While mid-day finds that civic and state-run hospitals in the city are ill-equipped to handle heatstroke cases, the state’s heat action plan of 2019, alarmingly, offers no clear guidelines for hospitals
Pedestrians attempt to shield themselves from the scorching afternoon heat at Dadar on April 26. File pic/Ashish Raje
While the India Meteorology Department’s (IMD) Santacruz and Colaba units recorded daytime temperatures of 35 and 33 degrees Celsius, respectively, on Sunday, and the mercury is expected to touch 40 degrees Celsius as May draws near, none of the four major civic hospitals have any special cooling facilities for treating heatstroke cases. This could be attributed to the vagueness of the 2019 Maharashtra State Action Plan on Climate Change and Human Health, which does not give specific directives to hospitals about addressing heat-related risks.
The Mumbai Climate Action Plan, which includes heat resilience strategies, was announced by the Brihanmumbai Municipal Corporation (BMC) in March 2022, but apart from mandating that heatstroke victims be prioritised and ORS be kept on hand, it doesn’t mention measures such as ice baths and cooling blankets.
“Though the temperature may not cross 40 degrees Celsius, for the city, this reading is quite high considering that Mumbai is a humid city,” said Bhagwan Kesbhat, founder, Waatavaran Foundation.
Pedestrians attempt to shield themselves from the scorching afternoon heat at Dadar on April 26. File pic/Ashish Raje
The major civic-run hospitals in the city that lack special facilities for heatstroke cases altogether are the Topiwala National Medical College and BYL Nair Hospital, Seth Gordhandas Sunderdas Medical College and KEM Hospital, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital (Sion Hospital), and Hindu Hriday Samrat Balasaheb Thackeray Medical College and RN Cooper Hospital.
Dr Mohan Joshi, dean, Sion Hospital, said, “We have the regular basic treatment available, such as ORS and IV fluids that help control and bring down body temperatures. So far, we have not seen any patient who has required hospitalisation. However, in case anyone needs it, the patient can be treated with IV fluids and other oral care.”
Surprisingly, JJ Hospital, one of the 18 sentinel hospitals across the state and the only one in Mumbai designated to deal with acute respiratory infection cases, also does not have any special services other than AC rooms. “We do not have cold-water bath facilities or cooling blankets. We do not have any orders to procure them. Whenever we have patients with heat-related issues, they are moved to AC rooms, instead of general wards, and given IV fluids and ORS, which helps reduce body temperatures quickly,” said Dr Vidya Nagar, HOD, Medicine, JJ Hospital.
The situation was similar at KEM Hospital, where the same sort of treatment is provided. The only civic hospital in the city that is doing a bit better is KB Bhabha Municipal General Hospital at Bandra, where cold saline (chilled intravenous fluids) is available for severe heatstroke cases. “We have not had to use them this season yet. However, we keep a few pints of saline under refrigeration and, thus, we have cold saline available round the clock,” said hospital superintendent, Dr Vinod Khade.
Why such a cool attitude?
Doctors at the civic hospitals say special facilities for heat-stroke cases are not required owing to the city’s climate! “Mumbai is a humid city, and we do not see any major heatstroke cases. Thus, it is not necessary to make such extreme and expensive facilities available,” said Dr Nagar.
Doctors also mention that since the symptoms of heatstroke cases are quite vague, not all cases can be put into the category of heatstroke. “People who experience heatstroke show symptoms such as nausea, vomiting, dry skin, racing heart rate and severe headache, which can be symptoms of any other illness as well. For instance, if a married young woman walks into our OPD [outpatient department] with these symptoms, she can be considered to be pregnant as well,” said Dr Rawat.
Private hospitals to rescue
Some private hospitals in the city, however, do have these special facilities. “The best way to rapidly reduce the body temperature of a heatstroke patient is ice-cold water immersion, a facility that is available at our hospital. Besides, we also have ice packs, water sprinklers and ECMO [extracorporeal membrane oxygenation] for severe cases of heatstroke. Though not many cases of heatstroke, we have definitely seen a rise in the number of patients suffering from heat exhaustion in the last two years,” said Dr Sandeep Gore, director of emergency medicine at Fortis Hospital in Mulund.
Sir HN Reliance Foundation Hospital also provides ice-water baths and has cooling blankets. “In case the patient shows a temperature of above 102, we have trained our doctors to immediately put on the cooling blanket, even before putting an IV line.
This is because once the body understands that it is in a cool place, mentally the patient starts relaxing. And then the regular treatment of saline and fluids shows faster results,” said Dr Divya Gopal, consultant, internal medicine.
Vidarbha situation
Meanwhile, all cities in the Vidarbha region have already reported temperatures above 40 degrees Celsius except Buldhana, which was not much further behind at 37.6 degrees Celsius, as of Saturday. However, the majority of the government hospitals in the region lack special cooling facilities. “Every year, we see a maximum of seven to eight cases which are severe and need admission at the hospital. We keep such patients in AC rooms and give them the regular treatment of ORS and saline. We neither have cooling blankets nor cold water baths,” said Dr Meenakshi Gajbhiye, dean, Government Medical College and Hospital, Akola.
The Vasantrao Naik Government Medical College of Yavatmal also provides the same basic line of treatment. “We see heatstroke cases every summer. But all of them can be treated with ORS, IV fluids and by keeping them in a cool atmosphere,” said Dr Girish Jatkar, the dean of the hospital.
Ahmedabad shows the way
Ahmedabad was the first city to have a heat action plan in place, and that has been seen as a model plan by many other cities in the country. However, surprisingly, hospitals there, too, do not have many special facilities. However, they do have other ways to help patients suffering from heat-related illnesses. “Considering the rising heat levels, we have installed 70 coolers across all our non-AC wards. We also have an e-auto that goes around the campus providing drinking water during the daytime. Though we do not have an ice-water bath facility, we ensure that enough ice and cold water are stored to provide sponging in cases of low-level hyperthermia. These facilities are above the regular facilities of ORS, cold saline and IV fluids,” said Dr Rakesh Joshi, medical superintendent, Civil Hospital, Ahmedabad.
35°c
Daytime temperature recorded in Colaba yesterday
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