NEW DELHI — Viveki Kapoor has been a nurse for 23 years. And yet, she said, the past month has been the most difficult of her career — one night in particular. On April 23, 25 patients died in the hospital where she works in New Delhi because of a shortage of oxygen — a covid-19 crisis that has engulfed the capital and other cities in India.

“I have never felt so angry and helpless — we could see that the people we were caring for wouldn’t make it through the night. I didn’t know what to tell their family members. How will we ever forget this and move on?” the 47-year-old said.

The limitations of India’s health-care system have come into sharp focus as the second wave of covid-19 ravages the country, with more than 300,000 new cases reported every day (a number that is probably a vast undercount). Apart from a shortage of crucial medical equipment and oxygen, the lack of medical staff is being felt acutely — leaving doctors and nurses particularly overwhelmed.

Medical staff attend to covid-positive patients in the intensive care ward at the Holy Family hospital on May 6 in New Delhi, India. (Rebecca Conway/Getty Images)
Medical staff attend to covid-positive patients in the intensive care ward at the Holy Family hospital on May 6 in New Delhi, India. (Rebecca Conway/Getty Images)

As the United States starts reopening, with more than 46 percent of the total population partly or fully vaccinated, India is the sole region in the world where coronavirus cases are rising — and vaccinations stand at less than 3 percent. The day-to-day reality for essential health-care workers there differs vastly from that of many living in the States.

“Nurses are always overworked, but right now we are also putting our own lives at risk,” Kapoor said, shortly after her shift last week. In the past year, at least one of the nurses in her hospital has succumbed to the virus, she said, and more than 50 others have tested positive.

“Being a nurse is a noble profession. They call us ‘sister’ because we’re someone they can trust. But we need support, too,” Kapoor added.

As Delhi’s coronavirus infections began to surge in April, Kapoor’s husband tested positive. “That week was a real test for me — I was guilty that I had spread the infection to my husband. I questioned my reason to keep working,” she said. Taking time off from work was not an option. “We are already short-staffed,” Kapoor said.

Kapoor is part of the United Nurses Association, a national union that has tried to bring attention to the issues affecting its members. Kapoor said that increasing pay at private hospitals and guaranteeing job security are among the most important demands. But for now, she said, there are more-pressing issues: “We’re in a national emergency and we’re soldiers at the front lines.”

An Indian Air Force helicopter showers flower petals on the staff of INS Asvini hospital on May 3 in Mumbai. The event was part the Armed Forces' efforts to thank the health-care workers. (Rajanish Kakade/AP)
An Indian Air Force helicopter showers flower petals on the staff of INS Asvini hospital on May 3 in Mumbai. The event was part the Armed Forces' efforts to thank the health-care workers. (Rajanish Kakade/AP)

Earlier this month, Prime Minister Narendra Modi announced that more nurses will be recruited, adding that more than 25,000 had been hired since the beginning of the pandemic, a move that is seen as a reflection of the dire shortage of health-care workers. “The announcement to recruit more nurses, including students, has come this month, but many who are working on the front lines are burnt out already. The government should improve their pay and working conditions first,” said Harish Kumar Kajla, the president of the All-India Institute of Medical Sciences (AIIMS) Nurses Union in New Delhi.

Kapoor is not alone in feeling overworked and yet knowing that a sense of duty prevails. Philomina Dange, 30, works at a Mumbai cancer hospital that also has a covid-19 unit. “Every day feels like war for us,” she said.

A nurse rests at an NGO-run station providing supplemental oxygen on a pedestrian pavement on May 8 in Bengaluru, India. (Abhishek Chinnappa/Getty Images)
A nurse rests at an NGO-run station providing supplemental oxygen on a pedestrian pavement on May 8 in Bengaluru, India. (Abhishek Chinnappa/Getty Images)

Caring for patients who are battling cancer and have tested positive for the coronavirus is something nurses like Dange were not prepared for, she said. As Dange put it: “It’s a fight between covid, cancer and the patient’s will. Getting covid affects their immunity, but also their morale. The patient thinks, ‘Now I’m going to die.’”

