As the COVID-19 cases and fatalities are on the rise in Leh district, the state of affairs seems to be grim. Since the start of the outbreak, a total number of 5409 positive cases were confirmed, and 49 death cases were reported in Leh district (Data till November 14).  

Health institutions are struggling to cope with the surge in new cases of COVID-19. With the onset of winter, more gathering and function are becoming a matter of concern as the district witnessed a sudden spike in the COVID cases in the past few days. 

Many of the patients have become so ill that they need to be treated in the hospital. Both the SNM and Mahabodhi hospital is in dire need of more healthcare workers, cleaning staff, and other facilities. 

Oxygen crisis

COVID positive patient and attendants at SNM hospital are complaining about the lack of oxygen supply. On November 6, Executive Engineer Mechanical Division wrote a letter (no. MDL/TS/681-84) to Medical Superintendent (MS), SNM Hospital, Leh. The letter mentioned that oxygen plant capacity is only 500/LPM (Litres Per Minute) and consumption of the hospital is currently more than 800 LPM which is resulting in the dropping of the pressure. Currently, the plant is running 20hrs/day and the remaining 4 hrs the supply is done through Jumbo (7000Ltsx30 Nos in 4 hours) cylinders inline and shutting the plants for a cool down.

Executive Engineer Mechanical Division advised Medical Superintendent to restrict the consumption of oxygen to its capacity by providing oxygen cylinder to the extra ventilators currently in use and filling of B-type cylinder needs to be done from outside (currently filling 1200x25=30,000 litres/day) so that full 500 LMP can be made available to the hospital inline. 

A COVID positive patient admitted at SNM hospital complained about the oxygen crisis. He said, “The present situation is critical and the everyday number of patients is increasing. Oxygen supply is a must to all the admitted patients but due to the rising cases, the requirement of oxygen exceeds the capacity of the plant. Cylinder is there but it is not sufficient also very inconvenient as it has to get it replaced several times.”

 “I fear it is going to be worse if the problem is not sorted at the earliest”, he added.

Dr. Tsering Morup, Senior consultant Anesthetist/Intensivist said that the existing oxygen plant is established as per the hospital requirement which is more than enough normally. But in the present situation is completely different because of the pandemic. The oxygen requirement is increased manifold because of the number of COVID cases and to meet the demand the cylinders are refilled from the private oxygen plants and also have a plan to establish a mega plant at SNM hospital in the coming days. 

The administration is procuring 30,000 litres extra capacity oxygen cylinders. The refilling of the cylinders will be done by the private oxygen supplier at Phyang and Chuchot.  

Tashi Gyalson, CEC, LAHDC, Leh directed CMO, Leh and Medical Superintendent, SNM Hospital, Leh to place an order for procurement of 10 High-Flow Nasal Cannula (HFNC) machines immediately.

Some patients bought the High-Flow Nasal Cannula machines at their expense. 

Need for healthcare workers

Frontline warriors, including the doctors and healthcare workers, are working excruciatingly hard for the welfare of the patients in this pandemic situation. But due to the increasing cases every day, the sole district hospital, SNM is short of medical staff. Nurses are working 9 to 10 hours per day without any leave or break. The threat of them catching the disease and infecting their own families also looms large over them, due to which the nurses work on 15 days shift basis in the COVID ward. They are shifted to isolation after 15 days of duty and relieved back home after getting tested. The story does not just end with this, health institutions are running with the help of NRHM employees who are working with a meager salary day and night. Many are working in the health department for the past 15 years and are waiting to get regularised. Some are hired during the COVID-19 pandemic and are serving the people with a salary of ₹ 15,000 per month.

“We are working as much as all other staff are doing and despite this our salary which is just 15000 per month is still pending from few months. We can’t raise much voice because we fear that we will get fired”, an NRHM employee said.

An admitted patient in the hospital said, “The healthcare workers are overloaded with work and are also facing lots of issues. I have seen myself nurses getting fainted due to overwork.”

Due to the manpower crisis, there are few attendants of COVID patients who are helping the hospital staff. Commissioner/Secretary, Health, Rigzin Samphel informed that 100 nurses each for Leh and Kargil will be outsourced to meet the crisis. 

Lack of facilities

Questions are also being raised about arrangements made for COVID patients at Mahabodhi COVID dedicated and SNM hospital. 

Along with shortages of healthcare workers, lack of proper heating facility at Mahabodhi hospital, common washrooms is also a concern. Common washrooms for the patient and attendant are increasing the risk of virus spread. There are patients at SNM hospital who are admitted to the hospital for the past month and are still waiting to get a negative report.

CEC, Hill Council, Leh directed concerned officers to ensure basic facilities like the heating system, running water, and other facilities in the Mahabodhi hospital.

On one hand, administration issues guidelines and SOP’s contain the spread of the virus but on the other hand there is no restriction, check and balance in a public gathering. An increasing number of private and public gatherings hosted by the administration, different organisation, and families are also one factor in surging COVID cases. The question is who has to blame?