to take his Covid-positive father to the hospital last month.

Panchal’s father had been in home quarantine but his family decided to hospitalise him when his oxygen levels began dropping on May 21. Even though he didn’t need intensive care, getting a bed took 11 hours and rejections from six hospitals. Since there were no ambulances available at the 108 helpline, and private ambulances were too expensive, Panchal finally drove his father to Chembur’s SRV Hospital by car.

"We are lucky that he was not critical and because we are privileged," said Panchal, whose father is now recovering at the private hospital. "For those who are not privileged, it must be so much harder."

One organisation providing relatively cheaper ambulance services is HelpNow, an initiative by three alumni of the Indian Institute of Technology-Bombay. Started last year on a very small scale, the platform now has 347 private ambulances in its network, which it sends to Covid patients’ homes within an average of 45 minutes. "We received around 1,500 calls in all of April, but in the past week, we are getting around 800 calls a day," said Aditya Makkar, one of the founders of HelpNow.

HelpNow ambulance staff wearing protective gear escort a patient aboard an ambulance. — Photo by Indranil Mukherjee
HelpNow ambulance staff wearing protective gear escort a patient aboard an ambulance. — Photo by Indranil Mukherjee

The platform is currently providing free ambulance services to the Mumbai Police force, whose staff have been reporting between 25 to 30 coronavirus cases a day, according to Makkar. For others, HelpNow provides ambulances for INR5,000 for a minimum distance of 5 km — a "zero margin cost", according to Makkar. "The amount includes the cost of the PPE [personal protective equipment] and the payment for the ambulance driver and medical worker, as well as the cost of sanitising the vehicle after every trip," said Makkar.

But this rate of INR5,000 is offered only for the handful of ambulances owned directly by HelpNow. For the other ambulances in its network, regular private charges apply.

Treatment in the corridors

While most private ambulances are equipped with first-aid, oxygen supply and defibrillators, ambulances attached to public hospitals are often just plain vehicles with room for a stretcher.

"Our ambulances don’t have doctors or any equipment in them — if anything happens to a patient inside, there is no help," said a nurse from KEM Hospital who did not wish to be identified. The hospital has been using its ambulances largely to transfer Covid-19 patients without a bed to the BMC’s Seven Hills Hospital, which has a larger bed capacity. "But five or six patients are sent together in one ambulance."

This is just one small part of the sea of problems plaguing public hospitals in Mumbai. The nurse, as well as the nursing union leader Kalpana Gujala, cited several cases of hospital staff contracting Covid-19 and then struggling to get beds.

"A nurse at one of the big public hospitals died of Covid last month because she did not get a bed," said Gujala. "At another hospital, a senior management worker took a room for herself for isolation when she got Covid-19, but when junior staff asked for a separate Covid ward for them, they were told it was not available."

"Our emergency wards are overflowing, there are no empty beds, so patients and their relatives are just left lying or sitting in the corridors," said the anonymous nurse. "Because of this, many patients get tired of waiting for a bed and just leave. The number of such absconding patients is increasing every day, and the task of tracing them falls on us."

For patients who are critical, this poses an even bigger risk. "The ICU is absolutely full, so if a waiting patient needs a ventilator, we try to clear out other patients’ relatives who form crowds inside the ICU to make space for an extra stretcher," said the nurse. "Otherwise, if patients need oxygen, we just try to help them as much as possible in the corridors or in their wheelchairs."

More disturbing is the condition of patients at hospitals like KEM, whose policy is to admit all those who come for Covid tests, whether or not there are beds for them.


This article originally appeared on Scroll.in and has been reproduced with permission.

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Aarefa Johari is a Mumbai-based journalist with Scroll.in, an online news publication. She writes on gender, communities, culture and urban planning.

She tweets @AarefaJohari

The views expressed by this writer and commenters below do not necessarily reflect the views and policies of the Dawn Media Group.

