Health

Ground Report: Inside a Mumbai Hospital Caring for Critical COVID-19 Patients

Doctors at the St. George Hospital say massive changes have been made, both in terms of outlook and structure, to meet patients' needs.

Mumbai: It is noon. A senior doctor paces up and down the alley right outside the out-patient department (OPD) of St. George Hospital, answering the nth call of the day.

This time, the caller is an “important person” from the ruling state government’s office, asking for an update on a 67-year-old patient hospitalised a week ago. Ten minutes and three calls (to his staff) later, the doctor is informed that the patient died earlier in the day. He calls the government person back and patiently informs them about the patient’s co-morbidity and other age-related complications, which caused his death. The caller casually places the blame on the hospital before hanging up.

Though the call troubles the doctor, he says it is just “another day in the life” of the medical workers at the state’s ‘dedicated infectious disease’ hospital set up to handle only critical COVID-19 cases.

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The 342-year-old colonial-era structure has been running at full capacity for the past two months. Mumbai city, one of the worst-affected Indian regions in the pandemic, has close to 42,000 cases. To tackle that situation, the pressure on a special facility with 210 beds – all engineered to only handle critical COVID-19 patients – has been immense.

“Such calls have become a new norm now. But since they are mostly made out of desperation, to find out about the patient’s well-being, we don’t take it to heart,” the doctor says, further adding that medical workers here are inundated with calls from local politicians, businessman, policeman – all asking to get “their patients” treated here on priority.

“Every patient reaching us is precious and we are trying our bit to save each one. It doesn’t matter if he is a VIP or an ordinary person,” the doctor says.

St. George, a 342-year-old colonial era structure, has been converted into the critical care COVID-19 hospital in Mumbai.

As per the set protocol, only critical patients are to be referred to St. George Hospital. The complications they face range from underlying medical conditions, age or even the severity of the viral load in the body.

The hospital, since early April, has gone through a radical change both in its outlook and structure. The original hospital of 467 beds had to be brought down to 30 beds – 10 ICU and 20 general beds – in March. “This was partly because of social distancing norms and partly because the hospital was not prepared to handle the sudden surge in patients,” a senior official says. But by April 7, the number of beds had been increased from 30 to 210 and in the coming week, another 32 new beds will be added.

A part of the hospital is undergoing structural alterations to set up new wards for COVID-19 patients.

To match the special demand, St. George Hospital, one of the four hospitals that are a part of the Sir Jamsetjee Jeejebhoy Group of Hospitals in South Mumbai, has brought in several structural changes. Public Works Department workers, after the initial fear of getting infected, agreed to carry out work and over the past two months have been building partitions and refurbishing the wards.

The work has been carried out even as patients are being treated here. The wards have been enclosed from all sides to ensure no passers-by catch a glimpse of what is happening inside. Outside, it is business as usual, with scaffolding and wooden partitions strewn across different floors.

The hospital lobby has been converted into testing centres where hospitalised patients and medical staff undergo tests regularly. A part of the lobby has been converted into a special ward to treat the infected medical staff.

The only “visible sign” of the hospital being a COVID-19 centre is the contactless testing booth set up right at the entry of the OPD centre, and another one on the first floor of the hospital building. Doctors arrive every morning from JJ hospital to collect samples. “Since we don’t have walk-in patients, these samples are of the patients already admitted here and also of the medical staff,” a doctor tells The Wire. An average of 60-80 nasal swabs are collected every day.

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The person enters a small glass enclosure attached to the testing booth, and stands there for a few minutes before a liquid disinfectant is sprayed on her. Once done, the person’s swab samples are collected.

A doctor overlooking the setting up of ward with 70 new ventilators points us to the neatly aligned beds, placed across the perimeter of the room. On one side, several ventilators – of both foreign and indigenous (Indian) make – are placed. Towards the corner, a glass nursing station is built.

Special Donning (putting on) and Doffing (taking off) booths are set up outside each ward to minimise contamination and security of the medical staff. Shower rooms are also attached to the booths.

Also, from its earlier capacity of 1,000 litres of oxygen support, the hospital has increased its capacity to 6,000 litres now. “Most patients here are in dire need of oxygen. And this increase in capacity is just about meeting the demand,” shares an in-charge doctor.  The hospital also has 10 dialysis machines for patients needing renal support.

The hospital received its first COVID-19 patient on March 27. Two days later, 15 more were added. This number steadily grew and as of May 31, 590 patients were admitted at the facility.

