Working in a district affected with left wing extremism is not easy. The villages are not well connected. Villagers are semi-literate. They are hard pressed to win their daily bread, cope with the ever-present threat of malaria and try to stay out of the ongoing strife involving extremists.
And then COVID-19 hit the district. The capacity of the health facilities to accept and treat patients is way short of the number of people reporting sick. How to serve them? How to demonstrate one’s concern? How to deliver concern in its most practical form, medicine?
A lot of infected people find it difficult to travel to the district health facility. Many of them have a mild infection, and many have no symptoms. Thus, they choose to remain in home isolation. They need to be looked after too, to minimize the period of sickness and convalescence, and to decrease the potential load on the district facility.
Yet, most of those villages may have no oximeter, no thermometer, and no medical shop. Their only contact with health service providers till date may be via the accredited social health activist (ASHA) and the local anganwadi center. How to serve these villages?
Lohardaga district in Jharkhand shows the way. Under the Integrated Disease Surveillance Project, the administration started collecting information about affected people. Often the details were incomplete and insufficient in almost all cases to deliver any required materials to the persons in need.
Caring for thousands of COVID-19 cases in the absence of established infrastructure is very complex. The Jharkhand Integrated Development for Health and Nutrition (JIDHAN) project, supported by Azim Premji Philanthropic Initiatives and Transform Rural India Foundation (TRIF), organizations working in the district, came forward to help the people of Lohardaga district, given the urgency of the situation.
The first task was to ensure that pulse oximeters as well as infra-red thermometers were made available to the village ASHA worker, so that patients could be monitored. Then the question of caring becomes more amenable to solution.
The collector of Lohardaga created a home isolation cell, which is a team of volunteers. This team comprises school teachers. Varun Sharma, the aspirational district fellow (ADF) in Lohardaga, heads this cell, along with the deputy district collector.
They ensure that the volunteers get contact details of persons who have tested positive in the last two days, and every teacher is provided with a daily target list of persons who have tested positive. They call each of the listed patients every day and ask for their health status, provide moral support, and offer guidance on things such as medicine consumption.
They pass on details of critical patients or emergency requirements to the ADF, who ensures that the issues are resolved on the same day. Among other things, the volunteers ask if the patients have obtained medicines. Most of them answer in the negative. In such cases, volunteers collect information so that the required medicines can be delivered to the infected persons.
Siddhant Gupta of TRIF works on the project as the health system transformation fellow (HSTF). It was difficult to ensure that the medicines reached the patients, given the remote location of the district. The list of 10 drugs given to them were as per government guidelines. An additional list of five substitutes is given if these are not available.
Some of these drugs are not available in supplies received from the state system, and often not available in the few private medical stores. However, the team takes efforts to prepare a kit comprising the available and prescribed drugs.
The collector roped in civil society organizations (CSOs) to ensure that the home-isolated patients got these drug kits. Jharkhand State Livelihoods Promotion Society (JSLPS) and Nehru Yuva Kendra, both state societies, and Professional Assistance for Development Action (PRADAN), Marwari Yuva Mancha and Lohardaga Gram Swarajya Sansthan, which are CSOs, participated in this.
Home delivery of medicines
Siddhant Gupta, along with the ADFs Divya Tewari and Varun Sharma, formulated a detailed plan tagging each of the 66 panchayats in the district to one of the above organizations roped in for the home delivery of medicines.
They created collection points to streamline daily collection and delivery of medicine kits. Anganwadi workers from the Integrated Child Development Services (ICDS) department were roped in for preparing the kits, since the health department did not have manpower.
The volunteers in charge of delivering the medicine kits at home are provided with a list of persons to whom they should deliver medicines every day. At present, 98 volunteers deliver medicines to patients across 354 villages of the district. Some of these villages are very remote with little road connectivity. In exceptional cases, the volunteers deliver medicines from medical stores to patients’ homes.
The kit is delivered along with a communication material in Hindi which states what medicine is to be taken when. The district corona control room, under the supervision of the ADFs and the HSTF, monitors the delivery, by making calls to selected persons to verify that the delivery has actually been made.
There are still some issues to be resolved, however. First, unless the supply of medicines at the district level becomes smooth, supply to home-isolated patients in remote villages cannot be streamlined. To address this issue, Tiwari, Gupta and Sharma have jointly started a fundraiser on the Milaap platform, urging people to donate.
The second issue is to ensure that the patient knows the dosage and frequency of taking each medicine. The print on all medicines is in English and the patient or his family may barely be able to read Hindi. How does one ensure they take the right medicines?
This difficulty is sought to be addressed by the volunteers of the NGO reaching out to the patients, the teachers from the home isolation cell, and by someone educated in the village or by the ASHA worker. The biggest challenge is that this needs to be done while maintaining social distancing.
So far, medicines have been delivered to over 350 home-isolated COVID-19 patients in this manner. The volunteers demonstrate grit and the spirit of reaching out to help the needy. There of course are challenges. The most significant challenge is that the persons working in the NGOs, in the home isolation cell and in the villages take ill with COVID-19.
Yet, their coordinated attempt at alleviating the current situation in this time of crisis has proved to be a ray of hope for many people in need. And it is proof that where there is a will to serve, there will always be a way to overcome the challenges.
Divya Tiwari and Varun Sharma are aspirational district fellows. Siddhant Gupta is a health system transformation fellow. They work at TRIF. Views are personal.