Comments (54) Closed

Randeep Hooda
Jun 04, 2020 11:57am
This shows why BJP is necessary in the states too. I live in utter Pradesh which have much more population and also poverty, But BJP government does good management with more than 50% recovery rate.
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Paggri Sambhal
Jun 04, 2020 11:57am
Sad.
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Marquis de Sade
Jun 04, 2020 12:02pm
Nothing about the near 50% recovery rate. Nothing about only around 200,000 patients in a population of over 1,350,000,000. Nothing about the selfless service provided by frontline workers. Just negatives. Without any constructive suggestions. Keep it up...
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shaq
Jun 04, 2020 12:15pm
Our population loves to read about problems of other countries more than own graver situations.
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Bipul
Jun 04, 2020 12:51pm
Yes. China virus has worst impact on financial capitals of all countries like New York, Mumbai, London, Karachi etc. Not sure why.
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Fastrack
Jun 04, 2020 01:31pm
What's actually tragic is the shameful way the BJP government is hiding all its failures on all fronts using paid keyboard trolls.
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Jeyaraj
Jun 04, 2020 02:19pm
Mumbai got adequate public health system, but the current situation is different as these hospitals used to be occupied in treating various deceases but now it has been over burdened by 40K plus wuhan virus. Knowing the situation it would be better to strictly follow social distancing and other experts recommendation.
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Musfiq
Jun 04, 2020 03:08pm
Are they getting Ambulances like taxis on Pakistan
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Johnpauljonesljones
Jun 04, 2020 03:38pm
That’s sad. Not much different in Lahore now. Differences aside but no one wants to see the suffering of the common folk. Prayers and wishes
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Joe
Jun 04, 2020 04:10pm
Mumbai's condition is bound to get worse....
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Saeed
Jun 04, 2020 04:14pm
Shining democracy
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Rashid
Jun 04, 2020 05:37pm
The US will donate ventilators to India to treat the COVID-19 patients and help it fight the "invisible enemy"
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Suresh Tekade
Jun 04, 2020 06:01pm
Welcome to Super Power India
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Dr. Salaria, Aamir Ahmad
Jun 04, 2020 06:03pm
What a grave, gruesome, gigantic and great tragedy in one of the poorest nations in the world which always falsely pretends to be rich and famous?
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M. Siddique
Jun 04, 2020 06:21pm
Modi needs to pay attention to the needs of his own people instead of causing trouble in neighboring countries and killing Muslims in India.
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Asif
Jun 04, 2020 06:28pm
Shortage of Ambulances is problem everywhere in the world. Hope it is solved.
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Rahul
Jun 04, 2020 06:39pm
This is shameful. India must address this.
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Rahul
Jun 04, 2020 06:41pm
Very sad situation indeed. India needs to fix the broken health system.
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Uttam R
Jun 04, 2020 06:44pm
Even China is not taking any serious Covid-19 patients in their hospitals.
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T-man
Jun 04, 2020 07:16pm
This is the first time Indians are learning about this. Indian media don't report such things.
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Kris
Jun 04, 2020 07:47pm
This pandemic has laid bare the abysmal state of health care in many countries. First we saw it in Wuhan, then we saw it in New York, and now in Mumbai. Hopefully this leads to increased allocation for health care and education in the future. Also we need more private players to enter the fray so as to supplement governmental efforts.
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Vinod Kumar Srivastava
Jun 04, 2020 08:06pm
Pakistan's 'ultra-advanced' health facilities are well known to all. A lot of patients from Pakistan came to India for liver transplant, eye surgery, cardiac and other treatments. This is pandemic situation, which arrived all of sudden. No country can have preparation for pandemic spread at such a large scale.
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Dr. Salaria, Aamir Ahmad
Jun 04, 2020 08:21pm
Forget India, we achieved the important milestone today, surpassed China in number of positive cases. Very soon we will make it to top 10 list!
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bhaRAT©
Jun 04, 2020 09:47pm
@Vinod Kumar Srivastava, So what happened to your much vaunted heath system there?
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Sri
Jun 04, 2020 09:50pm
@Dr. Salaria, Aamir Ahmad, sir, fo you still believe the nos given by China?
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Shakeel Gorakpuri
Jun 04, 2020 09:51pm
India, still a third world developing country. By the time, the infrastructure gets upgraded, the population expands disproportionately. Taking one step forward and going back two.
