COVID-19 second wave: Model Gujarat doesn't shine through

Geetaben Vasava is an Accredited Social Health Activist (ASHA), who has not had a single day off in the last five weeks. Based in Ghoghamba taluka of Panchmahal district, she sometimes walks the undulating terrain for over an hour to reach a patient, who is complaining of shortness of breath but refuses to visit the primary health centre (PHC).

Knowing that she is going to see a COVID-19 patient, she carries with herself paracetamol, vitamin C and zinc supplements, while praying that the patient is not serious as she neither has a blood pressure machine nor an oximeter to ascertain the patient’s health condition. She urges them to visit the PHC for a follow up but the tribal family would not budge.

A prerequisite to ensure that the rural health infrastructure works effectively in the tribal-dominated area is to convince people that it is safe. Those who do overcome the fear of COVID-19 medicines being a “shot of death or infertility” and make it to the sub-centre or PHC for treatment, are invariably directed farther to the community health centre for want of staff or testing kits.

“There is a severe staff shortage at PHCs. Every team is shared between two to three centres. Patients are asked to wait two to three days to take a test, whose results arrive after another three days. For CT Scan or oxygen support, the patients are invariably referred to urban centres like Godhra or Vadodara,” says Neeta Hardikar, an activist who has been working in the tribal areas of Panchmahal and Dahod districts for 25 years.

At the urban centre of the district, Godhra, Anwar Kachba is the nodal person at the designated COVID-19 healthcare centre that was started last year by a local trust. In February this year, it was disbanded, but restarted in early April on short notice in coordination with the state government.

For five weeks, between early April and mid-May, Kachba received at least 15 calls per day from COVID-19 patients seeking hospitalisation. Of these, the makeshift healthcare facility, created from donor support on the premises of a mosque, could admit less than half.

“Five of the 15 needed ventilator support, which we did not have. So they went to other government or private hospitals,” he says. “At one point, I have seen two patients sharing a bed in hospitals,” says Zuber Mamji, secretary of the trust that has set up the COVID healthcare centre.

Responding to the crisis, the district collector converted a section of Godhra Nursing School into a 40-bed intensive care unit (ICU) with 20 ventilators. Godhra Civil Hospital, too, added 15 ventilators. At the Narayan Eye Hospital in Tajpura, Halol taluka, 15 ventilator beds and a medical facility were added by mid-April. The district has over 400 COVID care beds with basic oxygen support.

The availability of oxygen, however, is another story. Kachba says, “we could deal with everything, except oxygen and medical staff crunch. Nobody anticipated things would get so serious,” he says repeatedly, shaking his head in despair. Panchmahal had elections early this year starting from the Godhra nagar palika polls in February, gram panchayat polls in March and bye-poll of the Morva Hadaf assembly seat, a tribal region, as late as mid-April.

“The shortage of trained medical staff is because appointments are made on an 11-month contract. This makes the government jobs less lucrative and the process cumbersome. We need a dedicated full-time health worker cadre immediately,” says Dileep Mavalankar, director of the Indian Institute of Public Health, Gandhinagar.

Staring at starvation

The slowdown in the economy has halted growth in urban areas, but some rural households are already facing starvation. “Most people from the region migrate to cities to work as construction labourers. Following the lockdown in early May, they have returned and are seeking wage-works under the Mahatma Gandhi Rural Employment Guarantee Act (MGNREGA).

Last year, MGNREGA helped the returning informal workforce tide over the lockdown. This year, due to the rollover of the financial year and the government law requiring renewal of job cards every year, several needy families are unable to apply for MGNREGA works. Payment disbursement, too, is not timely. “We see starvation as a problem in about 35 per cent of the households we work with in Ghoghamba and Shahera talukas,” says Hardikar, whose non-profit Anandi works on issues of food security and women’s health.

The Centre for Labour Research and Action, a Udaipur-based non-profit, recently conducted a study of eight districts in Gujarat and Rajasthan, including Mahisagar and Dahod districts that are contiguous with Panchmahal and share similar socio-economic conditions. It has found that 58 per cent households in the region suffer from food shortages.

Project director Sudhir Katiyar says, “We are still investigating the reasons for unusually high number of deaths in Panchmahal and surrounding regions. It appears that construction labourers employed in Ahmedabad are badly hit. The inter-state portability of ration cards is also not working.”

This was first published in Down To Earth’s print edition (1-15 June, 2021) 

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