'Not worth the risk': Why a junior doctor in Delhi quit her job at a makeshift Covid-19 facility

On May 2, the Central government decided to postpone entrance exams to postgraduate medical courses by four months to encourage recently graduated medical students to take up Covid-19 duties in hospitals.

The next day, Guru Teg Bahadur Hospital, which is run by the Delhi government, announced it was looking to hire 146 junior doctors to work at a 500-bedded makeshift facility at Ramleela ground. It said the junior doctors would be hired on a contract for “short term and emergent basis initially for 89 days”.

Delhi had witnessed a tsunami of Covid-19 in April that had overburdened its health systems, with patients dying at home and hospital lobbies, as they were unable to find vacant beds. To ramp up capacity, Delhi government had started setting up makeshift facilities, but it also needed an additional number of doctors and healthcare workers to run them.

A 23-year old medical graduate in Delhi, who did not wish to be identified, decided to apply for the job. “The whole year has been so overwhelming for healthcare workers,” said the doctor who had graduated in January from Maulana Azad Medical College. “Without any doubt, the one sentiment that took over was to actively participate in this war against the virus and help alleviate the burden of others.”

She was called for a walk-in interview on May 9, which barely lasted a few minutes. She was informed on the spot that she had been selected for the job that would pay her Rs 6,000 for every eight-hour shift. Along with her, 136 doctors were hired.

But barely ten days into their service, on May 23, Guru Teg Bahadur hospital terminated the contracts of 31 junior resident doctors without stating any reasons. The enraged doctors questioned their summary dismissal, made without any prior warning.

“We received a message on our WhatApp group that our duties were being disengaged,” said a 26-year-old junior doctor. “We are also doctors and we are also humans. Why did they hire us if they had to kick us out?”

On May 27, after public outrage over the dismissal of the doctors, the hospital issued another order – this time, keeping the previous order in “abeyance”. Scroll.in asked the hospital’s medical director and Delhi government’s nodal officer for the facility over email about the reasons for the abrupt sacking – and reinstatement – of the doctors. This article will be updated if they respond.

But while others had been asked to leave, the 23-year-old junior resident doctor chose to quit on her own terms, merely four days after taking up the job. Her experience suggests the hospital’s callousness towards health workers extended beyond the abrupt dismissals of the junior doctors.

‘Risking our lives’

The 23-year-old junior doctor’s first day at work was on May 14. The makeshift facility had eight patients admitted. The work on her eight-hour shift was not particularly strenuous, she recalled.

But, she noticed that the donning and doffing area – separate spaces where health workers put on or safely remove their PPE kits and other protective gear – had no partitions. Instead, the area was placed in front of a door through which medical personnel, administrative staff and patients went in and out, she said.

“So while someone is doffing, simultaneously in that area, someone is donning and that makes no sense because while someone is taking the virus off, someone else is taking it in the same room,” said the doctor.

Worse, the PPE kits were substandard, she claimed. “I would sweat and within 20 minutes the sweat would drip from the kit and that is how I know it is substandard,” she said. “Most healthcare workers are not aware of this.”

The kits tore easily and came only in one size enough to fit a person who is five feet and two inches tall. Those who could not fit into the kit, used polythene to wrap themselves, she said. “I am five foot four, and I just managed to fit into it. I do not know how the men managed because they are much taller.”

The doctor was concerned about the lack of protection from the PPE kits – she lived with her elderly parents in Central Delhi, and didn’t want to take the virus back home with her.

But while junior doctors were given substandard PPE kits, nurses, who spend longer time with the patients, weren’t given any at all – they worked in their scrubs, the doctor alleged. There were no soaps and hand sanitisers at the facility, no disposable cups for staff to drink water from, and out of the four washrooms, at least two did not have a functional flush, she claimed.

“It was like an architectural plan just laid out but nothing was functional,” she said.

Seeing the conditions at the facility, the doctor sent an email to authorities at Guru Teg Bahadur Hospital, detailing the shortcomings in the safety precautions for health workers.

“We are all risking our lives, and without any quarantine facility, we are falling back home daily, thereby risking the lives of our aged parents and society too,” she said in the email sent on May 15.

Two days later, she received a call from a consultant working as a senior resident at the facility, who gave her an ultimatum: “He said that I either join back with the immediate effect in the condition the centre is in or send my resignation.”

On May 18, she resigned after grievances were not addressed. “Their inability to comply with the WHO [World Health Organisation] standard made me discontinue,” she said. “I was told by the consultant that the facility would remain in the same condition.”

Questions emailed to the hospital authorities about the doctor’s allegations went unanswered.

Before she joined the facility at GTB hospital, the junior doctor had spent the whole of last year as an intern at another hospital run by the Delhi government – the Lok Nayak Jai Prakash Narayan Hospital.

The hospital was among the first to be turned into a dedicated Covid-19 facility during the nationwide lockdown in March 2020. “We were the first batch to see the change in the hospital being taken over by the pandemic,” she said.

Earlier interns would get more hands-on experience like surgical procedures and intubation, but this mostly came to a halt after the pandemic. “Our hospital was protective of interns, they did not want us to jump into the red zone,” the 23-year-old said, referring to the area housing the Covid-19 wards and ICU units. Her work as an intern was limited to handling files of patients, or arranging for blood. But she had learnt how to safely don and doff her PPE kit.

“That is how when I came to the facility, I knew what was the proper procedure for donning and doffing,” she said. “They [LNJP] followed the entire guidelines on this. They have a thick wall separating both areas.”

But the facilities at the GTB centre and the lack of response from authorities about improving them did not encourage her to stay on. “I really wanted to learn more but taking such a huge personal risk was not worth it,” she said.

It has been weeks since she resigned, and she has started to prepare for her postgraduate exams. But she is yet to receive her remuneration for completing one shift. “I asked the consultants about this but even they do not know whom I should address this with,” she said.

Shock dismissals

The 26-year-old junior resident, among those who was dismissed on May 23, narrated similar experiences – of having to use low grade PPE kits and reusing N95 masks because the facility did not have enough.

But she decided to stay on, despite frequent and erratic change in her shift timings, the long travel in a cab from South Delhi to the facility everyday, and the risk of infecting her parents with whom she lived. “To get exposure related to this field,” she said.

Some doctors had demanded their salaries be doubled for the night shift, which ran for 12 to 14 hours, but she was not one of them. She has no idea why she was disengaged on May 23. She pointed that in the offer letter issued by the hospital, it was stated that doctors could be disengaged at any point. The hospital “reserves the right to disengage your service without assigning any reason or giving notice,” the letter states.

For four days, the 26-year-old doctor stayed at home, clueless about what to do next. There was no one to answer her questions about her salary and reimbursements. Then, on May 27, the order halting the disengagement of the 31 doctors came in. Three days later, she rejoined work, along with the others who had been dismissed. This time, there was a pleasant surprise waiting for them.

“I noticed they have looked after our complaints about the PPEs and mask,” she said. “It is much better for us to work here now.”