Why the survivors of India’s brutal second Covid wave are left with crippling debt

As Harishchandra Dhaware, a small-town journalist from India’s heartland, was being wheeled into the intensive care unit in March this year, his wails filled the corridor — “Don’t take me to ICU. If I am to die, I want to die at home. How will you afford this? Don’t spend so much on me.”

“I can see the day in front of my eyes. He kept hitting himself in the face and wailing as they put him on a stretcher and took him away,” his wife, Jayashri, says as she recounts to The Independent one of the last memories she has of her husband.

Dhaware, 48, died inside the ICU of a private hospital in Solapur, Maharashtra, on 6 April after a 15-day battle with Covid, combined with mucormycosis, or black fungus, that damaged his eyes and kidneys and caused memory loss.

The last lucid moment for the journalist from Osmanabad, who worked for a local Marathi newspaper and earned about Rs 4,000 (£39) a month, was consumed by worry that his illness would push his family into poverty. Jayashri says the day her husband died, his blood-sugar level was 1,000 milligrams per decilitre (mg/dL). Post-meal blood-sugar levels of less than 140 mg/dL are considered normal.

The hospital handed them a bill of approximately Rs 400,000. By then, Jayashri had already sold off her gold jewellery and taken loans amounting to Rs 400,000 from relatives to meet the earlier costs of hospitalisation and treatment.

The small salon service she ran from her home was badly hit as a result of the pandemic. A grocery store the family also operated out of their house was barely making enough for them to survive. Jayashri, her ageing mother who lives with them, and her teenage daughter have not had a moment to properly grieve Dhaware in the midst of their financial crisis.

It is a fate they share with millions of others during the brutal second wave of the pandemic in India – those who find themselves battling not just deadly illnesses but also Covid-induced poverty from exorbitant hospital bills and rising unemployment after more than a year of intermittent lockdowns.

Swati Gaikwad, 23, from Chivari village in Tuljapur, Osmanabad, was to get married on 25 April. The family had been saving up for months and she had come home from the city of Pune, Maharashtra, where she works as a nurse, to help with the preparations. But the wedding had to be postponed when her mother, Laxmibai, fell sick with Covid. On 13 May, when her condition worsened, Gaikwad did everything she could to get her a bed at any hospital. Finally they ended up at Chirayu, a private hospital, and were overjoyed when she was granted admission.

But it came with a price — a bill for Rs 200,000.

“I put in the money I had saved for my wedding,” Gaikwad tells The Independent. “In addition, I took out a loan of Rs 70,000 from a local lender,” she says. Her father makes a living working in other people’s fields, has no land of his own, and many mouths to feed. Gaikwad says she was able to pay the hospital fees, but her wedding has been pushed back, and her mother, who was discharged after 15 days, awaits further treatment that is sure to cost more money.

“Most people in the villages aren’t even going to hospitals for fear of bankruptcy. People sometimes have to take a mortgage on their house to be able to afford treatment,” she says.

Treatment at government hospitals in India is free of charge. However, the deadly second wave has left almost all public hospitals bursting at the seams, forcing patients to seek private medical care for the severely ill. During its peak, most hospitals across India reported an acute shortage of oxygen that forced families of critical patients to buy oxygen tanks on the black market, sometime paying almost 10 times the usual price, deepening their financial difficulties.

Parth MN, a journalist covering rural Maharashtra, says he was at the office of a senior police official in May and witnessed anguished complaints by a family member of a Covid-19 patient who had died by suicide at a private hospital in Beed district.

News reports said the man, a sugarcane cutter, was worried about an outstanding bill of Rs 100,000 at the hospital despite assurances by his family that they would manage to find the money. “Sugarcane cutters toil for about six months and make around Rs 60,000-70,000. He took his life because of the worry that his family wouldn’t be able to arrange the money,” Parth says.

Although Covid-induced urban poverty is somewhat trackable, stories of financial crisis from rural India are largely underreported. A 54-year-old Covid patient in Hyderabad, Telangana, who was allegedly told by the hospital that he would only be discharged after clearing his dues, died by suicide on 29 May.