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Uzay Yazdani
Jun 04, 2020 10:01pm
Business first.
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Ronak Sheth
Jun 04, 2020 10:09pm
Still we have heart to treat and cure Pakistani patients who don’t get good care in their home country
Recommend 0
GULSHAN OMAR
Jun 04, 2020 10:40pm
@Dr. Salaria, Aamir Ahmad, Rightly said and congratulations. Let’s see whether we can beat our nabor or not.
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Jack Shedden
Jun 04, 2020 10:43pm
Thank you for exposing the inefficient bureaucracy in Mumbai. They are good at propaganda only, it seems.
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Vishal arora
Jun 04, 2020 10:53pm
@bhaRAT©, compare with population and you will know India performed very well.
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Naxalite
Jun 04, 2020 11:08pm
@Randeep BeHooda, Really?
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Isa
Jun 04, 2020 11:20pm
Anecdotal incidents do not contradict patterns. India has overall down a marvelous job at containing coronavirus. Now it is heading towards developing a vaccine and soon Inshallah it will be developed.
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bhaRAT©
Jun 05, 2020 12:32am
@Vishal arora, "you will know India performed very well." Yes, by surpassing Germany and France as well, India has marched into G7 now.
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Jag
Jun 05, 2020 04:43am
The message is “Pakistani’s stop complaining, look, even India is in a horrible mess?
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Udaya
Jun 05, 2020 05:04am
@T-man, did you even read the foot note, the article is from scroll.in
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farooq
Jun 05, 2020 05:13am
BJP paid keyboard warriors should remain on their home ground. Their presence here is as unpleasant as they are themselves.
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kamal chowkidar
Jun 05, 2020 06:51am
BJP Government is needed in Mumbai.
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AK
Jun 05, 2020 06:55am
China must be blamed for making entire work sick and causing major economic disruption.
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Anas Sardar
Jun 05, 2020 07:12am
@Fastrack, It is under Congress rule
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R.S
Jun 05, 2020 07:29am
@Marquis de Sade, Fudge Figures!
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R.S
Jun 05, 2020 07:30am
@Fastrack, So True!
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R.S
Jun 05, 2020 07:35am
COVID pandemic has clearly exposed India's public and health services as one of the worst in third world.
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Ds
Jun 05, 2020 08:03am
@Fastrack, Mumbai doesn’t have BJP government.
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schali
Jun 05, 2020 08:13am
@T-man, This is reprinted from an Indian magazine.
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Anuradha
Jun 05, 2020 08:47am
@farooq, visit the Indian media websites/you tube videos. most of the commentators are Pakistanis.
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Cramasaur
Jun 05, 2020 10:13am
not sure why, but why should a pakistani news paper carry out such a detailed report of the covid response system in the neighboring country. I am yet to see any such a detailed report for any cities in Pakistan. One would be forgiven for believing that Pakistan has conquered Covid effectively....
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Imran khan (Mardan)
Jun 05, 2020 10:42am
What a super poor country. The ambulance and healthcare staff’s gear tells it all.
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Dr. Salaria, Aamir Ahmad
Jun 05, 2020 02:08pm
A penetrating reality that racist Modi and his fascist R.S.S. and BJP cronies are unable to even acknowledge, understand, know and realize.
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Jhh
Jun 05, 2020 03:22pm
Ghhh
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Anusri
Jun 05, 2020 08:02pm
@Bipul, It's because of very high population density in financial capitals worldwide.- the virus is getting more people to infect in close vicinity. richer the city, higher the population density, higher viral infectivity.
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Ravi-Pune
Jun 05, 2020 09:32pm
@Dr. Salaria, Aamir Ahmad: who is in the list of poorest country see the list online...
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ACEGJKtime
Jun 05, 2020 09:42pm
@Randeep Hooda, BJP is not all good, but lesser evil for India’s future. Indian National Congress leaders are sold to foreign interests.
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WhatsInTheName
Jun 05, 2020 11:18pm
Sudden and unknown attack is always painful to deal with. When China herself struggled to contain the spread initially despite having tight control on every persons move, plenty of money in the system, advanced infrastructure - how can any other country in the world be better than her. Any country that denies having similar situation or may be worst than this is a plain lie. This is why Closed Door governance is dangerous because what is behind the Great Walls, no one know until They themselves want to declare what they have in surprise for everyone.
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