Inside the Covid-19 ward of Pune’s Sassoon General Hospital

At 5.30 am, Rajshree Kanade, 52, wakes up in her hotel room, gets ready, and has breakfast. By 7.30 am, a special bus, organised by the Pune municipal corporation, deposits her at Sassoon General Hospital, where she walks into a newly constructed 11-storey building.

Rajshree dons personal protective equipment and thus begins her workday in the hospital’s Covid-19 ward.

Summer is coming, and the temperature in Pune is already heading towards 40°C. There’s no air conditioning in the wards, and the full-body PPE kits add an extra level of discomfort. For the next six or seven hours, Rajshree will not eat or drink anything, even water, or use the bathroom.

Rajshree is one of millions of healthcare workers fighting India’s battle against the coronavirus pandemic. Newslaundry spoke to several of them – from doctors to morgue assistants – at Sassoon General Hospital, Maharashtra’s largest state-run hospital, to understand how Covid-19 has impacted their lives.

Rajshree works in the ICU designated for Covid-19 patients, on the seventh floor of the building.

Since April 13, Rajshree and 64 other nurses, who work in the Covid-19 ward, have been staying in a hotel, on the instruction of the district administration, to prevent them from transmitting the virus to their families. Doctors and ward boys have also been put up in hotels.

Rajshree’s day starts with wearing her PPE kit. “It takes about 10 minutes,” she said. “After taking over from the nurse in charge of night duty, I start the day with a song and prayer in the ward.”

The song, sung by all the nurses on duty, is “Itni shakti hamein dena data”, followed by a Marathi prayer asking for God's blessings to give strength to patients for their recovery. “We conduct the prayer to boost the morale of the patients,” Rajshree said.

Rajshree then changes bedsheets, asks patients to bathe, and serves them breakfast. “We make sure they finish their breakfast. Then we provide them with medicines and stand there until the patient swallows the pill,” she said. “Our other work then starts: giving injections, sponging, suctioning. From putting a patient on a saline drip to assisting doctors with putting patients on ventilators, we work on everything.”

Why doesn’t she eat food or drink water during her six-hour shift? “Once I have donned the PPE kit, I don’t drink water to avoid using the bathroom. It doesn’t matter how thirsty I am, I drink water only after the doffing procedure,” she said, referring to the removal of the PPE kit.

The hospital has arranged for nurses to take baths after their shifts end on the seventh floor. They then return to their hotel in the corporation bus.

Rajshree’s two decades of experience helps in dealing with the lack of air conditioning in the ward.

“It is suffocating inside the PPE kit and we are drenched in sweat. But it has been 27 years in this job now which helps me deal with it,” she said. “Once I am in the ward, nothing else comes to my mind, except my work.”

Rajshree said it helps that her family is “very supportive”. “My husband, two sons, and daughter-in-law worry about me but they always encourage me to do my work. My husband tells me I should take care of myself, only then will I be able to take good care of my patients.”

Sassoon is one of 16 hospitals in Pune handling Covid-19 cases. Until April 20, at least 1,215 patients were admitted to Sassoon’s Covid-19 ward, of which 1,019 were discharged. About 155 patients remain, including 107 positive cases of coronavirus. Nine of the patients are in critical condition, and 41 have died.

Until April 20, Pune district has seen 756 cases of coronavirus.

The availability of PPE kits has become a global problem for healthcare workers on the frontlines. The situation is no different in Sassoon: a resident doctor told Newslaundry the government gave the hospital only 200 kits, and they aren’t reusable. However, personal donations have filled the gap, so the staff haven’t faced a shortage yet.

There have been increasing reports of healthcare workers in the city testing positive. Nineteen nurses and six other healthcare workers have tested positive at Ruby Hall Clinic over the last 15 days. In Sassoon, three nurses, one doctor, and two other workers have tested positive so far.

Naval Kishore Ram, the Pune collector, said: "Sassoon is a very old and capable organisation. Doctors, nurses and other healthcare workers are doing a good job. They should strive harder to maintain it, and the adminstration is there to support them."

‘If something happens to me, who will take care of my family?’

It’s been 14 days since Prajakta Prajose saw her three-year-old son. A nurse at Sassoon General Hospital, Prajakta works the afternoon shift in the Covid-19 ward, from 2 pm to 8 pm. Like Rajshree, she’s been staying in a hotel to protect her family from infection.

Prajakta currently works a six-hour shift, though she worked nearly 10 hours a day in the first few days of the coronavirus outbreak.

“You cannot imagine how it feels in a PPE kit for 10 hours,” she said. “We could not drink water. Such is the sweating that the sweat would go into my mouth and you can’t even wipe it with your hands. On my first day, I did not think I would make it. But gradually, I got used to it.”

