The complex hospital admission protocols, overburdened health care system and travel restrictions amid the COVID-19 pandemic have only exacerbated the anxieties of Indians abroad.

The silhouette of a woman talking to her father in video call during the lockdownPicxy/Abir
Delve Health Wednesday, May 26, 2021 - 14:04

Maryam was in Qatar, nearly two thousand miles away from her maternal grandfather in Uttar Pradesh’s Prayagraj, as she was frantically trying to find a ventilator for him. Maryam’s 85-year-old grandfather had tested negative for coronavirus but his lungs suffered almost 80% damage. “For the medicines to work, we need the ventilator at the earliest,” she said on May 1. Sitting in their Doha residence along with her mother, she reached out to hospitals and organisations in Prayagraj as well as the neighbouring cities of Kanpur and Lucknow too, but in vain. She even unavailingly reached out to all organisations and helpline numbers that her friends in India suggested. The family did manage to find a hospital bed eventually, but it was too late. On May 5, Maryam’s grandfather passed away.

“I was contacting anyone and everything. But there is only so much one can do,” she said. Her mother, she said, is devastated. “My mother lost her mother also recently. She is shattered, especially during Eid. She was missing her father a lot as it was her first Eid without him,” said Maryam.

Over the past three months, hundreds of families in India have been helplessly running from pillar to post for hospital beds, oxygen cylinders and ambulances for their loved ones. For Indians living abroad, the enormity of their anxiety and the state of helplessness is unreckonable. Given the magnitude of the second wave of the pandemic, making numerous distressed calls, wiring money, waiting and praying are all they can do for their families back in India. Lack of clarity on the testing guidelines and the complex hospital admission protocols for patients exacerbate their trepidation. Some NRIs, including students, have had to make the hard choice of staying abroad, even in cases of deaths, amid the travel restrictions.

When family members are alone

Many non-Indian residents (NRIs) have parents and other family members living alone in India, with probably nobody to take them to the hospital and even arrange food. Some families, fortunately, have other family members to check up on each other. When Jyotsna’s parents were diagnosed with COVID-19, she coordinated from Singapore with her sister in Chennai to find medicines, labs for CT scan, oxygen concentrators and hospital beds. “It was a stressful period. There was not much I could do sitting in Singapore. All I could do was call hospitals and organisations. Fortunately, we have strong familial support in Chennai,” said Jyotsna, whose parents recovered, thanks to the timely coordination.

But what happens when all members of the family in India fall ill at the same time? Irwin, who resides in Australia, was in a quandary when his 93-year-old mother, sister (68) and brother-in-law (72) in Pallavaram, Tamil Nadu, took ill. “They fell ill suddenly. Assuming it was viral fever, they started taking medicines after consulting with a doctor. A relative would leave food for them at their doorstep. However, as their condition got worse, they could not get up, even to take the food kept outside. Dogs were eating the food,” Irwin told TNM.

“I was frantically making calls but nobody was willing to go see them. I reached out to volunteer organisations but did not receive assuring responses. I didn’t know which side to turn,” he said.

With the help of some friends, Irwin finally managed to get COVID-19 testing done at their Pallavaram home. However, it only increased his anxiety. “We did not get the test results. The staff at the government testing lab said if we did not receive the test result, it meant they do not have COVID-19; that was supposedly their policy. But my family members were showing all symptoms of COVID-19,” he said. Without a COVID-19 report, finding a hospital or ambulance is a challenge.

“My sister told me they won’t survive,” said Irwin. “That is my whole family in India. I felt helpless as there was nothing more I could do.” On May 16, just when Irwin was losing hope, his friend connected him to a volunteer, who helped Irwin find an ambulance for the family, do CT scans and even get them admitted to hospitals. “I could not speak to my mother when she fell ill. I finally spoke to her two days after she was admitted,” said Irwin.

Grieving, miles away from home

Shravanti, a student in the US, spoke to TNM on behalf of her friend who lost his father recently. Like many US-based Indians, her friend, too, feared he won’t be allowed to fly back into the United States due to the travel ban in view of the ‘double mutation’ variant first detected in India.

Shravanti coordinated to get a hospital bed for her friend’s 62-year-old father in India. He did not have COVID-19, but urinary infection and prostate issues that culminated in sudden kidney problems. Yet, he could not get hospital admission without a COVID-19 test, which did not come on time. Unfortunately, he passed away on May 6 due to the delay in getting medical treatment. Incidentally, two days later, on May 8, the Indian government announced that a COVID-19 test report is not mandatory for admission to a health facility and no patient would be refused services.

“I don’t think he (her friend) has fully processed it yet, for him to have a conversation about his father. Fortunately, his sister and brother-in-law are with his mother in Bengaluru to offer support. Until May, his father had been completely fine. Had it not been for the pandemic, he would have been treated and back home safe,” said Shravanti, who lost her grandmother to COVID-19 a week before the death of her friend’s father.

Frequent calls to parents in India

Some Indians abroad have found themselves checking up on their parents frequently, which was affecting their health too. For instance, by April-end, New York-based Shruti Kedia said her sleep cycle was awry. “I started waking up at 2.45-3 am to check if there were any updates or messages on the family WhatsApp group. When seven out of 15 members in my house got COVID-19, I was checking every few hours if everything is fine. I have to get an update from my parents in Bengaluru and in-laws, who are doctors in Delhi, once a day,” said Shruti, adding, “Parents and families in India are trying to hide the situation because they don't want to scare us or get us worried.”

