I have been acquainted with asthma since the age of four, and the thought of not being able to breathe has a very real power to frighten me. So, when the second wave came and brought with it a raging oxygen shortage, I had a minor ‘what-if’ moment. It made me call a friend with connections to doctors to ask if it made sense to keep an oxygen cylinder at home as a precaution. Her sources said there was no shortage yet in Chennai, which sounded reassuring, and I killed the thought.
It’s significant that I had wanted, momentarily, to ‘hoard’ an oxygen cylinder when I had resisted through the past year the idea of hoarding anything, whether masks, sanitisers, groceries or medicines. Clearly, a tiny window of fear had opened fleetingly, a window that many among us don’t shut, or don’t know how to, or don’t see why it should be shut.
The episode led me to think about the concept of medical triage, and how ignorant we are about it, despite its life-saving potential. The dictionary defines it as “the assignment of degrees of urgency to illnesses to decide the order of treatment, when both patients and casualties are large”. A pandemic is exactly when triage should kick in. Unfortunately, that’s exactly when we throw it to the winds and enter into a sort of wild race to corner resources for ourselves and our families.
The word triage comes from the French trier , to sift, select, sort out, and medical triage was invented by Dominique Jean Larrey during the Napoleonic Wars to prioritise which of the wounded would get treatment first, depending purely on the gravity of injuries, disregarding rank and other considerations. The format saved many lives during disasters, when resources and personnel are limited, and was soon widely adopted.
Zoom in to India. Even during a pandemic, many hospital beds, both public and private, are kept vacant “in case” a minister or industrialist might need one. Filmstars and sportspeople with the mildest symptoms are given prompt hospital admission. In an absurd reversal of triage, serious but uninfluential patients get pushed back to accommodate the influential.
As with everything else, medical resources in India are distributed according to power and pelf, on ‘who you know’. Even in a catastrophe, hospitals dare not declare that patients will be prioritised purely by medical urgency and nothing else because that would horrify the privileged. Ideas of prestige and status are so closely connected to ‘how best you can jump the queue’ that it would be inconceivable to tolerate a situation where money or influence can’t be brandished.
In New Delhi, a hundred rooms in Ashoka Hotel were booked as a care centre for members of the Delhi High Court, a move that was quickly reversed following a public outcry. Such ideas don’t come from a vacuum. They come from minds that believe it’s fine for some people to have medical care on standby while ordinary citizens languish in a pandemic.
This attitude is intrinsic to the democracy of ‘favours’ that we occupy. Here, utilities don’t flow to everybody because everybody is a citizen; instead, there is an individualised cornering of resources by those with money and connections. Consequently, just as everyone aspires to be ‘important’ enough to defy red lights like the cars with government or judicial plates do, every Tom, Dick and Kalyani also aspires to the same assured access to healthcare when money or names are dropped. Given this social reality, can you imagine a hospital CEO telling a minister or his protégé he can’t get a hospital bed because his symptoms are mild?
Ideas like medical triage work best when there is a social compact, an understanding that the community’s interest must be placed above the individual’s in order to save maximum lives. It can’t work if a Delhi MP dishes out Fabiflu like toffee instead of distributing it to public health centres. Or if ministers corner vital medicines for their own constituencies. Or if we begin to privately stock resources rather than work in tandem with a system that’s already stressed by the government’s abject failure to prepare for just such an eventuality.
Where the writer tries to make sense of society with seven hundred words and a bit of snark.
