Biases in healthcare at the time of Covid
The pandemic has, no doubt, complicated an already-taxed healthcare system
In an unthinkable turn of events, a woman in Kerala, India, lost her twin babies earlier this week after being turned away by multiple hospitals for lack of a Covid-negative certificate. Shahala, who was nine months pregnant, had contracted the virus on September 5, but recovered in two weeks and was issued a negative antigen report. On the morning of September 26, the 20-year-old went into labour, but was repeatedly denied admission by hospitals that either insisted on an RT-PCR result, didn't have a gynaecologist available, or was only accepting Covid-positive patients. She was finally admitted - 14 hours later - at Kozhikode Medical College, where she underwent a C-section, but doctors were unable to save the twins' lives.
The case has reportedly sparked angry protests by locals, and state health minister K. K. Shailaja - who called the incident extremely distressing - has asked for a probe into the matter. Perhaps, what is particularly shocking is that the incident occurred in Kerala, a state that has been lionised in recent months - even in international press - for its exemplary response to the pandemic. This was not a solitary case either. In July this year, Vijayan, a 65-year-old security guard complaining of high fever and breathlessness also died after district hospital authorities failed to provide prompt treatment; the hospital blamed the delay on Covid-19 protocols.
The pandemic has, no doubt, complicated an already-taxed healthcare system. However, in recent months, multiple Indian states have issued guidelines as well as warned hospitals of dire consequences if patients are denied emergency care on account of Covid - including Kerala. So, it is not for lack of policy direction that patients in urgent need of care are being turned away. If anything, Saturday's incident has turned the spotlight back on demanding a more human rights-based approach to emergency healthcare.
Despite having a doctor declare her unfit to be discharged in her state, Shahala was still referred to a different hospital. Despite the state government confirming in August that an antigen test would be acceptable in case of emergencies, officials at a third hospital insisted on a Covid-negative RT-PCR result over the antigen result that her husband presented. In Vijayan's case, authorities were reportedly unwilling to even take him out of the ambulance, where he eventually died.
Estimations cited in a World Health Organization bulletin last year suggest that emergency care could address 54 to 90 per cent of deaths in low- and middle-income countries. Those are astounding figures. ER is often the last chance for the healthcare system to save a life. That's why, all over the world, legal policies mandate that hospitals administer care - without discrimination and regardless of whether patients are insured or can afford the treatment - in critical situations. But without tasking authorities to ensure effective implementation, these laws are about as potent as placebos.
It is one thing to bemoan the lack of access to quality healthcare in rural or underdeveloped parts of the world, but to be complicit in preventable tragedies such as these is nothing short of criminal. If countries are serious about ensuring "healthy lives and well-being for all at all ages" (UN Sustainable Development Goal #3), establishing a comprehensive and rights-based emergency care system will need to be at the heart of that plan. Even one life lost - under these circumstances - is one life too many.
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