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The Covid-19 pandemic has created a crisis situation in Odisha. The sudden spurt in the number of seriously ill patients can push even the most advanced healthcare systems to the limit. In normal times there was a great shortage of hospital beds. Scenes of patients lying on the floors of government hospitals have been all too common. We now face a situation where planners and administrators must make quick and sensible decisions to make the maximum of scarce resources. We must save the maximum lives. The policy that ensures the greatest good for the greatest numbers is the best policy. Infrastructure, manpower and economic resources have to be efficiently used. Simple interventions sometimes make the maximum impact.
As per 2011 census around 83% of Odias live in villages. They are extremely vulnerable with sophisticated healthcare centres, often located very far away. A lot of lives can be saved with community based health interventions. ASHA (Accredited Social Health Activist) health workers are an excellent grass root network that can be effectively tapped. Belonging to the very rural communities they serve, ASHA workers need to be recognized as frontline health workers. They must all be vaccinated as soon as possible and provided adequate gloves, masks and sanitizers. This will help them serve rural patients safely and fearlessly.
Early recognition and prompt treatment of complications of Covid-19 is life-saving. It also reduces hospital admissions and preserves precious resources like ventilators and oxygen. ASHA workers armed with digital thermometers, and trained in recognising Covid-19 symptoms can quickly detect suspected patients in rural communities. They can guide patients to the nearest diagnostic centre for prompt diagnosis. They should be provided with medicines like Ivermectin and basic antibiotics that are used in the first line of treatment of Covid-19. This will help ASHA workers to start early community based treatment of rural patients. This can reduce the rate of hospitalization and deaths.
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Covid-19 causes happy hypoxia. This phenomenon causes a symptom free period in which the oxygen capacity of lungs deteriorate. Such patients can only be detected early by measuring oxygen saturation in blood by means of a pulse oximeter. ASHA workers provided with pulse oximeters, and trained how to use them can detect patients deteriorating early. This is crucial as once the body’s oxygen saturation reduces, function of vital organs rapidly declines. Early recognition and prompt treatment will save lives. It will also reduce the number of critically ill patients who will need ICU care and ventilators.
Rural communities with less access to internet, often face difficulties navigating telephonic helplines, mobile apps and websites. As most of the Covid related resources like hospital admissions and vaccines are routed through such platforms, they are rendered inaccessible to many of our rural poor. Every rural community needs designated workers who will help them use the technology platforms to secure hospital beds and vaccine slots. Such workers can prevent panic in emergencies and save crucial time securing hospital admissions.
The first health centre of contact for rural communities is the Primary Health centre. All primary health centres need basic equipment to monitor oxygen saturation and other vital parameters. They also need oxygen cylinders and oxygen concentrators to temporarily stabilize seriously ill patients until they are shifted to higher centres. Ambulances at all primary health centres should be equipped with oxygen cylinders, which will help keep patients alive, while transporting them to Covid hospitals.
Community Health centres have beds for admitting patients and specialists. They do not possess life-saving mechanical ventilators nor the trained doctors to manage them. A simple solution is to provide Non Invasive Ventilators in every CHC. These can be easily managed by existing personnel. Thus effective ICU care can be provided at every community centre rapidly.
Such upgradation of facilities in rural health system will help not just the Covid-19 infected persons but also help the patients suffering from other serious medical illness get better quality care in the long run.
(DISCLAIMER: This is an opinion piece. The views expressed are the author’s own and have nothing to do with OTV’s charter or views. OTV does not assume any responsibility or liability for the same. The author is an Orthopedic Surgeon and can be reached at sidusahu@gmail.com)
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