In Bihar's Gaya, one COVID-19 bed for every 7,700 persons: Patna, Muzaffarpur, Bhagalpur worst-affected districts

Over 2 lakh residents of Khijarsarai block headquarters in Gaya district are dependent on a lone Primary Health Centre (PHC) for their healthcare needs. The PHC has only one building, six general beds and a handful of oxygen cylinders in the name of infrastructure to fulfil this responsibility. There are just three doctors here, of which one holds the additional burden of running administrative duties the centre's in-charge.

The condition of another PHC located in Aurai in Muzaffarpur district, around 200 kilometres from Khijarasarai, is no different. There are only four doctors and 20 beds at Aurai PHC, none of which are equipped with ventilators; neither does the centre have an Intensive Care Unit (ICU) to cater to serious patients.

This is the situation of rural Bihar today, despite the state government having more than a year's time to prepare for the surging second wave of COVID-19 pandemic.

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Explaining the extent of load on the flailing health infrastructure, in charge of Khijarsarai PHC, Dr Bhola Bhai said that the staff has been trying to stay available 24x7 for over a year now in order to accommodate all patients.

"Around two hundred patients come here every day. Most of these patients complain of cold, cough and fever. Despite having only three doctors, we are providing 24x7 services. I myself have not taken a leave in a year," he said.

Bihar's rural population is usually dependent on the local PHC's for the crucial first medical intervention if and when people fall ill. It is their easiest and closest access point for healthcare. But even after so many years, infrastructure has not been improved enough to make these centres capable of treating patients in an emergency situation. Things did not change even in the last year despite the very real threat of the pandemic spreading in the rural areas of Bihar.

"If a serious Covid-19 patient arrives, we offer them oxygen and send them 30 kilometer away to the Anugraha Narayan Medical College and Hospital (ANMCH) or the city's Covid-19 designated private hospital," Dr Bhola said.

Prakash Kumar, 19, had a fever and cough for 10 days. He first tried medicines from a local dispensary. When his condition deteriorated, he rushed to a local private hospital in Aurai. Given his symptoms - fever, chest pain and a breathing problem - the private hospital told him to visit the Aurai PHC, which is barely two kilometers from the private hospital. Kumar visited the PHC where an antigen test confirmed he had COVID-19. He was immediately referred to Shrikrishna Medical College & Hospital (SKMCH) in Muzaffarpur, where he died after two days.

A doctor at SKMCH, requesting anonymity, said, "His oxygen levels had dropped very low and lungs were severely damaged. He died on the morning of April 21."

Dr Rakesh Kumar, in charge of Aurai PHC said, "He was very critical. We didn’t have sufficient doctors and treatment facilities like ventilator and Intensive care unit so we could not do much. We immediately sent him to SKMCH."

Out of 38 districts of Bihar, four are badly affected by the COVID-19 surge. These include Patna, Bhagalpur, Gaya and Muzaffarpur. Since the pandemic broke out last year, Gaya has recorded 28,897 positive cases and 138 deaths; Muzaffarpur has recorded 25,305 positive cases and 195 deaths. But between 1 and 8 May, Muzaffarpur has recorded 3,828 positive cases and 63 deaths, whereas Gaya has recorded 4,261 positive cases and 16 deaths.

The health infrastructure in these districts -- the testing facilities and the treatment status in private hospitals --  is very worrying; the tests are being done very poorly and private hospitals are charging arbitrarily for treatment.

Lack of basic infrastructure and oxygen

Gaya district is located at a distance of about 100 kilometres from Patna. The district has close to 43.9 lakh population (Census 2011) but it has only 570 Covid-19 beds -- one bed per 7,702 persons -- and oxygen is available only on half of these beds. There are just 33 ventilators, 57 BiPAP machines and 63 ICUs in the district. As of 7 May, only seven out of the 33 ventilators were available, while the number of available ICUs was only two.

