Mohali: While the spotlight remains trained on the tussle for power within Rajasthan’s state government, yet another patient suspected to have COVID-19 has reportedly died by suicide at a government hospital in Jaipur.This is the third case of a patient reportedly dying by suicide at a government hospital within a month in the state.On the night of July 12, an old man suspected to have COVID-19 reportedly hung himself to death at the RUHS Hospital. He had been undergoing treatment at the hospital for over a week. A day after his death, his COVID-19 test came back negative.The Wire has reached out to his family and it is yet to hear from them.Two other reported suicidesEarlier, on July 8, a 78-year-old man admitted to the same hospital on suspicion of having COVID-19 died, reportedly by suicide, even before his test results were available. They were later found ‘negative’.His family has accused the hospital of medical negligence.The grandson of the second man told The Wire that his family has filed an FIR against the hospital for medical negligence.The chief medical health officer (CMHO) of Jaipur, Narottam Sharma, said the man had cut open the bathroom window’s wired grill and jumped to his death.The police had earlier speculated to journalists that “phobia [of the suspected disease] got to him”.However, the second man’s family has rejected both the CMHO’s and the police’s accounts. “He had no mental stress. This is a clear case of hospital negligence,” the grandson said.Earlier this week, as The Wire reported, a 48-year-old patient known to have COVID-19 complained to his family about medical negligence in the hospital. After he died, the police found a self-recorded video on his phone in which he was heard saying, “I will kill myself, no one is taking care of me here.” The hospital denied that he died by suicide and that he succumbed to the infection instead.The third man’s family received his death certificate only after two weeks or so. It doesn’t mention the cause of death, and the family is confused about what really happened.Also read: How a Viral Video Tore Apart Bihar Govt’s Claims on Efficiently Handling COVID-19The people’s health group Jan Swasthya Abhiyan (JSA) had asked the chief minister of Rajasthan to ensure that the superintendent of RUHS Hospital be made to resign, and a special committee be set up to probe the last two cases.There has been a steady stream of news reports of suicides at hospitals treating COVID-19 patients from across the country. Earlier this month, a 37-year-old journalist employed by Dainik Bhaskar jumped out an upper-floor window at AIIMS Delhi.The Union health minister subsequently tweeted about the death, ordering an “immediate replacement of medical superintendent of AIIMS Trauma Centre”. He also said he had ordered the creation of a four-member committee – which later found there was no “malafide intent in the death” of the journalist.However, in a video doing the rounds on WhatsApp and YouTube, the journalist’s wife expresses dissatisfaction with the report. She has accused AIIMS of negligence and has demanded a CBI probe.No such probes have been launched into the deaths of the three patients in Jaipur.Reports of deaths by suicide have also come in from Bangalore, Thiruvananthapuram, Mumbai and many other centres around the country – but have largely remained confined to the regional press.Understanding mental distressDr Ashish Pakhre, a consultant psychiatrist in New Delhi and an alumnus of AIIMS, told The Wire that doctors and hospitals are trying their best to provide adequate care to COVID-19 patients, and they don’t deserve all the blame because most “people don’t understand mental distress and its symptoms” in India.He also said it’s equally important that a team of mental health experts be constituted. “All the important points and avenues – terraces and window spaces where such self-harm steps can be taken – should be restricted,” Dr Pakhre added.Last month, Union home minister Amit Shah ordered CCTV cameras to be installed in all wards of Delhi’s designated COVID-19 hospitals.This then prompts the question about the affordability of CCTV cameras, and access to the associated infrastructure, in hospitals outside Delhi.Also read: Kolkata: Teen’s Death After 3 Hospitals Refuse Entry Puts Focus on Collapsing Health SystemThe family members of the 78-year-old man from Jaipur told The Wire that they’re unsure if CCTV cameras have been installed at RUHS.“We asked the police if they’re checking any CCTV footage and they told me they are, so I think they have CCTVs installed there, but I am not sure,” the man’s grandson said.Narottam Sharma, the CMHO of Jaipur, said the Rajasthan government had issued an order on May 18 to launch counselling programmes for COVID-19 patients.