NEW DELHI — Franklina Juel laughed as she spoke in a light-hearted manner about feeling “left out” the day 11 COVID-19 patients that she had cared for were discharged from the hospital she works in in Haryana.
The 25-year-old nurse from Bilaspur, Chhattisgarh, said, “The patients were there, the doctors were there, the media was there, but no one asked about the nurses. I thought the media would come and speak with us or at least take a pic of us. But no one did.”
“Even one pic would have been nice. I think people forget that it is the nurses that spend the most time with the patients,” she mused.
Juel is part of a team of 14 nurses who are looking after COVID-19 patients at the Medanta Hospital in Gurugram, where 14 infected Italians were being treated since 4 March and at least six Indians have been recently admitted.
In interviews with HuffPost India, five nurses from the private hospital — Juel from Chattisgarh, Shivani Tyagi from Uttar Pradesh, Shalu Tiwari and Shweta Kalia from New Delhi and their team leader Mariamma George from Kerala — described what’s its like to be at the frontline of the fight against the coronavirus infection, which has killed thousands of people across the world, and plunged India into an unprecedented lockdown.
The nurses spoke of the extraordinary circumstances in which they find themselves, working 12-14 hours in bulky Personal Protective Equipment (PPE), rationing masks, pleading with roommates who no longer want to live with them, and giving versions of the truth about their work to their families back home.
Not only have roommates in their PGs (Paying Guest accommodations) asked them to either leave or stop working with COVID-19 patients, the nurses say that even other hospital staff are wary of having them around.
As countries around the world deal with the pandemic, there have been many tragic stories of healthcare workers dying as they try to save the lives of their fellow citizens. Italy, which has suffered the highest death toll, has lost more than 50 doctors. Two doctors in the United Kingdom have died. In China, where the pandemic originated, over 3,300 healthcare workers had been infected by early March and 22 had died by the end of February. The death of a nurse at a New York City hospital, where nurses wear trash bags as protection, is being blamed on the lack of protective gear.
In India, the number of COVID-19 cases has crossed 1,000 and 27 people have died.
Like many other nations, some far more developed, India is facing an acute shortage of gear and equipment to protect its healthcare workers from contracting the virus. Doctors in government hospitals told HuffPost India that they were afraid of being “overwhelmed” by a rush of COVID-19 patients soon, even as they struggled to manage with the bare minimum in terms of equipment.
India’s health ministry tweeted on Monday that currently, only 3.34 lakh PPE coveralls are available in hospitals across the country. While the government has identified 11 domestic manufacturers and is expecting donations from abroad by next month, there are concerns that even this will not be enough to meet the demand across the country.
The Times of India reported on Monday that government hospitals that have requested more gear have been asked to wait about a month for delivery.
The situation in Medanta, a private hospital, was a little better in early March, said the nurses interviewed by HuffPost India, but now the N-95 masks they need for their protection are being rationed.
Sushila Kataria, the doctor at Medanta Hospital who is in charge of the coronavirus-infected patients—HuffPost India profiled her last week—said the health workers handling coronavirus patients are tested periodically, but the private facility was running out of the PPE, especially the N-95 masks. As a result, the hospital is planning to sterilise the masks and goggles and reuse them.
“Initially, we were very liberal, but now I have started rationing,” said Kataria. “PPE is a big, big challenge and we have to really ration it. Sending someone into the coronavirus ward without PPE is a suicidal mission.”
Sending someone into the coronavirus ward without PPE is a suicidal mission.
The nurses say they have no regrets about working with coronavirus patients and would continue doing so, but they expected the hospital authorities would provide them with the proper safety equipment.
Even a cough, headache or a slight fever can cause them to panic, the nurses said, but they have learnt to manage their fears and soldier on.
George, the 41-year-old team leader from Kerala, said she is happy to be working with the COVID-19 patients, and that her husband supports her work, but they can never stop worrying about her four children—the youngest is only three years old.
While the hospital has designated an area for the nurses to bathe and change before leaving work, George said that she phones her husband before heading back home so that he gets water ready for a second bath.
“He is always ready with the water. I end up having two baths,” she laughed. “We are being very very careful because of the children.”
We are being very very careful because of the children.
Getting the job done
The nurses that HuffPost India interviewed have helped treat 18 patients since 4 March, working 12-hour-long shifts. The nurses say their duties include giving injections and medicines to the patients, checking their vital signs, and helping them at all hours.
While wearing protective gear can mean the difference between staying healthy or getting sick, the nurses say it is extremely challenging to work long hours in goggles, gloves, shoe covers, a mask, a cap and a gown.
“You feel like your whole body is one fire,” said Kalia, the 21-year-old nurse from Delhi, who was deployed from the endocrinology department.
“It gets really hot and it is hard to breathe. You start to feel suffocated,”said Juel, the nurse from Chattisgarh, who was deployed from the bone marrow department.
You feel like your whole body is one fire.
However, there are some silver linings. Juel said that working through this crisis has convinced her that this is what she was born to do.
The problems she faces at her PG and the barbs from her roommate, she says, recede into the background when she thinks of the task at hand and how the coronavirus has brought the world to a standstill.
The gravity of these difficult times is not lost on her.
