New Delhi: At Delhi’s mohalla clinics, there’s a pervasive air of fear among doctors on account of their crumbling infrastructure in the middle of the Covid-19 pandemic. The fear was already quite strong over the past few weeks, but it has deepened since a mohalla clinic doctor in Maujpur tested positive for Covid-19 this week.
Doctors claim they lack the preventive gear considered necessary for healthcare workers on the frontlines of the biggest health crisis the world has seen in decades. And it’s not just their own safety they are worried about — a possible infection will place their families at risk too, they fear, as it did with the Maujpur doctor.
The Maujpur doctor is suspected to have contracted Covid-19 from a patient with a travel history to Saudi Arabia who consulted him on 12 March. This interaction is said to have infected a total of eight people, including the doctor’s wife and daughter.
In light of the diagnosis, over 800 patients who visited the clinic in the week following the Saudi-returned woman’s consultation were quarantined. The clinic was subsequently closed and sanitised.
The fact that each mohalla clinic doctor tends to dozens of patients every day, especially with other hospitals currently prioritising Covid-19 cases over other afflictions, has stoked fears that any transmission of infection here may blow up into a public health crisis.
The Delhi government claims it’s doing its bit, saying the requisite gear will reach every clinic even if it takes some time. It has also ruled out any possibility of shutting down the clinics, saying it is a doctor’s duty to place their patients ahead of their own safety.
While some doctors continue to serve their patients despite their fears, many among Delhi’s 450 mohalla clinics have been reported closed in recent days with practitioners refusing to turn up.
Patients of different ailments feel equally scared, and helpless too. With the lack of protective gear keeping doctors away from several mohalla clinics and other hospitals prioritising Covid-19 cases over other patients, they say they are left with no place to go.
Confusion, concern in the clinics
Launched in 2015, months after the AAP swept to office in Delhi with a stunning majority, mohalla clinics are a network of medical facilities that offer free treatment and are meant to strengthen the national capital’s primary healthcare framework.
According to officials in the union territory’s health administration, they are primarily served by retired government doctors or those from private clinics.
On Tuesday, after the doctor had been diagnosed, the nodal officer for mohalla clinics, Shalley Kamra, issued an order saying they will remain closed until 31 March.
However, the order was withdrawn later the same day. In the ensuing confusion, some doctors kept waiting for further clarification and didn’t turn up at clinics the next day, while many took a conscious decision not to over safety concerns.
The order was reiterated by Chief Minister Arvind Kejriwal at a press conference Thursday, where he “denied rumours about mohalla clinics being closed down” and maintained that all remain open.
In the hours following the press conference, a feverish discussion ensued on WhatsApp groups as doctors and staff voiced anxiety and concern.
As reported by ThePrint, several doctors didn’t turn up for work Wednesday, the first day of the national lockdown, with a source saying at least 50 clinics in South Delhi alone were without doctors.
On Thursday, as ThePrint set out to conduct another ground examination, patients were seen queuing up at some mohalla clinics even as others remained closed.
At the clinics that were open, doctors and staff said they were willing to continue work but reiterated worries about lacking the requisite protective gear.
A doctor at a Dakshin Puri mohalla clinic, who was seen sanitising his gloves after every consultation, said he had bought the pair himself.
“I had the gloves lying in my drawer. The government has only given us masks, nothing else, but even those haven’t reached most of the clinics,” the doctor added.
The doctor said they had also arranged masks for their two assistants, who were distributing the prescribed medicines.
Similarly, the assistant at a Panchsheel Vihar mohalla clinic claimed he was provided the basic gear by the head doctor there. The assistant was also dropped at the clinic by the doctor’s brother on his request because the complete national lockdown had made her commute nearly impossible.
She’s not alone. Many hospital staffers – even doctors – who are yet to get their curfew passes are said to be finding it difficult to reach their workplace.
“I have my stethoscope to show, what will the staff show?” said the clinic’s head doctor. “They aren’t accepting their IDs.”
A 58-year-old, he said at least the aged doctors at the clinics should be provided PPE kits for protection.
Health experts, including those in the central government, have advised the use of ‘personal protective equipment’ or PPE kits for healthcare personnel. Each kit is supposed to contain goggles, a face-shield, a mask, gloves, coverall/gowns (with or without aprons), and head and shoe covers to mitigate the risk of infection.
“I am ready to compromise my life, but what about my family?” he said, adding that he was very perturbed when he learnt the Maujpur doctor’s wife and daughter had tested positive for Covid-19 too.
Dr V.K. Gupta, who didn’t open his mohalla clinic at Lajpat Nagar over the same concerns Wednesday, decided to keep it operational Thursday.
The majority of the mohalla clinics in the Lajpat Nagar area remained closed Thursday.