Madan Mohan Sharma, 75, a resident of Nutan Nagar in Gaya, developed a fever on 28 April and complained of body aches. His family got his HRCT (High-resolution computed tomography) done. On seeing the report, his family members decided to admit him as soon as possible. He was taken to Anugrah Narayan Magadh Medical College on 30 April. But he could not get a bed in the hospital.

Due to increased load of dead bodies at Bansghat crematorium in Patna cremations are performed in open area. Umesh Kumar Ray

Nitindra Kumar, a relative of Sharma said, "When we took him to the hospital, the doctors refused to admit him. They clearly stated that the hospital does not have a bed. We wandered for hours to get him a bed. Later, he was admitted to a private clinic. We got him tested and found out he was COVID positive. "

"Three days later the private clinic discharged him from the hospital saying he was recovering. He died after two days," the relative said.

Kumar alleged that if ANMCH had admitted him on the same day, Sharma could have been alive today. “ANMCH is the largest government hospital in the district. There should be all facilities. But my relative was not admitted that day only because of a shortage of beds. Had he been admitted, he would have been alive today." There is a severe shortage of oxygen in the district. The staff at several PHCs and hospitals said the supply of oxygen was considerably less than the demand.

ANM training school at Neemchak Bathani area in Gaya is a COVID-19 hospital. This hospital has 70 beds, but only has 25 oxygen cylinders. Dr. Awadhesh Prasad, the nodal officer of the hospital said, “At least, 75 large cylinders (35 litres) are needed to supply oxygen to all beds. But we have got only 25 cylinders, due to which we are able to admit only 6-7 patients who need oxygen."

ANM Training school at Tekari, around 55 kilometres from Neemchak Bathani, has also been converted into a COVID Hospital with 70 beds. Dr. Rajendra Prasad Singh, the nodal officer of the hospital, says, "We have oxygen available in only 12 beds, due to this, when more critical Covid-19 patients come, we refer them to ANMCH in Gaya."

“Patient load is increasing these days, so more oxygen will be required. We need 2-3 regulators so that we can supply oxygen to a few more beds, but have not yet received from the government. We are considering buying from a private shop,” Dr Singh told Firstpost.

Dr. BS Jha, superintendent at SKMCH, on 5 May had addressed the media and said that he had demanded 500 cylinders but the government provided only 300. One ventilator requires 12 to 14 litres of oxygen per hour, so it is not possible to run all the ventilators with the current supply, Dr Jha had said.

The Minority Hostel of Muzaffarpur has also been converted into a COVID-19 hospital. There are 100 beds here, but the hospital has only 21 oxygen cylinders of 10 litres each.

"The second floor of this hostel has been converted into a hospital. We only admit 4-5 patients who need oxygen because we have got an inadequate quota of oxygen. If I will admit more patients, we will exhaust our oxygen supply, so we admit fewer patients," Dr. Anil Kumar Singh, the nodal officer of the hospital said. 

"If we supply oxygen to all the 100 beds, we need 300 cylinders daily. Every day 3-4 such patients come here who need oxygen, but we ask them to go to other hospitals."

The district's civil surgeon also told Firstpost that more patients are coming to hospitals with the complaint of shortness of breath, but oxygen supply is limited compared to the demand.

Inadequate supply of test kits

In Bihar, on average, 90,000 to 1,00,000 samples are tested daily. But most of them are tested with a rapid antigen kit, whose efficacy has been questioned since the beginning.

According to the officials associated with the health department of Muzaffarpur and Gaya, PHCs in the districts have permission to test a maximum of 200 samples from the Rapid Antigen Kit daily, while the RT-PCR is done only once a week.

Dr. Rajesh Kumar, in-charge of Aurai PHC in Muzaffarpur district, said, "We test those patients who come to the OPD with the symptoms of cold, cough and fever. If their result comes positive, then we give them Covid-19 kit and recommend home isolation."

According to the officials, an indication that the second wave of the novel coronavirus has reached interior villages in the state is that many who come with generic flu-like symptoms get tested positive for COVID-19. Dr Bhola Bhai, in charge of Khijarsarai PHC, said, "At least, 150 to 200 people are coming to us daily and 20 to 30 of them are testing positive. Many of them don’t know how they got infected."