Of the total patients, as many as 108 patients have succumbed to the infection so far. The number of patients dying here is much higher than the rate at other hospitals. In the entire city, 1,319 people have died of the diease. The reason behind the higher number of deaths, the doctors say, is primarily because of the severity of the infection and the condition in which the patients are brought in. “Most of them are referral patients and with a history of co-morbidity,” a doctor explains. “Also, most of these deaths happened in the initial few days. Once we began following a strict protocol, we were able to bring the death rate down considerably,” a resident doctor says.

Most civic and state-run hospitals in the city have been reeling under tremendous pressure. With a dramatic increase in the number of patients and also deaths, there have been serious lapses in handling patients in many hospitals. Last month, a chilling video of a body piled up next to patients had gone viral from the civic-run Sion hospital. This video was a grim reminder of how the underfunded health care infrastructure in India’s financial capital was unable to hold up to the pressures of rising infections and deaths.

Contactless testing booths have been set up on different floors of the hospital. On an average 60-80 tests are conducted here daily.

This situation, doctors say, was a reality in most hospitals, including at St. George until the first week of April. “The morgue here (St. George) is in the neighbouring building. The average time taken for the BMC’s hearse van to reach hospitals is anywhere between three to 16 hours. Owing to the shortage of staff, reluctance of the staff to repeatedly shift (infected) bodies, they had to be wrapped and left on the beds until the BMC hearse vans were made available,” a doctor recalls.

“But we soon realised that we needed an alternative. Both for our staffs’ wellbeing and also for the dead patients’ dignity.” A room on the ground floor was converted into a temporary morgue, with four air conditioners fitted in. “It is all jugaad (a temporary arrangement), made by pulling strings among local contacts who were willing to donate for a cause. But the set up has ensured that bodies are preserved well and are kept away from the sight of the ailing patients and also media controversies,” a doctor says. Another one says that the arrangement was made by the recently appointed superintendent of the hospital, Dr Akash Khobragade.

At the intensive care units, however, the centre has made the best arrangements. When this reporter visited the hospital, two doctors – covered in personal protective equipment – were attending to the patients in the ICU. The room was latched and entry, even for other medical staff, has been restricted.

Five children, all below six, have been hospitalised at the special paediatric ward.

Small alterations are made to these strict rules at the paediatric centres, where five children have been hospitalised. Colourful murals and cartoon characters adorn the walls of the paediatric ward, making the space stand out from others. A child can be seen taking a stroll with a caretaker around the ward. “They are not critical patients and we allow them move around a bit in the ward. But they don’t step out of the assigned space,” a ward in-charge says. This paediatric centre is run in a critical care hospital since they already had a set-up, Dr Khobragade says. Parents and other family members of these children are also undergoing treatment in the hospital.

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Every ward, including the paediatric centre, has a dedicated section for donning and doffing. New bathrooms have been built outside each ward. “This minimises the infection. Doctors, nurses and other medical staff use the dedicated donning and doffing area and also bathe here before they set out of the hospital at the end of the day,” a doctor explains, as she readies to leave for one of the OYO rooms, a hotel chain where she will be living over the next few days. Once her nine-day work cycle ends, she will be moved to another quarantine centre and her room will be sanitised and readied for another doctor to move in. “Earlier, we followed a seven days work and seven days quarantine pattern. Now it is nine and five, since we are facing a staff crunch,” she explains.

Blood test lab.

In comparison with other city hospitals like Sion and Jaslok, where a bunch of doctors and medical staff got infected, St. George has had relatively lesser number of infections among its staff. This, the senior officials say, has been possible because the hospital had since the very beginning focussed on strict compliance with the set protocols.

So far, three doctors, four nurses, one clerk and four peons were infected. A special ward at the hospital lobby has been set up to treat the hospital staff, along with those infected at its partner JJ hospital. St. George hospital superintendent Khobragade confirmed that his hospital staff have all recovered. “Only those from JJ (hospital) are undergoing treatment at my hospital right now,” he tells The Wire.

The hospital, so far, has received additional funds of Rs 20 crore from the Centre and another Rs 5 crore from the chief minister’s fund. This, the officials say, is not enough given the fact that the hospital had to spend a great deal in making structural alterations, along with other procurements. “At least Rs 3-4 crore more will be needed to ensure we have all facilities running to optimum capacity. This will be discussed with the state health department,” Dr Khobragade says.

All photos by Sukanya Shantha.