Growing up, I believed the British-rule in India as one of loot and destruction alone. Hate slowly gave way to some reason, as I learned about architectural marvels and systems that still power 21st century state. Just as Europe colonised the world and plundered its resources, COVID has ‘coronised’[1] it and left us devastated. We are resisting, losing and yes, winning as well in some corners globally. The loss and fear out-shines any positive realm of light but if we wish to be hopeful of tomorrow, a flame needs to be lit today.
At IIH, we have invested a decade of work with the public health system (PHS). Our mutual engagement is limited to focused groups – ensuring care for tuberculosis (TB) patients, expecting and young mothers with newborns. When COVID was flagged as pandemic, everyone knew an unprecedented calamity is to strike us but we expected a heightened response to the standard mitigation protocol. As usual, we imagined army called for rescue, powers being centralised, taxes raised, etc. It’s pre-emptive with every disaster because governments are not prepared for it with routine employees. Our thoughts shattered when this was not fulfilled, an unprecedented shift as the infection itself. Hospital facilities were being managed through regular staff and trainees. Everyone was charged up, to follow the extra-mile serving against an invisible enemy and insurmountable odds. Our health system was not ready to manage a plethora of sick. There was significant pressure from the top but these doctors and para-medics delivered. Majority turned up to work on all 7 days a week and proved that given an opportunity with proper logistical support, they can do wonders. Thanks to them the health system is alive and the army is doing what they best do. The crisis has tested our potential and taught life-long lessons too.
We decided to step up and join the PHS functionaries’ mitigation efforts. Neither of us had an expertise nor essential resources for a healthy response. A match of the sense of thought to respond together as one, was our first win. A joint venture whose tenets were mutually decided and delivered. When we offered room to alter our list of support under COVID, the PHS Leads responded with unconditional approvals of our work. State Health Society, Bihar arranged 4 new ventilator support system for the district hospital – a first ever in its history. IIH will support these machines with advanced multi-parameter patient monitors, making it more effective. An additional 50 bed critical care unit at our sub-divisional block (Dalsinghsarai) has got centralised oxygen gas pipeline system allowing contactless oxygen support to patients on intensive care. Ownership for the unit will be transferred to the hospital authorities, so it may be used post-COVID as well. To augment testing for COVID suspects, IIH initiated a recruited, trained and deployed 5 lab technicians for a period of 6 months with the district testing facility. Together, these technicians conduct at least 300 tests a day during this crisis. This has boosted the examination of samples by almost 15% for the district. Besides, IIH personnel are working to support the district health authorities with fresh recruitments, technical support and intensive awareness campaigns on community level.
Moreover, our TB program which is operational even during lockdown has been reporting very healthy diagnosis levels as compared to pre-COVID period. Despite of a 90% drop-in field-based activities, we have ensured 81.4% case-finding over the last quarter. We tweaked our techniques to adapt as per the need, without compromising much on the quality. Not to forget, TB is a silent monster and as current public facilities get overwhelmed due to COVID, patients with TB are at the losing end. IIH has tried to plug-in the gap with employing telemedicine, sputum collection from clients’ door-step and arranging timely drugs delivery with fabric masks. Such feats will definitely place the district amongst the best performers in the state.
As part of advocacy, we get to meet several stakeholders often but it’s a challenge to convince everyone with our purpose. I struggle to re-collect the face of any individual, who denied engaging with me during this crisis. From guards to managers and medical officers to civil surgeon, everyone welcomed. Forget the door-step sputum collection and drug delivery, my colleagues have observed the value of a fabric mask, they shared with a TB patient during lockdown. Our ASHAs take pride in being associated with the IIH family, when suddenly multiple of her family members report COVID positive and she is looked down by her neighbours, while IIHers care for her and assure necessary help. Employees in PHS remember your name, dial back if you solicit help, hear you for a longer time, treat you as a friend and confidant over a phone call. If you visit them, you no longer wait but get priority over others, approvals are fast-tracked, your opinion on everything matters, physical files that concern you are shared with you directly so one could help oneself with any information. IIH has filled a huge void, that got created with the shifting out (due to lockdown) of the INGOs personnel that supported the district health system routinely.
Post-COVID, this strong rapport will help us collaborate and work better to realise other objectives. We shall be more confident of our actions during engagement. The coronised world has inflicted huge pain but has touched few positive chords as well, one that binds us closer and has taught to adapt.
[1] A person infected with COVID-19, is considered to have been coronised, matching with the sentiments of a colonised world.
Blog by: Homam Khan
Innovators In Health 