According to sources in the mohalla clinic network, the attendance marked online, out of the 32 clinics in South-East, only three were open Thursday. In South-West Delhi, the number was four of 58 clinics. ThePrint wasn’t able to independently verify the figures for other districts, but sources said the majority of the centres remained closed throughout.
Patients feel helpless
The closures have hit patients hard.
A 40-year-old resident of Saket told ThePrint over the phone how the closure of the mohalla clinic he visits had affected him. “The mohalla clinic at Malviya Nagar where I usually go was closed. I was having difficulty in breathing and now I don’t know where to go. I am worried.”
Lakshmi, a domestic help who brought her son to a Malviya Nagar clinic, said she waited for a long time before she was informed the clinic was closed.
ThePrint spoke to several patients waiting outside the Panchsheel Vihar, Dakshin Puri and Lajpat Nagar mohalla clinics, many of whom complained about how they couldn’t go for their regular checkup at hospitals because their OPDs had been shut down for non-COVID-19 patients. “Hum jaayein toh kahaan jaayein, beti ke pet mein dard hai (where should we go? My daughter has a stomachache),” said a shopkeeper in her 30s. “Baaki hospital toh band hain (the remaining hospitals are closed to us).”
Mahesh, a 48-year-old asthma patient, said Thursday that he had also visited the Dakshin Puri clinic Wednesday. “They are not allowing us in at other government hospitals. I have now come to the Dakshin Puri clinic, what else could I have done?”
State governments, at this stage, are prioritising coronavirus patients and those in isolation. As a result, many patients like Mahesh and the shopkeeper have been forced to visit mohalla clinics, increasing the number of patients at the facilities, and thus the risk of infection. The closure of several clinics may intensify this risk.
For Ashish Verma, however, who resides in the house opposite a mohalla clinic in Panchsheel Vihar, it’s a relief that the facility is closed.
“I had been observing the doctor, Divya, for two weeks. She was not well but continued to attend work as she is a sincere doctor,” he said. “The staff wasn’t provided adequate equipment. I live here and I used to see how people would stand in queues but doctors didn’t even have sanitiser.” Verma, who runs an NGO and is helping rehabilitate the poor impacted by the lockdown, said he received sanitisers in donations and offered to pass some of them on to the doctor and the staff a week ago.
Docs expected to cooperate, says Delhi govt
Sources in the Delhi health department told ThePrint that it was not possible to close down all clinics as this was a crisis, and doctors who entered the profession with an aim to put others’ lives first were “expected to cooperate and help out”.
They also expressed helplessness with regard to addressing the concerns raised.
“We have distributed 50,000 masks… While some have reached doctors, others are yet to. We expect them also to coordinate with us instead of looking for excuses to skip work,” a senior health ministry official told ThePrint.
The official added that sanitisers received in donations were already being supplied to doctors.
“It takes 3 or 4 days to reach and… this case of the Maujpur doctor testing positive only developed a few days ago,” the official said.
“We are trying our best to address their concerns but aren’t we all at risk? It is the time to come together and help the public.”
An AAP official expressed contempt for the doctors. “There is a reason we wanted retired or other private clinic doctors to join mohalla clinics… Typical government doctors want their concerns addressed before those of the patients,” the official said. “But we are seeing the same pattern again. Those on the frontlines are anyway at risk.”
The official said the PPE kits arranged by the government were being used by doctors posted with those in quarantine in hospitals or serving the ICU.
Experts say protection necessary
Experts, however, feel the doctors at mohalla clinics need to be provided with PPE kits to avert a larger crisis, or the facilities shut down. For example, a doctor at one of the Panchsheel Vihar mohalla clinics suspended work for a day due to fever – also a coronavirus symptom – but was back at work Thursday.
“I think the fact that one doctor tested positive is in itself alarming and the government should shut down all clinics completely,” said activist Loon Gangte of the Delhi Network of Positive People, which is involved in bettering healthcare access for people.
“To deal with emergency cases, the government can open only such a hospital or a big community clinic where patients can come on the basis of numbers assigned to them through a helpline to prevent overcrowding,” Gangte added.
However, Malini Aisola, co-convener of the All India Drug Action Network, a group of NGOs that works to bolster healthcare access as well, said it was important for primary health centres to operate during a pandemic.
“Perhaps the government can restrict the number of clinics operating in a district where doctors could come on rotation basis…” Aisola said, adding that this would cut the number of PPE kits required too.
She added that HIV and TB patients could be provided medicines for a month so that they don’t stand in queues often.
Shaleen Mitra, an aide to Delhi health minister Satyendar Jain, said doctors above 60 could be excused from treating patients at mohalla clinics.
“We want the elderly doctors to stay at home and protect themselves but, at the same time, we want patients to be taken care of, so they could probably suggest (some guest doctors),” he added. “Or we will also try to make alternative arrangements.”