After its first COVID-19 death, Meghalaya grapples with the health crisis

John L Sailo was the founder of Bethany hospital, a multi-speciality hospital in Shillong. Courtesy Shillong Municipal Board
27 April, 2020

On 15 April, Meghalaya recorded its first COVID-19 death—John L Sailo Ryntathiang, a 69-year-old doctor, who had tested positive two days earlier. On the afternoon of 16 April, the Riatsamthiah Presbytarian Church cemetery located in Shillong’s Lawmali area was abuzz with movement, a rare sight since the government imposed a nationwide lockdown on 24 March. A small group of men in personal protective equipment carried a wooden casket, while Reverend Lyndan Syiem of the Presbytarian Church conducted Sailo’s funeral service.

Sailo was the founder of Bethany hospital, a multi-speciality hospital in Shillong, where he had been working prior to testing positive. In 2014, he also set up Bethany Hospital Outreach, a hospital in Nongpoh, a town in Meghalaya’s Ri Bhoi district. The government planned to have the doctor’s body cremated at the Shillong Electric Crematorium. His family requested that after the cremation, his remains be buried at their farmhouse in Nongpoh.  

However, the news of his death led to panic and fear among locals in Shillong and Nongpoh. The residents of Jhalupara, a locality in Shillong where the electric crematorium is located, protested against the cremation of Sailo in their area. They feared that the staff of the crematorium lacked the skill and the necessary equipment, and that it could cause a virus outbreak in their locality. Similarly, the Nongpoh Dorbar Shnong, the local constitutional body of Nongpoh, rejected the family’s request to bury the remains of the doctor in the family-owned farmhouse in the town. 

On the day of Sailo’s death, Conrad Sangma, the chief minister of Meghalaya, announced that six other people, who were relatives and helpers of the doctor, had tested positive for COVID-19. After Sailo’s death, the government said that people who visited the Bethany hospital in Shillong from 22 March onwards, and people who visited the Bethany hospital in Nongpoh from 30 March onwards should call and register themselves on a government hotline number or register online on a government portal. On the government website, they were asked to fill a form and indicate if they had any COVID-19 related symptoms. The government further asked them to quarantine themselves at home.

According to a report published in The Shillong Times on 17 April, 5,092 individuals registered themselves. Of these, 4,622 individuals had visited the Bethany hospitals in Shillong and Nongpoh. Suddenly, in a matter of days, the state of Meghalaya, which had earlier been in the news for having no COVID-19 positive cases faced the prospect of having over four thousand probable cases.

After the first positive case was announced on 13 April, all the doctors, patients and staff of Bethany hospital in Shillong were quarantined in the hospital, which was sealed as per the government’s orders. “I am afraid to get tested,” a staff at the hospital told me on the condition of anonymity. “The same doctors that were exposed to the late doctor are taking our tests, and I don’t feel it is safe.”

He said the hospital staff had received more than fifteen calls from health officials but it seemed like they were only fulfilling a daily duty. “They ask me my name, age, and if I was exposed to the virus, but no action is taken,” he said. “Why doesn’t the health department send an independent body to test us so that fear of contamination is not there?” The staff added that he feared for his life and was afraid to step out of his room even to pick up necessities from the nursing station. On 19 April, six days after the first case was reported, the doctors and patients at the hospital were evacuated so the premises could be sanitised.

Meanwhile, as Sailo’s death was discussed on social media in Meghalaya, many supporters of the doctor expressed anger and disappointment against the residents of Jhalupara and Nongpoh who had rejected the cremation and burial of the doctor’s remains. However, staff at the Jhalupara crematorium and local government body representatives in Nongpoh said they had not received proper government guidance about safety measures and were therefore unable to assuage public fears.

“We were not giving training on how to handle a COVID-19 body,” a staff member of the crematorium told me on the condition of anonymity. “We did not have the equipment, we did not know how people wear PPE or how it is disposed after use. Learning all these things after picking up the dead body is not possible,” he said. “We did not receive any written notification from concerned authorities that corona casualties will be brought to the crematorium.”

Locals in Nongpoh and officials of the Ri Bhoi district spoke about the same lack of awareness regarding burial protocol. “We have been working hard to take precaution against COVID-19 by cooperating with the government and the health department,” a local headman of the Nongpoh area said. “We received basic instructions such as social distance, washing hands, covering our mouths and we tried our best to educate the people. But, unfortunately, there is no discussion about if someone suffering from COVID-19 died, what will we do and if it is dangerous or not.”

In a press conference on 18 April, officials of the Dorbar Shnong said that the Ri Bhoi district administration had not informed them that the health department was conducting burials of COVID-19 victims taking into account the safety aspects, protocols and guidelines. They said that had they been informed of the safety measures, and that there was no need for fear, they would not have objected to the burial. In another press conference the same day, Rosetta Mary Kurbah, the deputy commissioner of Ri Bhoi, announced that pamphlets will be distributed among the locals to educate them on COVID-19. Meanwhile, state officials held a meeting with the Greater Shillong Crematorium and Mortuary Society, which runs the electric crematorium at Jhalupara. They decided that staff of the crematorium will be sensitised on the protocols related to the disposal of bodies of COVID-19 victims, and will be given practical training on the use of PPE.