“I had always wanted to become a doctor, but I did not get the rank and I did not want to skip a year. I was unhappy for a while but now I’m feeling so proud to be a nurse and work in this life-threatening situation,” said Juel.
“The biggest thing for me right now is that I’m working with patients who other nurses and even doctors are afraid to work with,” she said. “I will remember these days all my life.”
“I feel very proud that I’m representing Chhattisgarh in combating COVID-19,” she added.
I feel very proud that I’m representing Chhattisgarh in combating COVID-19.
Shivani Tyagi, the 23-year-old nurse from Muzaffarnagar in UP, who was deployed from the cardiology department, said that she did not hesitate when her supervisor asked her to join the team being put together to treat the patients.
“No staff was ready to do it. My supervisor said, ‘Will you see them?’ I said, ‘Yes, ma’am. I will see them.’ Until corona goes away, I want to keep working in this field.”
Until corona goes away, I want to keep working in this field.
Shalu Tiwari, another 21-year-old nurse from Delhi, had only this to say when asked about her decision to work with the COVID-19 patients, and she put it matter-of-factly.
“I became a nurse to save lives. I did not think which patients I should treat and which ones not to,” said Tiwari. “Patients are all the same to me.”
I became a nurse to save lives. I did not think which patients I should treat and which ones not to.
When the Prime Minister’s Office (PMO) asked Medanta earlier this month to admit the 14 Italian patients, the hospital had scrambled to set up a facility to treat them. At the time, Kataria said, the government had given them 100 pieces of PPE, which lasted for just four days.
Most private hospitals are reluctant to admit coronavirus cases for two reasons. First, hospitals do not want to expose their facilities and staff to the contagious virus. Second, the presence of COVID-19 patients may scare away other patients.
Kataria said while the PMO had directed Medanta to treat the tourists, there was little or no hope of getting any more PPE from them.
On the news report that it would take 25 days for the government to provide the necessary gear to government hospitals, Kataria said “there can be nothing more shameful than this”.
“We consider at this time there is no difference the private and public hospitals. Everyone has to pitch in,” she said. “The government has to make it easier for us as well. Our hospital administration is doing everything possible to procure PPE at any cost. To get it made at any cost.”
The nurses that HuffPost India spoke with said they spend more time with patients than even the doctors and they are aware that their own lives depend on taking all the safety precautions including wearing the PPE.
That the N-95 masks have to be rationed or reused worries them.
The nurses expressed concern not only about their own safety, but that of the house-cleaning staff whose duties such as cleaning the beds of the infected patients and emptying the trash, making them even more vulnerable to the deadly virus.
Tyagi, the nurse from UP—she has a B.Com degree but her mother encouraged her to become a nurse—said that she was counting on the hospital to ensure her safety was not compromised.
“I’m not afraid because I’m taking precautions,” she said. “My mother also said that there is no problem taking care of the coronavirus patients, but you have to take care of yourself as well.”
The one thing that Juel says she was most touched by was how the Italian patients would always put on their masks when the nurses approached them.
“Even if it was two in the morning, they would say, ‘Please wait sister, let me put on my mask.’ To me, that showed they cared for our well-being as well,” she said.
My mother also said that there is no problem taking care of the coronavirus patients, but you have to take care of yourself as well.
The protocol when a patient who speaks a foreign language is admitted to Medanta is for the hospital to provide an interpreter, the nurses said. But in light of the contagious nature of the coronavirus infection as well as the limited protective gear, the doctors and nurses had to figure their way around the language barrier while interacting with the Italian patients.
The nurses said it was awkward for the first few days but it did not take them long to understand each other.
Laughing, Juel explained how the Italian patients and the Indian nurses would often use “Google Translate” to interact with each other.
“The Italian patients told us that they had never seen the medical staff interact with them as much as we did,” said Juel. “We knew they were sick and far away from home. We did not want them to feel lonely or depressed because that would hamper their recovery. We did our best to make them feel better.”
Juel said that she has learnt one Italian word — “Ciao,” which means “goodbye.”
To tell or not to tell
While the head nurse George has been able to speak freely with her family about her decision to work with the coronavirus patients, not all the younger nurses have found the words to tell their parents what they are doing or the problems they face with their roommates.
Juel said that she had told her brother and sister about her work, but concealed the details from her parents.
“My father is saying that I should come back because of the coronavirus. What he doesn’t know is that his daughter is working with the coronavirus patients,” she said. “As a responsible nurse, I have to do my work even if there is a risk to my life.”
As a responsible nurse, I have to do my work even if there is a risk to my life.
Most of their roommates — some of whom are young nurses like themselves — are also under pressure from their parents to not live with them.
“The situation is such that there will be some people who come forward to do the work while others will run away. I can’t run from my responsibility,” said Juel. “I do feel scared. But I’m doing this out of my own choice. We will see what happens.”
Kalia, the 21-year-old nurse from Delhi, said that she had not told her parents about her work with the COVID-19 patients.
“They will just get too worried and tell me to come home, but that is not the right way forward. If the doctors and nurses do not come forward then how will we fight coronavirus?” she said. “The sooner we fight, fewer people will be infected, fewer people will die, and we can try to end this crisis sooner rather than later.”
If the doctors and nurses do not come forward then how will we fight coronavirus?