The strategy for rural areas is also testing, testing and more testing. But for instance, in Wardha, a predominantly rural district, the RT-PCR test is available only in the two medical colleges. Unfortunately, more Rapid Antigen Tests (RAT) are being done, which miss a lot of positive cases. So, even if a villager tests negative, they need a confirmatory RT-PCR test, for which they have to come to the medical colleges. This is a huge problem for them given the lack of transport, as well as transport costs, which create hurdles in infected people getting access to tests. Since the start of the rainy season, acute fevers due to malaria, dengue or scrub typhus have gone up. There is a good degree of overlap in clinical symptoms of these and Covid. Cases of severe acute respiratory illness (SARI) which present with fever, cough, breathlessness and hypoxia are almost indistinguishable from Covid. We need to test and isolate them.
Without proper transport or health facilities closer to homes, are people coming in too late for treatment?
We do find people coming in relatively late, when already hypoxic. But most people would recover on their own and so what would they do coming earlier? It is only when you are hypoxic that you really need care. And it is good quality intensive care with dedicated doctors and nurses that saves lives more than any drugs. Oxygen is the most important medicine for Covid and we are really struggling with the rising need for oxygen.
Why don’t villagers, especially those with mild or moderate Covid, get treated at a public facility closer to them instead of traveling to Wardha town?
Public health is inadequately funded. Covid has revealed how the relationship between the various levels of care — primary, secondary and tertiary—is totally broken and we are paying the price for it now. Even now, there are vacancies in district hospitals and primary health centres (PHCs). Plus, the doctors, local nurses and ASHAs are not adequately trained to deal with Covid. The government has failed to plan properly and train health personnel. So if a villager reaches the PHC, there is nothing for doctors to do except to direct them to the district hospital and from the district hospital they are directed to the medical college. In this journey through the various levels, patients could lose time and spend scarce resources. This has led to a concentration of Covid cases in tertiary care centres and medical colleges, which are getting
overburdened. Many have drastically cut down on non-Covid work. It is a Herculean task, but we are trying to balance Covid and non-Covid cases because where will patients with heart or lung problems or cancer go? Cancer could become inoperable if treatment is delayed. Already in rural areas people struggle to access healthcare. If you turn them away, they might not come back and would be forced to depend on local quacks.
Didn’t the government augment facilities in district hospitals by providing more ventilators and oxygen supply?
The government might have dumped some ICU monitors, ventilators and haemodialysis units in district hospitals. But there was no proper training for the people supposed to use them. A few monitors or a ventilator cannot make an ICU. It’s like giving you a car without teaching you how to drive. A ventilator can kill you or cause serious problems if you don’t know how to use it. Doctors in district hospitals are reluctant to treat because they are unsure of their own skills. They tell the patient they got a bed arranged in the big hospital. He forgets that he is a doctor and not a commission agent or a travel agent arranging for travel and booking a bed. You cannot entirely blame the doctors. Often fresh MBBS graduates are posted as medical officers to far-flung areas with no support staff and no medicines. This young doctor is scared that if he tries to treat and something goes wrong the entire village would come and beat him up. So they hook up the patient to a saline drip and arrange an ambulance or any transport. The way doctors are being trained, their level of knowledge and skill is zero. So there is no competence or passion to treat even if they are posted in rural areas. People have lost faith in local healthcare facilities. They don’t have a choice because the government hospitals are in a pretty bad shape. They think private hospitals are better because they have better equipment, bigger buildings and better doctors. But there they make them undergo unnecessary CT scans, and overcharge for PPE, drugs, X-ray, monitoring etc. Such huge costs can ruin the entire family.