The headman said, “It was very difficult for us, the entire community had started panicking once they came to know that the doctor was positive. We were fully ignorant, but the health department has advised us to educate our people on the matter and we have already done it.”

I spoke to Vincent Pala, a member of parliament from Congress who represents the Shillong constituency, on controversy over Sailo’s burial. “There was no one from the government to explain about COVID-19 related deaths and the procedure to be followed to the locality in Nongpoh,” he said. “The local people were not aware of the safety, they have written a letter of apology to the family. It is a failure of the state government, in handling the local people and making them understand the entire protocol.”

Commenting on COVID-19 situation in Meghalaya and the preparedness of the state, he added, “The state is zero, they only talk, no work, just like Modi. They were not ready with PPE. If you went around Shillong, there was no protection for police officers, doctors and frontline workers. They did not have a quarantine designated location. Only after Sailo’s death, they started looking here and there.”

Other members of the opposition have also questioned whether the small hill-state is ready to tackle a surge of COVID-19 cases. “Meghalaya was one of the last states to come up with a positive COVID-19 case, yet government machinery has not been able to dispel the hundreds of myths, stigmatisation and unfounded fear,” Ampareen Lyngdoh, a member of the legislative assembly from Congress who represents the East Shillong constituency, said. “The virus is still not understood by the common man on the road. Meghalaya never thought they would have a COVID-19 casualty and they have not reached that stage of being prepared for a casualty. 

I also spoke to Lambor Malngiang, an independent MLA who represents the Nongkrem constituency which is located on the outskirts of Shillong. He noted that there were only six ambulances in the state capital. “I suggested that we should purchase new ambulances,” he said. “Twenty-five new emergency ambulances will reach Shillong shortly which will go a long way in helping the people who want to get tested.” Refering to the novel coronavirus, he added, “This emergency is the first of its kind we are facing and nobody expected this kind of situation. The state of ours is so small we could not believe that it will spread like this. In urban areas, people are aware about the virus but the setback is that there is a need for awareness programs in the rural areas. Many villages don’t understand the virus till now.”

On 13 April, the Meghalaya High Court Bar Association filed a public-interest litigation in the Meghalaya high court related to the state’s preparedness in dealing with the COVID-19 situation. On 16 April, the associated filed an additional affidavit questioning the state’s response after the first positive case was reported. It described the manner in which the authorities dealt with the situation as “incompetent.” The association noted, “There is no designated COVID hospital and that no notification has been issued with regard to the manner in which the State would handle the burial and cremation of the persons who fall victim to this virus and also the manner in which the quarantine centres are managed.” It said that local bodies which prevented the cremation and burial of the doctor are liable to be punished.

The association further stated in the PIL, that while Bethany Hospital and the Indian Institute of Management, Shillong had been identified as quarantine facilities, “the patients and occupants of the institution have not been given any assistance or adequate food and water.” It added, “Even though food was arranged and supplied from outside by citizens themselves to feed the inmates, there were no personnel in place to receive the said food packets for distribution and the road leading Bethany hospital had been sealed and barricaded thus preventing the aid reaching the stranded patients.” The association also pointed out that till the date the additional affidavit had been filed, “the test of persons who were in primary contact with the doctor are yet to be conducted.”

However, A Kumar, the counsel for the state government, said that with regard to the testing of the primary contacts of infected persons, “the contention that no test has been conducted is incorrect.” He noted, “as far as possible taking into account the availability of facilities, tests are being carried out.”

In response to the PIL, the court directed on 16 April that, “State Health authorities shall immediately ensure the testing of the primary contacts and in the event, the same is not possible to be conducted immediately, to place the persons who have voluntarily come forward in quarantine till such test has been conducted.” It also asked the authorities to ensure that “adequate assistance is rendered to the patients who are stranded in Bethany Hospital and also who are housed in the other quarantine facility and that adequate food and water be made available.”

The court also directed that authorities can take legal action and register cases against anyone obstructing the cremation or burial of COVID-19 patients. It further asked authorities to “sensitize the public” in areas where cremation or burial grounds are situated.

On 19 April, I spoke to AL Hek, the health minister of Meghalaya, on the state’s preparedness to tackle the COVID-19 situation. “Two hospitals have been declared as COVID-19 designated hospitals,” he told me. He added that there are sufficient testing kits in the North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences hospital and assured that doctors and frontline health workers are being given priority care and hotel accommodation. He further said that “equipment was provided” to the Shillong Electric Crematorium, but “staff was not there.” The Meghalaya health department did not respond to additional questions emailed to them.

According to a tweet by Sangma, as of 24 April, 1,130 samples had been sent for testing in the state, and 11 positive cases were reported. According to the figures on the Meghalaya government website as of 27 April, 1,169 tests had been conducted and 12 positive cases reported.  On 18 April, to spread awareness about COVID-19, government officials travelled to Pomlakrai, the village of a COVID-19 patient, to dispel stigma that could be associated with the virus. On 16 April, the state formed a committee to focus on tackling the COVID-19 pandemic called the “Meghalaya People’s Action Committee against COVID-19.” It will be headed by DD Lapang, the chief advisor to the government and includes members from the government as well as the labour unions and academia.