Dr Monika Chaudhary, Associate Professor, IIHMR University Jaipur details steps that can be part of a strategic response to the management of COVID-19 in villages which need to be developed at national and regional level. IIHMR University Jaipur has been implementing various strategies at the rural levels and has been working with the Government of Rajasthan for developing models. It played a key role in implementing the Bhilwada Model during the first COVID-19 wave
Corona cases seem to be declining in India, but there is a bigger worry. District wise data shows that rural areas are having bigger number of corona positive cases in most states. In the third week of My, 17 districts, many constituting small towns and rural areas, reported about 48 per cent positivity rates. In the villages, there is a hesitation and a lack of testing facilities, which account for a large number of undetected cases. The number of deaths also goes unreported. Television channels have been reporting spread of the virus in rural areas. In villages people tend to avoid seeking care and hide symptoms from others, in case of infection, which would result in preventable loss of life.
During the recent lockdowns and movement restrictions in many states, migrant labourers have returned back to their villages. Buses full of pilgrims had gone for ‘Kumbh Mela’, they brought back corona with them, when they returned. Jalalpur village in Greater Noida had seen 18 deaths in a span of 14 days, the first death being reported on 28 April. Kheerva village in Laxmangarh tehsil of Rajasthan, which has a population of 3500 had witnessed 21 deaths in 21 days during April-May. The burial of a man who had died in Surat was done in Kheerva village and many people had reportedly touched the body of the deceased. Although later the district administration issued a statement that the man was not a COVID patient. A community spread of the virus is imminent due to migrant movements, lack of mitigation measures, almost no testing done for the symptomatic or asymptomatic patients in rural areas and low social awareness about the disease.
Many villages in rural areas do not have health centres. Those, that have the health centres do not have the required facilities to handle the community spread of virus in the village. Many of these centres do not have basic medicines, or basic testing tools like pulse oximeters and thermal scanners. There are no facilities to conduct RT-PCR or rapid antigen tests. Many of these centres do not have adequate medical staff – doctors and nurses. Strategic response to the management of COVID-19 in villages has to be developed at national and regional level.
Identification of infected villages
The first step should be to earmark corona affected villages and distinguish them from corona free villages. In Rajasthan a team of three, Asha, ANM and Anganvadi workers have been assigned the job of area wise screening. Additionally, telephonic or messaging services should be used to get reports from Sarpanchs about the number of deaths in a village in the last two months. An unusual surge in the number should make for a case for screening and testing in the village. Gujarat CM launched a ‘Corona free village’ campaign with an aim to free villages of corona in 15 days. A ten member committee will to be formed in 14000 gram panchayats in the state to look after corona management.
Awareness for management of disease
People tend to ignore early COVID-19 symptoms in the villages. An awareness regarding early disease and quarantining protocols should be created through radio and television. School teachers and retired army officials in villages should be assigned the job. Mobile campaign through videos, digital posters in local language should be provided to the teachers and the army officials to raise awareness. People tend to hide that they have coronavirus case in a family. Targeted counselling of such families should be done by the health workers and other educated people in the village. Sarpanchs should be given strict orders to enforce mitigation measures in the villages. It is important that residents of infected villages should not be travelling to the other areas.
Testing
In other parts of the world, community spread of virus in rural areas was handled by testing every citizen in the community, when some positive cases are detected in the vicinity. Ambulance or mobile vans could be sent to the villages to conduct rapid antigen or RT PCR tests of all the residents, where the number of reported deaths is large. Strict lockdown should be imposed in the villages where large numbers of cases are found.
Establishing distribution channel for medicines
Availability of medicines locally, to tackle the early stages of disease is critical for saving lives. Supply of medicines kits for COVID-19 to primary health centres is a challenge. Regular medicines are also not available at some of these PHCs. Some states in India have free drug distribution outlets and online sourcing systems. For the other states, a bulk order to pharmaceutical retail chains could be placed to fulfil medicine requirements for COVID-19 in the PHCs. Unless, medicines are distributed at the health centres, people will not be motivated to seek care. There is a tendency to go to quacks in the villages. Those practices would lead to a further spread of the disease.
Tele-consultation with doctors
Tele-consultations with the patients for home treatment have worked very well in the urban areas. There are some constraints for the rural people to be provided such services as internet connectivity is low and phone numbers of the doctors that could be contacted are not available to the villagers. Dissemination of such information in a list of doctors who could be tele-consulted should be made by the state government at every PHC and Panchayat. In the rural areas a group of volunteers could be assigned the job of making telephonic calls to the doctors.
Care taken close to patients
Availability of mobile medical vans, oxygen and ambulance services for the patients having respiratory problems due to a COVID-19 infection have to be arranged. These patients in the rural areas are to be hospitalised in the nearest community health centres. COVID-19 beds have to be arranged at these centres. Hospitals in small towns could become overwhelmed due to a surge of COVID-19 cases in the villages. Care has to be taken close to the patients. Make shift hospitals could be made in the village schools, which are available, as it is holiday time.
Funds
CSR funding, local charity or crowdfunding could be resorted to, for the supply of medicines, masks, sanitisers and rapid antigen test kits in the interior. People are willing to help, but help channels have to be created. Chief Ministers have set up fund-raisers. Government has to take quick steps to organise testing and medical camps, establishing distribution channels for medicines and establishing make shift hospitals in small towns. A part of this work could be outsourced to CSR. For the efforts to be coordinated, funds could be sought by the government for providing quick relief response. Saving lives is the interior area is a challenge, which could be overcome only by coordinated efforts of the state, the private sector and the people.
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