A cascade of public health crises — including a new and highly contagious variant of COVID-19, extreme shortages of medical supplies, low vaccine availability and a powerful surge of infections — have all contributed to the devastation that has gripped India in recent weeks.
Sunil Eappen, MD, MBA, Brigham interim president and chief medical officer, expressed his concern and support for members of the Brigham community who have been affected by the dire situation in India.
“We care. Period. — that’s one of our core values. We embrace a culture of shared humanity and dignity, where our diverse community of patients, families and employees all feel welcome, cared for and valued,” said Eappen. “As members of the global community, we are watching the worsening COVID-19 crisis in India, and know that many in our community, particularly those with families and friends who live there, are hurting deeply. The Brigham community is here for you, and I encourage anyone in our community who needs support to take advantage of the resources that are available.”
Moved by reports of the rapidly deteriorating situation on the ground, several members of the Brigham community have mobilized to support the international response.
A Mask Mission
Ranu Dhillon, MD, of the Division of Global Health Equity, and Abraar Karan, MD, MPH, DTM&H, an aspiring infectious diseases specialist and medical resident in the Hiatt Residency in Global Health Equity program, have made it their mission to get better face masks into the hands of people who need them most.
Throughout the pandemic, Dhillon and Karan have become passionate advocates for encouraging governments, health care organizations and mask manufacturers work together to ensure that people in high-risk environments have access to high-filtration masks, such as surgical masks and N95 respirators. Cloth masks are still widely used in India, and higher-grade options are in scarce supply.
When Karan, who was born in India, first started hearing about the crisis in his native country from loved ones living there, he knew what he had to do next.
“When India was getting crushed, I thought that we’ve got to do something,” he said. “I worked on masks this whole year and developed tons of connections, and I wanted to leverage my expertise on this topic.”
Dhillon was similarly inspired to take action.
“My family came from India, and I’ve been working there to improve the health system for a number years,” he said. “We want to do all we can to stop the surge in India. There are lots of low-hanging opportunities to make an impact.”
Both have been working with Armbrust American, a mask manufacturer in Texas, and Indian government officials to arrange for large donations of surgical masks and N95s, as well as donations from Fix the Mask, a California-based company that produces accessories to secure loose-fitting masks more tightly against the face.
Karan is coordinating an initial donation of 1 million surgical masks and N95s to Delhi, India’s capital territory, with plans to send more masks in the future, along with a donation of 10,000 mask fitters.
Dhillon has been working with a nongovernmental organization (NGO) in Madhya Pardesh — a large state in central India, where more than a third of the population lives below the poverty line — to mobilize mask donations as well. While this effort is also still in the planning stages, Dhillon estimates the team will distribute more than a half-million masks. The team is also working with Fix the Mask to promote the use of mask fitters in this area.
“We are also working with local government leaders to ensure a supply of oxygen and planning for isolation of large numbers of patients,” Dhillon said. “In addition, we are looking into expanding the deployment of rapid diagnostic tests, but we are still working on the supply and details of this.”
Dhillon and Karan said they and their partners in this effort are exploring the possibility of establishing a nonprofit to have a more structured approach if — or, more likely, when — similar situations arise elsewhere around the globe.
“We’re realizing this is going to be an issue in a lot of unvaccinated countries, so getting better masks to places before they surge is going to be key going forward,” Karan said.
Supporting Vulnerable Populations
The deadly surge of COVID-19 has not spared the small, rural and remote villages of Rajasthan, one of India’s northern states. And yet these areas lack access to testing, medical resources and more. This weighs heavily on the mind of Neha Limaye, MD, a resident in Internal Medicine at the Brigham and in Pediatrics with the Boston Combined Residency Program in Pediatrics.
For the past decade, Limaye has been working with a nongovernment organization called Educate for Life, which supports education and community health programs for an indigenous and historically marginalized population in rural Rajasthan. She volunteers as the health trustee for the organization, providing public health guidance to local teams on the ground.
“When we were preparing for COVID last year, we were really worried something like what we’re seeing now would happen,” said Limaye, also a trainee in the Hiatt Residency in Global Health Equity program. “In the villages where we focus our efforts, there’s no real testing available, but many people have viral syndromes — about one per house is what our community health team estimates.”
In recent weeks, Limaye has been working to advise teams on the ground on how to inform residents about how to stay safe and to help patients manage symptoms at home and access medical care if needed.
As the surge has worsened, however, infections have spread among the community health workers themselves and their own families. Whereas workers previously visited homes in the village in-person, they now check in on residents by phone.
“It’s honestly quite scary to know all of what’s happening while being so far away, and I do feel genuine worry because I know so many people in this village as well as our team on the ground,” Limaye said. “At the same time, it’s been very motivating and inspiring to be part of this team and try to figure out solutions together.”