What’s more, the pandemic has meant that many patients have been putting off appointments in the past year, Dange said. Now, they’re having to go to the hospital because of advanced cancer as well as covid, and “by then, sometimes it’s too late.”

The exhaustion of working more than a year on the front lines is weighing on Dange. Three days before her first wedding anniversary, in May 2020, Dange had to go into quarantine — six of the eight patients she had come into contact with had tested positive. She had no symptoms, she said, but she “had to quarantine for the sake of my husband and in-laws.”

A nurse poses for a photograph inside a ward at the BKC jumbo field hospital, one of the largest COVID-19 facilities in Mumbai, on May 7. (Rafiq Maqbool/AP)
A nurse poses for a photograph inside a ward at the BKC jumbo field hospital, one of the largest COVID-19 facilities in Mumbai, on May 7. (Rafiq Maqbool/AP)

Like many other nurses across the country, Dange thinks she might have contracted covid-19 over the course of the year. “There were times when I had fever and felt tired to my bones. But I popped a paracetamol and ran to work,” she said.

With the latest surge in cases, several states in India have had to confront the shortage of nurses. They have started recruitment, but many say it’s too late — while new covid-19 hospitals are being set up, the gap in workers is harder to bridge. In Bihar, health-care workers went on strike last year demanding a salary hike. In Gujarat, less than 10 percent of the demand for nurses was met through a recruitment drive in April — a reflection of low salaries, limited perks and danger to life.

“It’s a thankless job,” Kajla of the AIIMS union said. “We are at the bottom of the rung. The system is dependent on us, but we never get the credit that is due.” Kajla said the salary for nurses can be as low as 10,000 Indian rupees, or $135, per month, even in the capital city.

The past few weeks have been trying for many as the death count rises. There is no official count of the number of nurses who have died of covid-19 — although nurses unions across the country have tried to keep count, some who were not members have slipped through the cracks, according to Kajla.

Medical staff help each other put on PPE equipment before tending to covid-positive patients in the ICU ward at the Holy Family hospital on May 6 in New Delhi. (Rebecca Conway/Getty Images)
Medical staff help each other put on PPE equipment before tending to covid-positive patients in the ICU ward at the Holy Family hospital on May 6 in New Delhi. (Rebecca Conway/Getty Images)

Ginni Kaur was a nurse at a gurdwara, or a place of Sikh worship, in New Delhi, where she had worked since 2005. It was perhaps while tending to a patient there that she caught the virus, according to her friend Gurpreet, who is being identified by her first name to protect her privacy.

Gupreet said she received a call from Kaur on April 17. Kaur, 37, said she had a fever and feared she’d contracted covid-19. “She knew things were so dire in Delhi and wondered if she would get a hospital bed if she needed one. But I told her to be positive and focus on getting better,” Gurpreet said.

Kaur’s fever rose and she had difficulty breathing, according to Gurpreet. Although Gurpreet and others helped get Kaur an oxygen cylinder, it wasn’t enough, and soon Kaur needed hospitalization. Politicians and doctors who were connected to the gurdwara tried their best but failed to help, Gurpreet said.

“We waited at a hospital for a doctor to at least come and see her, but there were 200 others who were also waiting — we knew then that she was slipping from us,” Gurpreet said.

Nurse Ginni — as she was known to her friends — struggled to keep up with the virus and lost her battle while waiting at the casualty ward of a hospital. She died April 27, according to friends. “She fought for her own life the way she fought for others — in the end, we lost her because the system failed us,” Gurpreet said.

Across India, nurses like Kapoor and Dange are aware of the dangers of their professions, especially amid such a devastating crisis. But they’re back in wards and intensive care units every day.

As Kapoor put it: “We can’t be scared, we are fighters. If we give up hope, who will take care of the people?”

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