New Delhi: Outside a Mohalla Clinic in Northeast Delhi’s Kardampuri, a queue of sick patients line up to see the doctor sitting inside the portacabin. One is seeking treatment for a rat bite, another holds a child with a skin affliction in her arms.
“At least 200 will come in a day,” said the doctor who didn’t wish to be named. “Coronavirus has affected the whole city, but there are other ailments too. OPDs are still quite inaccessible for these people, so Mohalla Clinics are their best bet,” she added as she saw patients, protected behind curtains and windows, which often means no stethoscopes, no blood pressure checks, and no temperature checks.
The city has recorded 34,687 Covid-19 cases as of Friday, and according to Delhi Health Minister Satyendar Jain, at least 50 per cent of these are of unknown origin, suggesting community transmission is underway.
As local doctors worry about their safety, ThePrint visited 17 Mohalla Clinics across the national capital — four in south, three each in east and west, and seven in north — to look at the functioning of the clinics through the pandemic.
Mohalla Clinics is the flagship primary healthcare programme of the AAP government in Delhi, aimed at providing free healthcare and medication to the city’s poor. The clinics have been hailed for bringing healthcare to political agenda, and for having helped Delhi tide over its dengue and chikungunya crises. Since the first Mohalla Clinic was launched in 2015, their number has climbed to 484.
With the outbreak, however, the role of these clinics has been overshadowed by reports of Delhi’s Covid hospitals crumbling under stress. When the nationwide lockdown was first announced on 24 March, Mohalla Clinics were directed to remain open, even after a Mohalla Clinic doctor had tested positive.
As of now, these clinics are largely open and functioning but barely so as they are grappling with shortage of protective equipment and delays in salary payments.
‘Services were needed’
Dr Sangeeta Basu, who services a clinic in Vikaspuri that sees an average of 70 patients a day said, “Initially, I was wary of coming in because I’m 59 years old. My staff also found it difficult to come because there was no means for them to travel. I took permission from the government and my clinic was closed for a month.
“But I realised that the services were needed, and that if I took whatever precaution necessary, it would be okay,” Basu said.
Most patients across these clinics seek treatment for skin infections like scabies, seasonal flus, and long-term illnesses like diabetes.
Patients have to approach the doctors through a window or from behind a curtain and describe their ailments. The doctor in Kardampuri, for instance, responded by asking a series of questions to ascertain the illness: Is there pain elsewhere? Are you able to use the toilet as you normally would? Do you have a history of this ailment? A diagnosis would then be made, and medication prescribed accordingly.
In March 2020, there were a total of 10,65,630 visits to the clinics — nearly double the number of visits compared to government data from April 2019.
A number of clinics were shut during the lockdown months, and while official data is unavailable, it is likely the number of visits declined, too. As of 3 June, when lockdown measures were eased considerably, 405 of 484 clinics were open.
The open clinics were a relief to patients. Mohammed Hanif and his wife Jamila from Seelampur have depended on the clinics for over a year. “During the lockdown, they supplied us with medicine when all other places were shut. If there are more serious issues, they refer us to bigger hospitals,” said Hanif.
Alternatively, a closed clinic meant zero access to healthcare for many. Narayani Devi visited the Sangam Vihar clinic Wednesday only to find it shut. “My son has been bitten by a dog and he needs a tetanus shot. I am too scared to go to a hospital due to Covid and now this is also shut. What do I do?” she asked.
Doctors in a double bind
For doctors, coming to work in the clinics means being torn between a sense of duty and fear of contracting the virus. Of the 17 doctors ThePrint spoke with, 10 complained of thinning supplies of masks, gloves, and sanitisers.
“We’re here seeing patients with all kinds of symptoms — including cough and fever. At the very least we require a supply of masks and gloves. But we’ve been given 10 pairs of gloves and 10 masks for three months. How is that sufficient?” asked the Kardampuri doctor.
Without adequate protective gear, doctors have had to change the way OPD consultations take place. No formal orders have been made about what the doctors should and shouldn’t do, leaving it to their own discretion.
In most clinics, patients don’t come inside unless absolutely necessary and taking blood and other samples have ceased. If a patient comes with severe Covid-19 like symptoms, the clinic draws up an OPD slip and refers the patient either to the nearest dispensary or Covid-19 hospital for testing. Dressings for patients with injuries aren’t done anymore, and the pharmacist simply hands over medication through a window in the cabin, sometimes using a cardboard tray.
“Earlier we did routine blood tests, urine tests as well as injection shots here. But now unless they give us PPEs we will not offer these services. We are referring them to the nearest dispensary for these services,” said Dr Mohammad Nishat from south Delhi’s Lal Kuan.
In Trilokpuri Block 12, where a Mohalla Clinic is functioning right next to a house under home isolation, the staff is scared.
“We have written to the CDMO (chief district medical officer) multiple times that there’s a home isolation case right next door, but their explanation is all houses will eventually get infected so nothing can be done,” said the doctor on duty who didn’t want to be named.
East Delhi CDMO Dr Rekha Rawat told ThePrint that the clinic staff didn’t require full PPE kits. “Mohalla Clinics serve as OPD services. Government directives clearly state that full PPE gear is only for In-Patient services (IPD). Masks and gloves are enough for Mohalla Clinic staff,” she said.
Asked about the shortage of supplies, state nodal officer for Mohalla Clinics Dr Shalley Kamra said face shields, masks and gloves had been provided to the doctors and staff. “I will ask my CDMOs to look into these cases to see if there’s a shortage on their end because there isn’t any on our part,” she said.
Adding to the troubles of the Mohalla Clinics’ healthcare workers is non-payment of salaries for at least two months. These workers are paid per patient, at a rate of Rs 40 for doctors, Rs 12 for pharmacists, Rs 12 for assistants, and Rs 8 for multi-taskers.
“Continuing without salaries is difficult but what option do I have? I have to treat the 100-120 patients that come to me every single day,” said Nishat.
The staff claims that salaries are not late just this time but have been delayed for a while.
“I joined in September 2019 and got my first paycheque only six months later. Now we are used to planning ahead, with the assumption that salary won’t come for three months at least,” said a pharmacist at a Tughlakabad Mohalla Clinic.
But Kamra said salaries have only been delayed due to the pandemic. “My accountant himself has been infected so several calculations are pending. But we are working on it and salaries hopefully will come this month,” she said.
Without salaries and enough protective gear, though, some doctors have gone great lengths to provide treatment – especially during the peak of the lockdown.
“I walked 4-5 km every day with my staff during the lockdown to get to the clinic. Keeping the clinic shut would mean depriving my patients,” said the doctor at a Mohalla Clinic in Lakshmi Nagar who didn’t want to be identified.