Limaye has also been connected with India COVID SOS, a newly formed, grassroots coalition of scientists, clinicians, engineers, policymakers, epidemiologists and others from around the world working to coordinate several disaster response efforts.
“I have a lot of family in India, so I’ve been hearing from folks on the ground in various different cities how bad things really are,” she said. “It’s been quite stressful, but one positive that’s come out of this is seeing the number of people who have united around trying to support India in whatever way possible.”
Extending Knowledge, Providing Advocacy
For Joia Mukherjee, MD, MPH, of the Division of Global Health Equity, responding to the crisis in India is both a personal and professional endeavor.
“My dad was an immigrant, and I still have family and friends in India. I know the situation is dire,” she said.
In addition to her role at the Brigham, Mukherjee is chief medical officer for the nonprofit Partners In Health (PIH), which works with governments in 11 countries to ensure quality health care is available in some of the world’s most vulnerable communities. While PIH doesn’t have direct ties to India, the resources it has created are now actively being shared with clinicians there.
“Early in the pandemic, physicians and nurses working with Partners In Health affiliated with the Brigham’s departments of Medicine and Emergency Medicine developed and openly shared COVID protocols for delivering COVID care in low- and middle-income countries,” she said.
The United States Agency for International Development asked these Brigham clinicians and PIH to join forces with the University of California San Francisco Institute for Global Health Sciences to make the protocols web-based. Within weeks, the website was up and running, and it continues to be updated regularly as our understanding of the virus evolves. These protocols are now being actively shared with clinicians in India.
“What we see in developing countries, or even in non-trauma hospitals in the U.S., is that knowledge such as how to manage oxygen or take care of critically ill patients is not widely disseminated,” Mukherjee said. “Until you need it, you don’t look it up. Now, in India, they are considering field hospitals, and they need to know how to manage oxygen with or without ventilators — and we have knowledge to share.”
Mukherjee is also working hard to make the point that until everyone gets vaccinated across the globe, we won’t get control over this crisis. She recently published a commentary about this topic on WBUR’s Cognoscenti site. On May 5, Mukherjee appeared on MSNBC’s Rachel Maddow Show after the Biden Administration vowed to allow for patent flexibilities to mass produce the vaccine.
“Today, it feels very much like the AIDS pandemic: We have tools — in the case of COVID-19, vaccination and therapies — but they are not yet available around the world. We need hundreds of billions of dollars in investment to get this right,” she said. “The global economy has lost trillions of dollars from COVID. It makes good economic sense to make this investment. But more importantly, it’s good moral sense, and that’s what I’m focused on.”
Helping Alleviate the Oxygen Shortage
Brigham anesthesiologists Sujatha Pentakota, MD, and Lalitha Sundararaman, MD, of the Department of Anesthesiology, Perioperative and Pain Medicine, are working in coordination with several organizations to help coordinate delivery of oxygen concentrators and other essential supplies to India.
They have been collaborating with the American Association of Physicians of Indian Origin and, to support local relief efforts on the ground in Bangalore, with CARE India, a nonprofit dedicated to alleviating poverty and social injustice. Additionally, Pentakota is working with the Indian Chamber of Commerce to ensure any equipment delivered gets into the right hands.
“We have been working tirelessly — on U.S. and Indian time — to help combat the COVID catastrophe there,” Sundararaman said.
To generate awareness and mobilize action for the public health crisis, Sundararaman also recently published a call to action in the ASA Monitor, the official news publication of the American Society of Anesthesiologists.
“We all became doctors because we care. Both Sujatha and I are doctors from India, and when we heard personal accounts of how the lack of oxygen — a drug we take for granted here in the USA — is causing so many deaths in India, we could not stay as observers,” Sundararaman said. “We decided to do what we could to raise awareness and help as many people as we could live to see another day.”
Sundararaman and Pentakota have started a fund to support on-the-ground efforts to assist rural areas with poor infrastructure to combat the crisis, with Pentakota managing the logistics.
Sundararaman was also recently interviewed on the podcast Post Call as part of a special episode highlighting the crisis in India.
“I was an anesthesiologist in India as well, and I still have many contacts among anesthesiologists and intensivists there who keep telling me heartbreaking stories,” Sundararaman said on the May 2 episode of the podcast. “People are dying on the streets — and I mean literally on the streets. Hospital beds are in such a deficiency that people are hiring ambulances with oxygen tanks so that they can live off of the oxygen tanks while they wait for a spot to open up inside the hospitals.”
As a demonstration of support for the people of India and those who have been touched by the country’s public health crisis, members of the Brigham community are invited to attend a virtual ceremony on Tuesday, May 11, 12:30–1 p.m., via Zoom. Co-hosted by the Center for Diversity & Inclusion, the Division of Global Health Equity and Spiritual Care Services.