As part of her work Dr Azmera Sheikh, would often visit the municipality office and ward offices for meetings with officials for Covid-19 patients, do thermal screening at multiple containment zones and check oxygen levels of patients using a pulsometer and wearing N95 mask, gloves and goggles. When in close contact or examining Covid-19 patients these healthcare workers are provided with personal protection equipment (PPE).

Dr Sheikh is a dental and healthcare professional, working with Doctors for You (DFY), an NGO with interventions at four isolation wards of the Municipal Corporation of Greater Mumbai (MCGM) – the metropolis with the highest Coronavirus infections in India. While at work, she got infected and even passed it to her mother. Both were quarantined for 15 days at Joy Hospital, Chembur. 

The more traumatic part of their ordeal, however, was not battling the infection but suffering the humiliation at the hands of neighbours in their building and the colony. They not only shunned them but also circulated videos when the ambulance came to pick them up from home. 

“When the ambulance came and we walked down, the residents of the housing colony were sitting down and started shooting videos which were circulated on social media. This was traumatizing for my entire family. Despite the knowledge that I am a doctor, my family had to face a tough time for 15 days when people in the building and the colony turned hostile as the building was sealed and declared a containment zone,” says Dr Sheikh.

Sheikh eventually recovered to return home but the experience shattered her. Though on recovery she had thought of quitting Covid-19 related work, she has chosen to put aside the bad experience and rejoined work.

DFY is working to provide medical care to the vulnerable communities affected by natural disasters, conflicts and epidemics, and is currently involved in various projects involving health professionals, disaster management practitioners, social workers and administrative staff across four states in India.

Fighting Covid-19 in an overstretched healthcare system, what is an average day for an overloaded healthcare worker? “When I go visiting wards, I have to stay back for four-five days,” says Dr Vaishali Venu, another dental and public health professional at DFY working in the areas of immunization, malnutrition, emergency response, skills development and livelihood, water sanitation and hygiene, environment and sustainability and capacity building and research. “It is stressful as after spending an entire day at work with no family around to give support, you have to face it all alone. I leave in morning around  9-9.30 and come back home at 10-10.30 at night, picking my vegetables and groceries along the way. After reaching home I wash myself, soak my clothes in soap for washing and cook food. There is an emotional breakdown and it gets very difficult.” 

Challenges ahead

Sheikh along with her team from DFY has been working in Shivaji Nagar slums, Govandi and other M-East ward offices. “The fact is that due to low education levels M-East ward required awareness generation. Comparatively speaking, in the area where I live people are educated, yet when it comes to perception, everyone is the same. There is much negativity and myth. It needs to be understood that one should be humane and maintain social distancing, not emotional distancing. Most of our colleagues have faced similar issues,” she says.

The ward however has had a spike in infection even though numbers have remained stagnant lately. While the number of beds is increasing the number of patients is coming down due to less testing and the departure of thousands of migrant labourers for their homes.

“In Shivaji Nagar where the isolation ward has 100 beds which was initially full, it now has hardly 32-36 beds occupied on weekly basis. Initially when along with MCGM when we wanted to provide food the figures were 50,000 meals per day. Now it has come down to 43,000,” says Dr Venu.

The government has repeatedly advised people to stay at home, and the advisories have been largely followed except in slums where up to seven-eight people live in a single room of 8x10 feet and use common community toilets. Under these conditions, maintaining social distancing is a challenge. Lack of it has emerged as a main reason for infection transmission.

“Our intervention is in areas of daily wage workers. No matter how much we tell them to stay indoors, it is not practical because either they will die of infection or they will die of hunger. They choose the latter, so their families do not suffer. As compared to the first two months, people have become casual about Covid-19 and many are seen roaming around without masks. They feel infection will happen with or without masks and might as well take it easy. The lockdown has delayed infection but not helped contain the numbers. Now with unlocking, as companies are beginning to open up again and the demand for jobs sets, there is a possibility of reverse migration. While we are trying our best to help out we have limitations.”

Since the outbreak of infection, DFY along with MCGM has been providing doorstep services through its mobile medical unit activities with doctors and nurses so that people can avoid going to hospital not only for Covid-19 checks but also for non-Covid-19 issues.

Sounding a word of caution that the government must bring back its attention to existing health problems, Venu says, “We must understand that like other infections Covid-19 is here to stay and there is a death rate. India had many other public health issues like malnutrition, maternal and child death etc, and we need to address these too and cannot ignore them in the face of Covid-19.

“Immunization is yet to resume and got further delayed due to cyclone. The NGOs that want to undertake vaccinations are not being allowed to do so until Covid-19 restrictions are in place, and many are now going back to their earlier non-Covid-19 activities like immunization and malnutrition. ASHA and anganwadi workers who were being used for contact tracing are now coming back to their original work and collecting children’s data. The human development index is very low in places like Govandi and Bihar and we have to consider these things. DFY has started daily OPD or community clinics for immunization. We are in continuous talks with authorities as we need regular vaccine supplies. For malnutrition, we are resuming our contacts and doing telephonic follow-ups with mothers who were already enrolled before the lockdown and after a fortnight will be able to start ground implementation,” she says.