Bengaluru:When India’s first coronavirus-related death was reported from Kalaburagi, the sprawling but sleepy ESIC hospital in one of the most backward districts in north Karnataka came to life. Of the 500 beds in the hospital on the Afzalpur Road, 200 have been set aside for covid-19 patients.
With large numbers of migrant workers returning to their hometowns as earnings dry up in cities during the lockdown, the number of coronavirus cases in remote areas is also rising. Till 4 April, 211 of India’s 720 districts reported cases, and the big challenge staring at all state governments is ramping up district hospitals and designating them as covid-19 centres.
“The challenges are the same in any district hospital anywhere in this country,” said a public health worker from Kalaburagi district. “There is a shortage not just of personal protective equipment (PPE), labs and testing kits but also of doctors, healthcare workers and support staff. Thousands of migrant workers have arrived in Kalaburagi from Pune, Delhi and Mumbai in the past week. While some fever clinics have been set up, we’ll need more as people are coming in with flu-like symptoms,” the public health worker said.
Countrywide, district hospitals are always woefully short of medical equipment and health personnel. The World Health Organization (WHO) recommends 25 health professionals per 10,000 population. In India, there is just one government doctor per 11,000 people, going by national health data from 2017. India has about 1,003 district hospitals.
“Usually, the doctor does not come to the government district hospital unless there is an emergency. A nurse and a health officer (who does not hold an MBBS degree) manage the show. Many young doctors or fresh graduates do not want to take up jobs in the districts as the caseload is so high. Thousands of posts are lying unfilled, even for paramedicial staff, across district hospitals in the country,” said a health policy analyst.
An 11% increase in India’s health budget in 2019 and ₹5,328 crore increased allocation for the National Health Mission in the same year did nothing on the ground.
“Our district hospitals may be able to handle ordinary flu or pneumonia, but if there is a surge of patients with distressed lungs, we will need ventilators and specialists,” said physician and Magsaysay award winner Dr H. Sudarshan.
In Assam, Bihar, Jharkhand, Madhya Pradesh, Haryana, Uttar Pradesh, West Bengal and Odisha, 80% of health centres operate out of rented buildings and do not have the required infrastructure. “In the current crisis, it is dangerous to function with limited resources. Having a doctor without adequate power supply defeats the purpose,” said Sudarshan.
Accredited social health activists (ASHA) have come to the rescue of state governments. “ASHA workers have been going door-to-door and screening people to prevent crowding at fever clinics. If a person shows symptoms, he/she is taken to a fever clinic, screened and then taken to a hospital. As of today, we are comfortable. No one knows what will happen if the numbers surge,” said Karnataka’s education minister S. Suresh Kumar, the official spokesperson for the state’s covid-19 taskforce.
Delhi has identified Ram Manohar Lohia hospital and GB Pant hospital as covid-19 hospitals. “I believe the lockdown has effectively prevented large-scale migration from bigger cities to states. All daily wage labourers have been accommodated in camps across Delhi or near borders,” said Dr Nutan Mundeja, director general of health services, Delhi government.
The lack of health infrastructure in rural areas prompted the government to rope in Indian Railways to convert coaches into makeshift isolation wards. “About 20,000 coaches will be converted into isolation wards. Southern Railway has been asked to convert 473 coaches into isolation wards, and we’ve started work at our Perambur workshop in Chennai and Golden Rock workshop in Trichy,” said B. Guganesan, chief public relation officer, Southern Railway, Chennai.-Livemint