Three days before he died, Dharam Chand, a farmer, started experiencing breathlessness. He had tested positive for COVID-19 at a hospital in Jammu and Kashmir on 29 April but was asymptomatic.
At 78 years, Chand, a retired cement factory worker, was a high-risk patient. But doctors at the hospital, in Ramnagar block of Udhampur district, advised his son to isolate him at home and keep an eye out for symptoms.
The family lives in Kirmoo village, 95 km away from Jammu, the winter capital, where specialised treatment is available for handling severely ill COVID-19 patients.
The union health ministry has made it mandatory for healthcare workers to monitor home-isolated COVID-19 patients “through personal visits along with a dedicated call centre to follow up the patients on daily basis,” the ministry’s guidelines state.
“A mechanism to shift patient in case of violation or need for treatment has to be established and implemented. Sufficient dedicated ambulances for the same shall be organised. Wide publicity for the same shall also be given to the community,” the guidelines note.
'They Didn't Send Anyone to Check on Him'
On the fourth day of home isolation, Chand’s health started going downhill. According to his family, multiple phone calls to the government’s call centre didn’t fructify.
When they tried to seek the help of doctors, they bitterly realised that they were on their own.
"“When they sent us home, they (doctors) hadn’t given us any medicines. Doctors didn’t care to check his health condition even once after he tested positive (for COVID-19).”" - Satpal Sharma, Dharam Chand’s grandson
Accusing the doctors of “murdering” his grandfather, Satpal added, “We tried to contact the hospital authorities but they didn’t send anyone to check him. We also made phone calls on the helpline numbers. But either the number was busy or they would offer to send doctors but they never came.”
Following the allegations, the J&K government has ordered probe into the death of Chand. The health department and the administrators of the Sub District Hospital in Ram Nagar have been asked to “explain the circumstances” under which Chand died.
The administrator of the hospital has been asked “why the criminal complaint has not be filed under relevant sections of law and legal proceedings be initiated against you.”
Financial Commissioner, Health and Medical Education, J&K, Atal Dullo could not be reached for his comments.
What About Health Ministry's Guidelines?
Since the last week of April, the novel coronavirus has been killing more than four home-isolated COVID-19 patients in Kashmir every day on an average, according to official data. These patients either die at home or have passed away by the time they reach hospitals.
This year, May has been the worst month. While the total death toll due to COVID-19 stands at over 4000 since the pandemic broke out last year, official data shows 1200 of these deaths were reported in May only. Of these, 130 were home isolated patients.
According to the central health ministry guidelines, COVID-19 patients and their immediate family members are required to download the government’s Aarogya Setu app which provides click-of-a-button access to doctors and advanced healthcare.
Under these guidelines, the government has to train the attendants in using pulse oximeter for monitoring the home-isolated patients.
In case of Chand, initial probe has found that no one from his family was asked to use the Aarogya Setu app, although some of them have working smartphones. They were not provided pulse oximeter either.
The guidelines on treating COVID-19 patients isolated at home were rolled out last year in July and issued again on 28 April this year. But doctors say the “inadequacies” of the government and the challenging terrain in the mountainous Kashmir Valley confine them largely to papers.
"“These tragedies have happened due to the dysfunctional and unaccountable system. The acute dearth of trained healthcare workers has only made it worse.”" - Name Withheld, Senior Doctor'The System is Not Perfect'
To make up for the shortage of healthcare staff, the government has ordered the UT’s contingent workers, who get paid less than a dollar a day, to work alongside doctors and frontline workers at hospital wards and quarantine centres for COVID-19 patients.
These workers are not insured by the government and, unlike doctors and other frontline staff, the families of these workers, who normally work as sweepers and cooks, won’t get cash compensation in case of their death.
Admitting the shortcomings in the death of Chand, Indu Kanwal Chib, deputy commissioner of Udhampur district said the government has sought a report from the chief medical officer of Udhampur.
“The system is not perfect,” said the deputy commissioner. “There are shortcomings and we are trying to overcome them. We have learnt a lot of lessons (in the death of Chand).”
Reacting the allegations that the health department failed in providing them medical assistance, Dr K C Dogra, chief medical officer of Udhampur district, the native of Chand, said they receive almost 2000-2500 distress calls daily from patients with COVID-19.
“We are trying our best to reach out to every patient but we also have limitations,” he said.
The death of Chand isn’t the only incident in Jammu and Kashmir where alleged lapses have taken place in treating home-isolated COVID-19 patients.
Other Similar Cases in J&K
Harbajan Singh, a high risk category patient like Chand, and a resident of Srinagar, the capital city, had a mild cough for two days after his wife was admitted on 23 April to a hospital with COVID-19 symptoms. SP Singh, his nephew said, they were asked to home quarantine him till the time his wife’s COVID-19 test report arrived. At midnight on 24 April, Singh, 82-years-old, was found struggling to breathe by his son who rang up his cousin.
"“We dressed him up before going to the hospital. He was struggling to breathe but he could walk on his own.”" - SP Singh, Harbajan Singh’s nephew
“But just when we walked out of home to get into the car, he collapsed. Somehow we dragged him into the car. When we reached the hospital, doctors said he was dead,” said Singh.
Like Chand, Singh was not provided life-saving drugs or oximeter for monitoring his condition, “We had our own oxygen concentrator which provided him some relief during the night while we were waiting for the dawn to break,” said SP Singh.
A day after Singh’s wife, Kulwant Kaur, 78, was admitted to the hospital in Srinagar, healthcare workers collected her sample for COVID-19 testing. Since the next day was a Sunday, the report was prepared on Monday which confirmed the family’s fears.
Kulwant Kaur had tested positive for Covid-19 and she passed away on Tuesday, without knowing that her husband was already dead.
Chand’s grandson, Satpal Sharma, said he went through a lot of suffering before his death, “He was choking while trying to breathe. Had they come to help him, he could have been alive,” he said.
"The government abdicated its responsibility. They must pay for it," he added.
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