An inadequate rural healthcare system, a lack of awareness about the spread of coronavirus, combined with the difficulty in home isolation leads to increase in number of infections in Odisha
When Balmiki Majhi (39) of Alatara village in Madanpur Rampur administrative block of Kalahandi district developed cough, fever and body ache, the basic symptoms of COVID-19, he went to a nearby community health center (CHC) for a RT-PCR test.
As a social worker at an NGO, creating awareness among villagers about COVID-19, he knew the symptoms and hence immediately isolated himself. Seven days after the swab test, he received the test report pronouncing him positive.
When his oxygen saturation fell and he started feeling breathless, his family took him to Bhawanipatna District Hospital, from where doctors referred him to a covid care center. “Before he could get proper treatment he succumbed,” said Sarat Chandra Bhoi, a community mobilizer and Majhi’s colleague at the NGO.
Bhoi too sensitizes villagers about COVID-19 and frequently visited villages of Madanpur Rampur block till the first week of May. “After Balmiki’s death, I got scared and stopped visiting villages as the COVID-19 cases of in the second wave are more fatal and increasing in rural areas,” he said adding, these days he conducts online meetings, where villagers maintaining physical distances listen to him.
Increasing infection
In Mohangiri, a remote tribal village in the same block, 14 persons died of COVID-19 in the first week of May. These persons, mostly tribes and returned migrants died within a gap of 20 days. Many suffering from the infection are in home isolation.
“Those who are aware are going for the test, while others ignore it considering it a normal fever and cough. But the most pathetic is that some people with symptoms hide it, with a fear of being ostracized by villagers,” Bhoi told VillageSquare.in.
Those visiting community health centers face a different situation. Ratnakar Majhi (38) of Dangabahal village went to a CHC in Madanpur Rampur block where a crowd of nearly 80 people were waiting for a RT-PCR test. “After testing 20 people they asked us to come the next day. When we protested, they took swabs of everyone; among them 50 persons were positive,” said Ratnakar Majhi.
Kalahandi district with 47% test positivity rate (TPR) was among the districts with high TPR in the state. But Ratnakar Majhi alleged, “In most of the CHCs medical officers do not test villagers, citing shortage of testing kits. If they conduct more tests the number will increase.”
Isolation of patients
In rural areas, another problem is advising home isolation of COVID-19 patients. In villages nearly 70% people live in one-room houses, built with financial support from state or central government schemes such as Indira Awas Yojana or Biju Pakka Ghar Yojana.
Others live in small houses with thatched roof. “In these small houses where 4 or 5 people stay under one roof, how home isolation guidelines will be followed?” said Bijayalaxmi Biswal, a medical practitioner and a member of Citizens Collective for Public Health Network (CCPHN) that works on increasing health equity across communities in Odisha.
“Also the infected people who are advised for home isolation know they had been asked not to step outside the house. But there is no awareness that if they don’t wear a mask at home they will infect other members of the family,” Biswal told VillageSquare.in.
Quarantine centers
“In rural areas women are unable to follow home isolation guidelines, as they have to do all the household chores,” she said. To solve this problem and contain the spread of virus there is an immediate need to reopen temporary medical centers (TMCs) in villages, so that they can be used as quarantine centers.
Last year the state had provided Rs 5 lakh to each of the 6,798 panchayats across the state to set up TMCs to quarantine people coming to Odisha from other states, and to accommodate those showing symptoms of coronavirus infection.
The 16,815 TMCs set up in rural areas, are now defunct. “If opened, these TMCs will solve the issue of home isolation,” said Bhoi, adding that in rural areas other family members of the infected persons walk around the village without understanding that they may infect others.
Delayed results
Biswal said that the delay in getting RT-PCR test results also creates problems in rural areas. She shared one example of her patient, whom she was tele-consulting. Pradeep Kumar Sahu (45), of Thuamul Rampur administrative block called her when he received positive report 12 days after he took a RT-PCR swab test.
By then he had already infected eight family members; the condition of his elder brother (60) and younger brother Anil (32) became critical. When he consulted Biswal, 12 days had gone by without him having taken any medication.
“In rural areas people feel if you are positive then you need medicines and the RT-PCR positive report reaches them after 6-10 days of the swab test, owing to its geographical locations. This delays treatment and hampers getting admitted into hospitals, if the condition gets critical,” Biswal VillageSquare.in.
Strengthening grassroots
CCPHN which works at village level and provides tele-consultation to patients in rural areas, has given a few suggestions to the state government to tackle the COVID-19 situation in rural areas. The team found that in most villages there was one pulse oximeter and 100-odd thermometers were shared by 700 to 1,000 people.
“We suggested that the frontline workers should be provided with funds to procure pulse oximeter and thermometer. The ground level health workers should instruct people on indoor masking, use of pulse oximeter and calling district helpline at lower levels of oxygen. The ASHAs and ANMs should be trained to provide medicines once they detected symptoms through thermal screening,” said Biswal.
On rising cases in rural areas, Gouranga Mohapatra, national joint convener of Jan Swasthya Abhijan, a network of civil society organizations, said, “During lockdown people stay indoors to make it easier for the frontline workers to do door-to-door screening of every individual. This protocol does not exist in rural areas.
“There is no screening of villagers who have symptoms, no swab collection from door step and those who are positive are not sent to quarantine centers, besides no regular awareness program about COVID-19 guidelines,” Mohapatra told VillageSquare.in. “Because of this we are not getting real data of COVID-19 patients from rural areas.”
Health infrastructure
In Odisha, while a total of 1,700 intensive care unit (ICU) beds are available in Cuttack and Khordha districts, the number is very less in other districts. In Nabarangpur and Deogarh districts there is no ICU bed in district hospitals, while in Subarnapur and Bhadrak districts, the number of ICU beds are six and four respectively.
To meet the demand in the pandemic emergency, the state government has opened dedicated COVID care centers in the districts. An official from state health department on request of anonymity said, “In a district like Sonepur (Subarnapur) where government has opened a COVID care center with 20 ICU beds and ventilators, there is no operator to operate these ventilators.” The situation is quite similar in other districts too.
In most of the western districts where the TPR is high, there are few oxygen ambulances to bring patients from remote villages to COVID hospitals. “A prolonged neglect to the public health system in rural areas will create problem if the number of cases rises in villages,” said Mohapatra. “If the health system had been ready to cater, we could have provided better health service during this pandemic.”
In Kalahandi there are instances of villagers going to private hospitals when they could not get ICU beds in government hospitals. “In Madanpur Rampur block some people have taken loan from money lenders against gold and land to treat their family members in private hospitals,” said Bhoi.
In rural areas, another issue is that most of the people do not have regular health check-ups like those in urban areas. People in remote villages have no idea whether they are suffering from any co-morbidities like diabetes, asthma, blood pressure, etc.
“Before treating any patient for COVID-19, the doctors have to conduct other co-morbidity tests, else the treatment will go wrong creating problems for the patient and families,” said Mohapatra. Meanwhile, Anil, younger brother of Pradeep Sahu also succumbed when his oxygen level fell. He breathed his last before he could be treated, adding a number to the state’s COVID-19 death list.
Some names have been changed on request.
Rakhi Ghosh is a Bhubaneswar-based journalist. Views are personal. Email: rakhighosh@rediffmail.com
