Opinion: A Faulty System And Beloved Ranjana's Death

On a really hot summer day, in May 1980, a group of women were marching down a small, dusty lane in a workers' colony in Faridabad, enthusiastically shouting slogans as part of a campaign against dowry. They were undeterred that there was not a person to be seen except when a window, shuttered to keep out the searing heat, would open slightly through the march, and a woman would peak her head out to see what the noisy slogans were about. Ranjana and I paused, looked at each other and laughed out aloud with the same thought in our minds - a thought which she voiced. "Only crazy women and Communists out in the noon day sun!"

Ranjana Nirula. Age 75. Communist. Trade union and women's rights activist. Convenor of the All India ASHA Workers' Union. Editor of the journal "Voice of the Working Woman". Beloved friend to many, comrade, mentor to hundreds of young people, fifty years devoted to the struggle for justice. Full of fun and humour, with a dazzling smile, always optimistic even in the worst of times. Ranjana died last night of Covid. She is one of the 4,000, the average number of deaths in India in a single day, a death toll that is the highest in the world.

Millions of families in India are touched by the dark shadow of Covid. A son, a daughter, a parent, a sibling, a friend, a partner, a colleague in a factory, a neighbour in a village - lost, sometimes in a matter of days. A collective mourning spreads across India. Many have written about the terrible experience of a personal tragedy relating it to the wider issue of policy. So it is with Ranjana too. Questions which need answers and solutions to help cut the suffering of others affected.

What happens when a patient has Covid symptoms but the RT-PCR test is negative? This is the question we faced. The CT scan Ranjana had for her lungs after she developed Covid-like symptoms showed a score of 12/25. Ranjana's doctor advised hospital admission because of serious comorbidities. But because her RT-PCR test was negative, no Covid-designated hospital would admit her. The private hospital where she had earlier been treated for other ailments was not a Covid hospital. They held that even though she had tested negative, since her CT scan showed typical Covid lung damage of 30%, they could not admit her. So, no hospital - Covid or non-Covid - could take here. Many patients we were told faced the same problem because of the inaccuracy of tests. Either way, the patient suffers. There are patients who may be treated at home through tele-consultation and a provision of oxygen supply. That is what experts constantly say on national television. Don't panic. True. But what about those who like Ranjana need urgent hospitalization? A second RT-PCR test was conducted, but the report was delayed. Meanwhile, the Covid effects worsened and her oxygen level plummeted.

Coincidentally, around the same time as our desperate search for a hospital, the Delhi High Court was hearing a petition on exactly this issue. It directed the Delhi Government that patients with Covid symptoms must be admitted without a positive PCR report. But we found, to our dismay, the order made not a jot of difference to the admission protocols being followed. After the High Court's order, a senior doctor at AIIMS messaged me saying, "Bring patient to emergency for help, but for admission, will require antigen test." This meant that if the antigen test, known for often giving false negatives, erroneously said she did not have Covid, she would not be admitted. It was only a week later that the Health Ministry's expert panel woke up to the court order to issue guidelines that lack of a positive test should not hamper admission, but whether anything has changed on the ground is doubtful.

What if the test had not been wrong, what if hospitals had not denied Ranjana admission? Did the delay affect her condition irreversibly?

The government-run Ram Manohar Lohia hospital became our lifeline. Here, a most humane and helpful senior doctor informed us that the hospital had a SARI ward. This is the acronym for "Severe Acute Respiratory Illness". To this ward, the hospital was admitting patients who had Covid symptoms but not a Covid positive report. They had a very limited number of beds and we were fortunate that a bed did become available. Only a few hospitals have such wards. Surely many more hospitals should also start such facilities of a SARI ward, which serves as a tier of treatment for patients suspected of Covid but without a positive report.

Within two or three days, the test done by the hospital showed that Ranjana was indeed positive for Covid. She was shifted to the Covid ward from the SARI ward.This is where we faced the second issue which is perhaps common to all Covid-affected hospitalized patients and their families: the almost impenetrable wall of separation around a Covid ward or ICU. What is happening to your loved one behind that wall becomes a haunting thought day and night, while the patient, deprived of individual care even in the best case scenario since medical staff are overburdened and overstretched, is in a dark place of terrible loneliness. This is somewhat relieved if the patient is well enough to speak to her family on a phone. But once the oxygen mask is put in place and she struggles to breathe, the only line of communication gets cut.

In the SARI ward, attendants with PPE kits were allowed. In the Covid ward, it was different. Even though doctors could see the need for personal care, it was against the policy. One can understand and appreciate the strict necessity for isolating patients. But just as nurses and staff with PPE kits risk their lives in Covid wards, if family members wish to take the same risk wearing self-procured PPE kits or if they are Covid-recovered with high antibodies, can't there be a policy for allowing them even once a day to see their patient? Ranjana did get personal care and it helped her and her family enormously, but what about others?

A grieving mother who lost her son told me, "I curse myself, I cannot forgive myself for not being with him when he was alone and sick." Outside the ward where Ranjana was admitted, a young girl waited for news of her father, ill with Covid. She had been there since the early morning, hoping to get news, and to deliver a packet of personal items he required. She was extremely concerned because he had sent her a message that he needed to go to the toilet, but there was no one to help him. The Help Desk was unable to send her message to the ward concerned, beleaguered as they were with numerous requests. There were scores like her, waiting for news or getting messages from their patients asking for help. There was no protocol in place through which families of patients could get regular updates of their condition.

Families are so relieved if their loved one gets admission in a hospital. But once the separation sets in, the desperate wait for information, for news, worsens the anxiety. Doctors can't be blamed. But surely we can find a solution. These are issues which need to be discussed and resolved. This is all the more urgent since more young people are getting affected by Covid in this second wave, and they require higher levels of care and family support.

The hospital provided the hearse for the cremation for which one is so grateful. The horror stories of what is happening at crematoria did not haunt us - there was efficient system of timings which were more or less adhered to. Our beloved comrade was given a dignified farewell.

Ranjana was not deprived of treatment after she was hospitalised. We thank all the doctors and nurses who cared for her. Nevertheless the question "what if" remains - if not for Ranjana, certainly for thousands of others who died because they could not get treated in time, they could not get the personal care which may have given them strength and encouragement, and because of the spectacular collapse of the system of governance and health care.

Lal Salaam, dear comrade. Always in our hearts.

Brinda Karat is a Politburo member of the CPI(M) and a former Member of the Rajya Sabha.

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