Officials, however, alleged that no initiative has been taken by the state government led by the BJP-JD(U) alliance to conduct the tests at the village level. This reporter spoke to more than half a dozen local representatives from both districts, who unanimously said that there are no COVID-19 test camps in villages.

Dharmaraj Paswan, mukhiya of Chiraili Panchayat of Khijarsarai block in Gaya district, also complained about not having a testing camp and said that the nearest testing centre is 20 kilometres away.

The scarcity of rapid antigen kits is also a major problem for these districts. Due to the non-supply of antigen kits, COVID-19 test could not be conducted at any centre on Thursday (5 May). At a time when positivity rate is rising across the country, halting tests in a populated district for one whole day could mean that hundreds of people who might be positive are going undetected and can lead to further spread of the virus.

Over 2 lakh residents of Khijarsarai block headquarters in Gaya district are dependent on a lone Primary Health Centre which has only six general beds and a handful of oxygen cylinders. Umesh Kumar Ray

Muzaffarpur civil surgeon SK Chaudhary said, "We needed 7,000 rapid antigen kits daily, but only 2,000 kits were available. We have asked the health department to provide more kits. On Friday we were been given 7,000 kits."

It may be noted that in the last week of April, there was a backlog of 9,000 RT-PCR samples in Muzaffarpur, due to which the RT-PCR test had to be stopped for 4 days.

Testing is not satisfactory in Gaya either. Dr Gaurav Kumar, in-charge of Paraya PHC in the district said, “Our PHC used to get only 75 rapid antigen kits daily. Now, it has increased to 150, but still, it is less because we get around 200 patients daily."

Ajay Kumar, 24, who hails from Shiva Bigha in Tekari block of Gaya, gave a sample for RT-PCR test on 21 April. He died on 28 April, but the test report had not come till 8 May. Ajay's brother Chandra Bhushan Kumar said, "His health deteriorated on 19 April. On 21, his rapid antigen test was done at Tekari PHC. The result came negative. He then gave a sample for the RT-PCR test. Meanwhile, his health was improving. On the afternoon of 28 April, he suddenly started having trouble breathing, so we took him to PHC Tekari. When doctors put Pulse oximeter the oxygen level was 100, but he was facing difficulties in breathing."

"We told the doctors that he should be given oxygen, but the doctors did not do so and he died within half an hour. It has been 17 days since the sample for RTPCR was given, but we didn’t get a test report till date," he said.

Arbitrary pricing by private hospitals

The Bihar government has designated private hospitals for the treatment of COVID-19. The government has fixed rates for them as well. However, people complain that hospitals charge more money in the name of treatment. Most private hospitals at Gaya and Muzaffarpur have neither ICU facilities nor ventilators, government data shows.

Shahjahan Khatoon, 38, a resident of Muzaffarpur city, was suffering from shortness of breath in the last week of April when she was admitted to a private hospital in the city designated by the state government. She was admitted there for two days. She died at night on the third day. His family has complained that there was no facility in the hospital, but the money was recovered in the name of treatment.

Md. Ejaz, a relative of Khatoon, said, "When we took her to a private hospital in the city, at first the hospital refused to admit. After a lot of persuasions, they agreed but demanded one lakh rupees in advance. We somehow deposited the money. She was in the hospital for two days."

"On the night of 29 April, we were told by the hospital that her health was deteriorating. The hospital management asked me to arrange for a ventilator. We ran from pillar to post, but no arrangements could be made. After some time the hospital told me that she had died. There was neither ventilator in the hospital nor ICU, but in lieu of two and a half days, we were charged Rs 1,25,000. This is loot.”

Complaints of huge hospital bills by private hospitals is such that on Thursday, Pranav Kumar, district magistrate, Muzaffarpur had to warn private hospitals against the arbitrary charges from covid-19 patients. But, the warning seems to have no impact on the ground as people still complain of huge hospital bills.