Lingering effects of COVID-19 taking financial, emotional toll on India’s population

World

While India provides public health care, the system is chronically underfunded — and there's a growing dependence on private hospitals, with a large proportion of Indians forced to pay bills out of pocket. At the same time, those left widowed or orphaned by the pandemic are struggling to access government assistance.

Neeraj Jaiswal helps his wife, Neelam, with her oxygen intake at their home near India’s capital, New Delhi, as she slowly recovers from COVID-19 after a nearly three-month stay in hospital.(Salimah Shivji/CBC)

With COVID-19 cases raging across India in the spring, Neeraj Jaiswal was desperate with worry for his wife as her breathing became more shallow and he wrangled for a New Delhi hospital bed equipped with a crucial oxygen cylinder.

Five months after the devastating second wave that pushed India's health system to the brink, it still pains Jaiswal to think of that frantic time — even as his predominant worries now are his wife's recovery and the stack of medical bills piling up.

"No words, really," Jaiswal, 53, told CBC News, choking up at the memory.

"I was crying at home when I was alone," he said, his mind turning over the constant question: "What to do, how can I save her?"

His wife, Neelam, 49, was in an intensive care unit for nearly three months. She's home now, on the road to recovery, but she still spends nearly 23 hours a day hooked up to an oxygen machine beside her bed.

She's also prone to anxiety attacks after such a long stretch struggling to breathe.

Health-care costs a burden

The Jaiswals are among the more than 60 per cent of India's population that doesn't have health insurance, adding a financial burden onto the family's emotional one. The country provides public health care, but the system is chronically underfunded — and there's a growing dependence on private hospitals, with a large proportion of Indians forced to pay out of pocket, at one of the highest percentages in the world.

"The total cost is more than [$40,000 Cdn], and it's still going on," Jaiswal said, with continuous prescriptions to fill and hospital tests to undergo.

The family has been paying the extra costs with the help of relatives living in the United States, and Jaiswal tries not to dwell on the debt piling up.

"Money doesn't matter. Life is more important than money," he said. "She's my partner, she's my life."

People register to receive a dose of the Covishield vaccine manufactured by the Serum Institute of India, in an alley at a slum area in Ahmedabad, India, on Sept. 28.(Amit Dave/Reuters)

Officially, more than 33 million Indians have been infected with the virus, many during the country's brutal second wave in the spring, but experts believe the actual number could be up to 20 times that number. The effects, both emotional and physical, linger for many of the country's recovering patients.

COVID-19 widows struggle to access aid

Sapna Devi, 40, is not so worried about a potential third wave as she's concerned with surviving the ripple effects of the second. Her husband, Vijender, died within four days of being rushed to hospital in April.

Devi and her three sons, whose home is a small hut in one of the poorest areas of Delhi, are now scrambling to get a stack of documents together to claim government compensation intended to help those who've been widowed or orphaned by the virus — all while they grieve.

The process hasn't been smooth. Devi is illiterate and can barely afford the price of transportation to the various government offices to fill out forms.

"They tell me, 'You don't have this [document] or that document'," she told CBC News.

"I get overwhelmed," Devi added, shaking her head. "How much can I run around?

"I feel like my strength is gone."

In May, the Indian government announced additional support for those who have lost a primary caregiver to the coronavirus, including insurance benefits and a pension equivalent to 90 per cent of the loved one's average daily wages.

Various states have also implemented support programs, such as the Delhi government's one-time lump-sum offer of 50,000 rupees (less than $900 Cdn).

The proliferation of different funds, administered by different levels of government, means a complicated process for those trying to navigate it as they struggle to pay monthly bills.

Sapna Devi, 40, left, talks to Sonal Kapoor of the Protsahan India Foundation about her struggle to gather the documents needed to apply for government compensation after the death of her husband from COVID-19. Devi can barely afford the price of transportation to the various offices to fill out forms.(Salimah Shivji/CBC)

Sonal Kapoor, founder and director of the Protsahan India Foundation, an NGO that operates in the poorer areas of West Delhi, said there's a "massive gap" in terms of whether the support announced is reaching those it is meant to help.

"More than 90 per cent of the people from the urban slum clusters where we work do not have an inkling of such schemes being announced," she said.