Navigating the complex system

For Australia-based Irwin, the whole process of getting his family in Tamil Nadu tested for COVID-19 and finding a hospital took 10 to 14 days. “Is this what we get when we leave our country? Do our own people need to suffer like this? The Indian government needs to strengthen and spend more on the health care system,” he said.

“The health system is overburdened with COVID-19, understandably, but it leaves little room for other emergencies to be prioritised,” said Shravanti. “We were trying to find a nephrologist in Bengaluru but that seemed difficult because they were all on COVID-19 duty.” 

While they appreciated the doctors for their service amid the crisis, the NRIs noted that the trouble would start when they were asked to get medicines and other equipment. Although Jyotsna was able to ensure her parents are safe, what upset her was the lack of organisation. “The doctors were stretched beyond human capacity, handling hundreds of patients. They were doing everything they could, and informed us about the course of treatment. But when they sent us to get medicines, it felt like we were blindfolded and sent on a treasure hunt. Where do we find remdesivir or an oxygen concentrator, especially on weekends?” 

A system to help NRI families

When the second wave of COVID-19 infections precipitated a new health crisis, and medical professionals shifted into overdrive, individuals and organisations volunteered to help patients find resources, hospitals with beds, and source medicines. Lists of numbers and websites shared on social media platforms significantly helped NRIs, although some numbers were either invalid or not reachable on time.

In Irwin’s case, where his entire family took ill and did not have an immediate family member to step in, volunteers had to double as attenders. Sunny Natrajan, a volunteer with Chennai COVID Angels (a group that provides assistance to those affected by COVID-19), and Sangeeta Isvaran, prominent Bharatnatyam dancer and social activist, helped Irwin’s family get treatment in time. For both volunteers, who have been helping families connect to resources, Irwin’s case was an eye-opener.

“Patients can get lost in the system if there is nobody to accompany them, especially to contact them in case of an emergency. As volunteers, we assumed we could take Irwin’s family members to a triage centre and then the government’s health care system will take over. Both ambulance drivers and doctors, however, insisted we stay back with the patients through every process. Though the Tamil Nadu government has said no attenders are allowed in COVID-19 wards, the doctors said they were overburdened,” Sunny recalled.

Read: Who gets to live? COVID-19 is causing moral distress among India’s doctors

From scanning centres to hospitals, both Sunny and Sangeeta stood by the three family members until they were finally admitted. “That is when we thought about this scenario involving NRIs — what happens to patients if nobody is around.”     

Sunny said they have identified agencies that provide nursing care and attenders for patients who are alone. It would cost about Rs 4,000 for an attender, which is a viable option for families who have the financial means, he said. Some NRI families arrange a driver to take their parents to a hospital and set up teleconsulting access to doctors. Many COVID-19 Care Centres and luxury hotels also offer quarantine services, including beds and medical care, albeit for patients with mild or no symptoms. However, what happens to NRI families who do not have the financial means to access such facilities, especially when the family member(s) has severe symptoms.

“There must be a helpline number where NRIs can contact and seek help. Even their neighbours in India can call this number if the family/individual’s children are abroad,” said Sangeeta, who did not find most of the government helpline numbers resourceful. “None of the municipal officials’ numbers were reachable. The 104 helpline officials said they only provided information on oxygen and bed, and not attender,” she said, explaining why there should be a system for such instances. “No official in the system knows what to do. As volunteers, we are still gathering information. In case of any misfortune, families would probably blame volunteers,” she pointed out, reiterating that the government should provide the physical ground support for such families.

On May 22, Mangaluru City Commissioner N Shashikumar launched the Samanvaya (Mangalore police with NRIs) initiative to provide help to NRIs and the Indian diaspora of Mangalore origin with COVID-19 problems that their relatives and friends staying in Dakshina Kannada face. “We have a WhatsApp group of volunteers and organisations working in a range of areas, including providing food, finding oxygen cylinders and beds and ambulance and telemedicine services. When we started receiving inquiry calls from NRIs for their families in Dakshina Kannada, we decided to open the lines for NRIs too,” Shashikumar told TNM.

NRIs can call the helpline number (+91 9480802300) via calls, SMS, WhatsApp voice and video messages to share their concerns for COVID-19 related queries. The Samanvaya COVID-19 coordination group will attend to their needs. “Although residents in the district also call this number, we maintain a separate register for NRIs. Among the several calls from NRIs, eight calls were seeking intervention to provide food and ambulance services,” said Shashikumar.

Apart from raising funds and sending oxygen concentrators and resources to India, NRIs are also helping each other. Shruti, for example, said she has been trying to coordinate for verified leads in India by calling the number of lists and sharing them with friends who need them for their families in India. "I also donated money to a cafe that provides food for frontline workers in Bengaluru, and urge everyone to do so,” Shruti said. “I came to the US and got access to all health facilities, including the COVID-19 vaccine. If we are not present in India, the least we can do is make calls.”

Read: How US-based Indian students are joining hands to help India in its COVID-19 fight

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