“Under the programme, a team of mental health experts visits patients regularly,” he said, without elaborating on what they do or whether patients are satisfied.Earlier in the pandemic, Kerala had been among India’s first states to recognise mental health issues among people suspected to have COVID-19, at home as well as in hospitals.However, despite this early acknowledgment, the Kerala government instructed hospitals in the state to streamline their monitoring mechanisms only last month, after two patients reportedly died by suicide.According to Dr Pakhre, state governments have been working to improve access to counselling services, but “effort is required to ensure that people [are] made aware of these services and encouraged to utilise counselling”.He also said information that promoted hope, reduced stigma and informed people, especially of the high chances of recovery from COVID-19, should be circulated.“A lot of negative, panic-creating news is being circulated on COVID-19. It is our collective responsibility as a society to not let this happen,” he said. “I, a mental health professional and you, a media professional, can make this happen in our own small way.”Health rights activists like those associated with the JSA have also said all governments should draft and publish robust guidelines on patient counselling at COVID-19 hospitals and quarantine centres – “if at all they are serious about preventing more such deaths”.When asked if Jaipur’s RUHS has taken any corrective measures after the three alleged suicides, JSA activists said that nothing has happened.The CMHO of Jaipur, however, told The Wire that at the district level, the government is intervening. “We have started meeting the families of patients who have COVID-19 and are in home isolation. Our health workers gave them roses as well. We have also told them to reach us if they face any difficulties,” he said.At AIIMS, The Wire’s calls to the PRO went unanswered. But a senior doctor at the hospital has confirmed that there are mental health counselling sessions for all patients “on a need basis”. The doctor said that with increasing sensitivity to the COVID-19 situation, more people are talking about seeking such measures.When asked if the hospital intervenes on its own or the patients’ family seek help from the hospital, the doctor said that doctors keep an eye out for anyone who may be going thorough mental distress.A lack of careWhile the families of both the patients who reportedly died by suicide, and who spoke to The Wire, have blamed the hospital for medical negligence, independent public health researcher Sana Contractor, said that she wouldn’t call it medical ‘negligence’ but would say that there is a lack of dedicated and attentive care for patients right now.Speaking to The Wire, she said, “Negligence is a very legal term to use, I would rather say there is a lack of dedicated, attentive care.”Contractor says that COVID-19 has made the hospital a very impersonal space. Earlier, doctors and nurses would interact with patients; attendants and family members were allowed to meet with them too. But with COVID-19, families and attendants can’t be around and PPE-wearing doctors can hardly interact with patients.Contractor echoed Dr Pakhre and said that to avoid suicides at COVID-19 hospitals, the first thing would be “to understand what the patient is thinking and why they feel like this is the end”.When asked if medical intervention, in terms of infrastructure and human resources, should be increased, she said, “It may not necessarily be an infrastructure problem to begin with”. Contractor added that infrastructure can come later if patients can be made to feel that they’re attended to.She said that with a dearth of staff and a massive inflow of patients at hospitals, care is lacking.“Doctors and nurses are working under really tough circumstances. Working in PPE is incredibly uncomfortable. Our doctor-to-patient ratio is poor but nurse-to-patient ratio is worse. In the public sector, there is a proper shortage of nurses and a lot of COVID-19 care is about nursing,” she said.She also said that the medical staff is working under the fear of contracting COVID-19 along with exhaustion, so the entire care-giving process “has become impersonal”.According to her, volunteers and social workers can be brought in to help out, but she reiterated that COVID-19 care will remain a very isolating affair.If you know someone – friend or family member – at risk of suicide, please reach out to them. The Suicide Prevention India Foundation maintains a list of telephone numbers (www.spif.in/seek-help/) they can call to speak in confidence. You could also accompany them to the nearest hospital.