Some of the healthcare workers developed rashes and blisters on their bodies in reaction, Prajakta said. “It is tough, but that is what I am supposed to do as a health worker. Patients come first,” she said. “Many of them feel depressed and lonely as they can’t see their families, so we talk to them to boost their morale. It’s very important to keep their morale high as it keeps them motivated.”

She added that the “negative attitude” towards healthcare workers and Covid-19 patients needs to change if we want to “win against the pandemic”.

Outside one of the hospital’s buildings, Raju Chavan and Ravindra Chavan sit on a platform. They work as morgue assistants and are anxious: today is the first day they have to shift the body of a patient who has died of Covid-19. With their faces covered with masks, they said they have carried thousands of dead bodies before, but this time it’s different.

“The body is getting sprayed now and will be ready to be shifted to the morgue in sometime. We are waiting for the call from inside,” said Raju, 59. “We will be given PPE kits before carrying the body. Although we will be fully protected, a sense of worry still prevails.”

Unlike the nurses, Raju and Ravindra haven’t been put up in a hotel by the hospital. “I live with my family,” Raju told Newslaundry. “The disease is highly contagious. My only concern is that they shouldn’t be affected because of me.”

Ravindra, 40, is a contract employee. He’s worried about his family. “My job is to shift the dead bodies from ward to morgue,” he explained. “I have not been given any insurance. If something happens to me, who will take care of my family? Despite that, it’s my duty to complete whatever task I have been assigned. Maybe someday I will become permanent.”

‘We have to motivate our nurses’

Some of the nurses who don’t work in Sassoon’s Covid-19 ward continue to live in a hostel about 15 metres away from where Raju and Ravindra sat. About eight or 10 nurses stand outside, maintaining a gap of 10 feet from each other, while a male nurse distributes hydroxychloroquine tablets, which they take as a preventive medicine.

Three nurses at Sassoon General Hospital tested positive for coronavirus a few days ago. All three had been on Covid-19 duty for about a month and lived in the hostel.

“Ideally, they should have been kept on duty in the Covid-19 ward only for seven days, and then sent for quarantine to a hotel,” said a nurse, on the condition of anonymity. “But they were made to work for almost a month. They were living in hostels with the others, and no arrangement was made for them in hotels. Imagine working for a month wearing the PPE kit continuously.”

However, Rajashree Korke, the head of the nursing staff at Sassoon, told Newslaundry: “Nothing of the sort happened here. We are taking adequate care in these matters. It’s a rule that a healthcare worker should not be kept on Covid-19 duty for more than seven days. On the fifth day itself, a swab is taken from the worker. We get the results within 10 hours. If they test positive for coronavirus, they are shifted to a Covid-19 ward designated for healthcare workers.”

She added: “Lots of things are going on. We are doing our best to deal with this pandemic.”

According to Korke, there are 1,100 nurses in Sassoon General Hospital. Eight hundred more have been trained since January to deal with Covid-19. “Working continuously drains them and we have to keep motivating our nurses,” she said. “They have been trained on precautionary measures, taking care of suspected or isolated patients, treating patients on ventilators, critical care nursing, how to operate ventilators, donning and doffing of PPE kits.”

A resident doctor who works in the Covid-19 ward told Newslaundry that the decision to designate Sassoon as a Covid-19 hospital was “taken abruptly”.

“Our manpower is low, our duty schedules are not fixed, our routine operation theatres and outpatient departments are still going on,” the doctor said, on the condition of anonymity. “Although very few patients come in, we still have to attend to them. Due to this, the manpower gets distributed.”

The doctor continued, “Because of less manpower, doctors on Covid-19 duty have to work more. We have a scheduled duty of eight hours, but we are sometimes asked to report back to duty after a break of four or five hours.”

Sometimes, the doctor added, doctors assigned to non-coronavirus duties are called to work in the Covid-19 ward.

As a result, the doctor said, doctors on duty get less time off. “Residency means long working hours, but what makes this tougher is the PPE kits. I have been working in the Covid-19 ICU for the past one week. I don’t drink or eat anything at least 1.5 hours before reporting for duty. After my duty, I go through the doffing procedure, take a bath in the hospital, and then go back to my hotel. It’s very tiring.”

This doctor is not afraid of the infection “because we deal with infectious diseases on a regular basis at the hospital”. “But yes, this routine drains us physically.”

Healthcare workers are putting themselves at risk every day to battle the Covid-19 pandemic. We need to hear their voices and we need to support the journalists who tell their stories. Subscribe to Newslaundry and pay to keep news free.