A Chandigarh-based father, 73, who lost both his sons to Covid within 14 days of each other, was handed a bill of Rs 3m.

“This is a calamity and these private hospitals are just cashing in on the situation. They don’t know exactly what is to be done and are just charging money from innocent patients by asking them for injections, which we don’t even know are being used or not,” he told The New Indian Express.

India’s Supreme Court said in December that tackling Covid was akin to “fighting a world war” and insisted that states cap the daily charges in private facilities. It ruled that the “right to health included affordable treatment”.

In June last year, the country’s Ministry of Home Affairs capped the daily treatment charges for Covid-19 patients in private hospitals in the national capital, Delhi, at Rs 8,000-10,000 per day for an isolation bed, Rs 13,000-15,000 for ICU without ventilator support, and Rs 15,000-18,000 for ICU with ventilators. However, patients have complained that private hospitals have still found ways to overcharge patients.

As the disease progressed and hospitals ran out of beds, desperate appeals for oxygen cylinders, ICU beds, ventilators and essential medicines flooded Twitter and Facebook.

Pushed to bankruptcy, many people in urban areas sought to crowdfund medical costs, putting up scanned copies of their hospital bills, with desperate appeals on platforms such as Ketto and Milaap.

“Salaried people who had exhausted all their savings resorted to crowdfunding as the second wave hit,” says Mamta Jaiswal, official spokesperson for Ketto.

The platform says it hosted over 1,200 Covid relief campaigns from March 2020 to the end of April 2021, with more than Rs 3bn raised. Then the second wave hit, bringing with it a “surge” of new fundraisers as the public healthcare system collapsed, Jaiswal says. The platform has hosted 4,000 Covid-related campaigns since 20 April, of which 30 per cent are oxygen-related and 70 per cent for hospitalisation or medicines.

The focus of most appeals on social media has now shifted to finding financial support for devastated families who in many instances have lost their only bread-winner. The federal government recently announced that they would provide pensions to such families, but there is typically a lag in providing this kind of relief on the ground in a country as big as India.

“If  you go by healthcare standards in the world, the kind of medical care that is being provided in the good hospitals of India is at par with the world. But the cost would be a big factor. For the quality of healthcare we provide, India is one of the cheapest countries, but even that is too much for most Indians,” says Dipshikha Ghosh, a doctor at Apollo, one of India’s largest chains of private hospitals.

“People who are not supported by their companies will never be able to afford corporate hospitals. Because the cost is so high that even if they sell off everything they will not be able to cover it,” says Ghosh.

As a critical-care physician, she routinely sees patients with gruesome injuries coming into the emergency department needing immediate hospitalisation – but not necessarily having the means to pay for it. Often, kindhearted doctors find ways to help those in desperate need of medicines, sometimes in the form of donating to the needy the free medicine samples they receive from medical representatives, or by either discounting or forgoing their service fees, she says.

Experts warn that a third wave of the pandemic will leave the already struggling rural economy devastated, and that not enough is being done to avert it. In his speech on 14 May, India’s prime minister, Narendra Modi, asked “farmers and brothers and sisters living in villages” to remain alert. “This pandemic is spreading fast in rural villages,” he said.

And while he urged them to take precautions, the reality on the ground tells another story. In most states, the Primary Health Centres – often the first and only facilities within the reach of rural populations – are understocked and in bad shape, compelling villagers to take critical-care patients to distant towns and cities for treatment and tests.

In October 2020, a World Bank report estimated that the “pandemic and global recession may cause over 1.4 per cent of the world’s population to fall into extreme poverty”. A Pew Research Centre analysis in March 2020 found that the middle class in India “is estimated to have shrunk by 32 million as a consequence of the downturn, compared with the number it may have reached [without] the pandemic”.

The Centre for Monitoring Indian Economy says that unemployment in India has soared into double digits, hitting almost 15 per cent in late May. And while most states are starting to ease their second-wave lockdowns, the situation is likely to get worse before it gets better.

India still has about 1.7 million active Covid cases and is adding thousands each day to its total death toll of more than 370,000. Experts say the true number of the dead is almost certainly far higher.