SCOTT SIMON, HOST:
India is battling the world's biggest and deadliest COVID-19 outbreak. And the country's junior doctors - they're similar to medical residents in the U.S. - are on the front lines as India's health system buckles under the strain. NPR's Lauren Frayer has more.
LAUREN FRAYER, BYLINE: Three years ago, when Shiv Joshi was in medical school, he had to choose a specialty. So he chose pandemic preparedness. This was 2018. Did he know something the rest of us didn't know, I asked him.
SHIV JOSHI: (Laughter) I don't think so...
FRAYER: When the coronavirus hit, it didn't matter what you were studying. Medical board exams were postponed. It felt like everyone was thrown into the deep end, Joshi recalls.
JOSHI: Yeah. I think I cannot understate that. Definitely, it has been very stressful. All of a sudden, a lot of additional tasks and responsibilities were shifted to us.
FRAYER: He was assigned to a fever clinic in rural central India. He was supposed to be shadowing a supervisor. But there aren't enough doctors, so Joshi hardly gets any instruction. And he recalls the first time he was left in charge by himself. An ambulance pulled up.
JOSHI: The patient inside - I took the oxygen saturation. And I tried to locate her heartbeat. But she was already cold. She was in shock. And I had to inform my superiors. So I gave them a call. I said, sir, such and such patient has arrived. I didn't think she had a lot of time. And we did not have beds. Not a single bag was vaccant. I mean, that was a time when I felt absolutely helpless.
FRAYER: The patient's relatives were all there staring at Joshi. Do something, they pleaded. His supervisor couldn't come.
JOSHI: And, you know, you feel sometimes so stranded. So you cannot just say that the patient's not going to survive to their relatives because you cannot take their hope away. Whatever the sciences we study, the books read, they do not prepare us for such situations.
FRAYER: Joshi's patient died a half hour later. He had to deliver the news to her family. And in the years since, he's had to do that dozens of times, more than doctors might expect in an entire career.
RIMY DEY: Young people, 16 years, 20 years, 25 years, pregnant ladies - that's quite distressing.
FRAYER: Rimy Dey is another junior doctor in a suburb of New Delhi where hospitals have been running out of medical oxygen. She recalls how one night last month, a patient's son turned violent in his grief.
DEY: It was around 2 a.m. or 3 a.m. in the night. A young guy comes in and tells, please do something, doctor. Just save my father. And so I had to tell him that, sir, this cylinder is going to run out of oxygen. We're having a severe crisis of oxygen cylinders. And that's when the patient's son started telling us, if my father dies, you will be responsible for his death. And we are going to break this emergency room down.
FRAYER: As in trash the emergency room. Patients were lying there wide-eyed behind oxygen masks. She had to call security. What's so difficult is that Dey worried the man was right. She was responsible for his father's care in a health system that often feels like it's collapsing on her shoulders, she says
DEY: Like, you know, just checking a patient and declaring a patient dead, then going back and crying for hours. There have been many times that I've thought to myself, like, I did not become a doctor for this - to, like, you know, be scared to death while attending to patients.
FRAYER: She says she's angry at India's government for not preparing better for COVID's second wave here, for investing less in public health than most other countries, even before the pandemic.
DEY: Because of the lack of doctors, they started assigning COVID duties to even medical students - third or fourth-year students who have not even completed their basic medical education.
FRAYER: I asked these doctors if their hospitals offer them counseling, any mental health support at all. Dr. Dey kind of laughed.
DEY: I don't think hospitals have that facility. They are not providing us with psychotherapists.
FRAYER: And so it builds up. And every week, she and her colleagues trade news reports about junior doctors taking their own lives.
DEVIKA KHANNA: Right. Wow. That's unbelievably terrible because what this is going to generate potentially is a generation of doctors who are traumatized, basically. And...
FRAYER: And Dr. Devika Khanna is a psychiatrist who's trying to help India's junior doctors by holding support groups over Zoom from her base in London. She says post-traumatic stress disorder, PTSD, is compounded by the feelings that Dr. Dey describes, that it didn't have to be this bad.
KHANNA: When there's a natural disaster, then trauma is obviously huge. But the PTSD from a manmade disaster is much greater. You know, there's a sense that people weren't looked after. You know, if God or the universe did it to you is different to if human beings did it to you. Then it feels so much more personal.
FRAYER: After a year of treating COVID in a rural fever clinic, Dr. Joshi recently tested positive for antibodies. That means he probably had the virus at some point and didn't know it. It was a relief, he says. He'd spent a year wondering if he would be able to get a bed in his own overflowing hospital.
JOSHI: That saddens me the most. I mean, how can you work in a hospital in a pandemic at your fullest knowing that, if you get infected, there might be nothing available to you?
FRAYER: In lieu of professional counselling, he and his fellow junior doctors have a WhatsApp group where they counsel one another because only they understand what they're all going through, Dr Dey says.
DEY: We've seen a lot more than we should have at our age. When I see friends from school, they are enjoying the lockdown. They are enjoying the COVID by being at home. And here I am seeing a lot of death every day and coming back to my room and crying. I think I've grown ahead of my years.
FRAYER: She says her hair is turning grey prematurely. She's 28. But she has no plans to leave medicine. Lauren Frayer, NPR News, Mumbai.
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