Imparting health services to the tribal population in a District like Nandurbar (Maharashtra) is a stupendous task because of the poverty, illiteracy, remoteness, unwillingness to mix with the mainstream of the society. Mountainous terrain and the lack of proper roads in the inaccessible regions make the problems more severe. Most of the PHCs do not have enough staff, well maintained buildings and staff quarters. The number of medical personnel available are below national average.
The underlying medical conditions like Sickle Cell Anemia and weakening immune system heightens the severity of the infection and increases mortality rate. The spread of COVID-19 among the elders would have put the entire generation at risk.
There is no industry nearby in the vicinity of Nandurbar District that would have been capable of generation and supply of oxygen in the case of urgency. The District Collector, Dr. Rajendra Bharud recognized all these problems and had the foresight to make the district self-reliant not only in terms of oxygen requirement, but also other necessary preparation to fight Covid-19.
Nandurbar did not have a single liquid oxygen plant or tank before the Covid-19 outbreak last year. However, the Doctor turned Collector envisioned the Coronavirus threat of future and effects of weak health infrastructure in the district.
After steady decline in the cases in first wave as well as the assurance from Central Government regarding the vaccination programme, many district administrations dismantled their Covid-19 facilities. However, Nandurbar didn’t do it. As cases were coming down in India, Dr. Bharud kept an eye on events in America and Brazil that were facing a massive surge. He wanted to be prepared in case a similar surge took place in the District. So, District Planning and Development Council (DPDC) allotted Rs. 85 Lakhs from DPDC fund for the installation of Oxygen plant. In September 2020, the District Administration installed the first oxygen plant, which had a capacity to produce 600 liters per minute. Forecasting the surge, the District Administration went ahead to install another plant of similar capacity at District Hospital by using funds from State Disaster Relief Fund and Corporate Social Responsibility.
When the second wave hit Maharashtra, Nandurbar reported as many as 1160 cases in a span of 24 hours on 7th April 2021. The District Administration installed another plant at Shahada block in few days. At present, with the proactive effort, the total oxygen capacity in the district is 1,800 liters per minute. By adding two more plants at Navapur and Taloda with combined capacity of 1200 liters per minute, the total capacity of Oxygen generation will reach 3000 liter per minute by 20th May 2021.
Availability of funds is always a crucial component in setting up a robust healthcare structure, which includes ambulances, ventilators, beds, oxygen plants, vaccines, medicines, staff, a website, and control rooms in every block. Dr Bharud used a combination of resources, including District Planning and Development Council (DPDC) funds, State disaster relief funds, Local Bodies’ Cess and CSR to meet expenses.
Apart from erection of Oxygen Generation plants, many steps were taken by the administration to fight the pandemic. Nandurbar had to depend upon the GMC Dhule for get its swab samples tested in initial days of Covid-19 pandemic. The administration installed its own RTPCR lab with capacity of testing 2000 samples per day. Keeping in mind the second wave of Covid-19, the testing capacity was augmented with addition of second RTPCR machine of same capacity.
Schools and community halls were converted into COVID-19 centers. The administration set up 7000 beds just for isolation and 1300 beds for active treatment.
During the first wave, the district had faced a massive crunch in terms of frontline doctors. Since there are no medical colleges in the region, finding experts was a challenge. So, all local doctors were roped in and were trained to perform vital procedures of Covid-19 treatment such as intubation and monitoring oxygen levels.
The health department has to bear the burden of data management, inventory management etc. at DHC, DCHC & CCC. Hence, the teachers, staff from ITI instructors etc. have been made available for the purpose.
Considering the future demand, 27 ambulances have been arranged from CSR; 4 ambulances have been hired with the help of Nandurbar and Shahada municipal councils while 16 ambulances have been purchased from Local Cess Funds. In addition to this, two dedicated hearse vans have been made available to Municipal Council for disposal of dead body.
One of the early steps taken by the administration was creating a website and control room to help control the panic and systematically guide the citizens. This would also ensure that people were not running from pillar to post in search of beds. The website www.ndbcovidinfo.com is created and being updated real time to let the people know about bed availability, Covid-19 Test reports, ambulance status and nearest vaccination booth status etc. Due to user-friendly design of website, the complaints of citizens regarding non-availability of information have been drastically reduced.
Control rooms (24 X 7) had been established in all six talukas in the district under the supervision of Incident Commanders as well as at District Headquarter under Additional Collector. FDA officer was also made available with the control room for mitigating any shortage of medicines as well as oxygen. District Administration has provided 4 separate helpline numbers. Separate logbook is being maintained for calls received and action taken on it.
Railways has turned 21 coaches into isolation wards at the request of the State Government in Nandurbar. There are 16 beds in every coach. The isolation coaches have been covered with layered gunnies and water drip system to lower the temperature, making it suitable for the use of COVID-19 patients.
The ongoing small but effective practice of appointing nurses was started last year in Nandurbar. One nurse is appointed for 15-20 patients. These nurses have to monitor the requirement of oxygen every 2-4 hours, round the clock. They have the discretion to increase or decrease the flow depending on the patient’s need.
The district presently has 52 government and 4 private vaccination centers. Out of the 3 lakh individuals aged above 45, one lakh have already received the first dose. This is despite the lack of awareness around vaccination. Effort has been made to reach out to the target group Instead of calling people over for vaccination as a part of ‘Camp Approach’. This way, people didn’t have to travel in hilly terrains. Teachers and sarpanches were deployed to spread the word about the seriousness of the situation.
On account of improved health infrastructure, people from neighboring districts and states (including Madhya Pradesh and Gujarat), have been admitting themselves in Nandurbar. Even with this added caseload, the district has managed not only to control the positivity rate, but also slash it by 30%. The single day spike is reduced from 1200 to 300 i.e. by 75% by various active interventions at local levels.
Dr Rajendra Bharud and his committed team of officers, doctors and para-medics have demonstrated that even an unprecedented crisis, like COVID can be managed with foresight, meticulous planning and execution. They have made-it-happen. It is indeed a lesson for others.
Anil Swarup has served as the head of the Project Monitoring Group, which is currently under the Prime Minister’s Offic. He has also served as Secretary, Ministry of Coal and Secretary, Ministry of School Education.