On top of that lack of awareness, many Indians widowed by the virus don't have the proper documentation to prove their spouses died after contracting COVID-19 — particularly if the death occurred during India's devastating second wave, when the whole system was overwhelmed.

"Many of the bodies were taken from the hospital mortuaries directly to the cremation grounds, especially if they were COVID-positive bodies," Kapoor said, adding that authorities would often call weeks later telling families to pick up a COVID-19 death certificate.

One woman who the NGO is trying to help told Kapoor that her first reaction was: "Now my husband is dead. Of what use will the report be to me?"

She never collected the document.

'It's nothing short of a national emergency'

Indian Prime Minister Narendra Modi also announced in May that his government would cover the school fees and health insurance costs for children orphaned by COVID-19, as well as set aside funds they will be able to access when they turn 18.

Most of the children orphaned by India's sudden surge of cases in the spring are staying with relatives, but according to child protection authorities, a small number have been placed in institutions.

Vikas Singh, 16, and his brother, Akash, 15, are living at a New Delhi orphanage after the loss of their father to COVID-19 in May. Their mother died when they were young, and their extended family was unable to provide for them.(Salimah Shivji/CBC)

At a New Delhi orphanage, Vikas Singh, 16, and his brother, 15-year-old Akash, are trying to process the abrupt loss of their father to COVID-19 in May. Their mother died when they were young, and their extended family was unable to provide for them.

"I feel useless, it's terrible," Vikas said, adding that he no longer knows how to plan for the future without his father.

That pain is multiplied by thousands, and experts say the children are at a higher risk of depression, of leaving school, and of being exploited.

For many child protection authorities, the severity of the crisis, compounded into such a short time span, is hard to grasp.

Children who've lost a parent to COVID-19 gather to play at New Delhi's Don Bosco Ashalayam orphanage in September. They are cared for by relatives but often spend their days at the shelter.(Salimah Shivji/CBC)

"Eighty-thousand children losing one parent and this country [potentially] losing a whole generation is a disaster that will be worse than COVID," said Anurag Kundu, chair of the government watchdog agency, the Delhi Commission for Protection of Child Rights.

"It's nothing short of a national emergency."

'50 days of hell'

The scars of the second wave are also still fresh at New Delhi's Holy Family Hospital, where Dr. Sumit Ray is in charge of critical care.

At the height of the pandemic's second wave, the hospital had run out of ventilators, oxygen was running dangerously low on a daily basis and the ICU was operating with 70 per cent more patients than average.

"Our systems were totally overwhelmed," Ray said. "We were working non-stop, and still we didn't have enough time" with every patient.

Dr. Sumit Ray at New Delhi's Holy Family Hospital. At the height of the pandemic's second wave, the hospital had run out of ventilators, oxygen was running dangerously low and the ICU was operating with 70 per cent more patients than average. Today, it has only two COVID-19 patients.(Salimah Shivji/CBC)

"It was 50 days of hell, absolute hell," he continued. "It was a traumatic experience."

Today, the hospital has only two COVID-19 patients, down from a high of 400.

Since the wave abated, Holy Family Hospital has amassed a large supply of extra ventilators and has stocked up on oxygen cylinders. The facility is waiting on a new liquid oxygen generating plant to be installed on hospital grounds so staff won't have to depend on external supply if a third wave hits India hard.

Holy Family Hospital has a large storage space full of newly acquired oxygen cylinders in anticipation of a possible third wave of the pandemic in India.(Salimah Shivji/CBC)

That's in line with a push from the Indian government to increase the country's oxygen production levels by 50 per cent, up to 15,000 tonnes a day.

For Ray, it's the only way to stay ahead of a potential third wave.

"We should not be in denial," he said, noting how important surge capacity is, a lesson learned during India's second wave.

"I am hopeful that [the third wave] won't be as bad, but we have to always be alert to the fact that it possibly can."

ABOUT THE AUTHOR

Salimah Shivji is CBC's new India correspondent, soon to be based in Mumbai. She has been a senior reporter with CBC's Parliamentary Bureau and has covered everything from climate change to corruption across Canada.

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Credit belongs to : www.cbc.ca

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