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Resource centre on India's rural distress
 
 

Rajendra Bharud, district collector of Nandurbar, Maharashtra, interviewed by Chitrangada Choudhury (Article.14.com)

-Article-14.com

As the Supreme Court demands an oxygen-supply plan from the Centre, caught off guard by an exploding pandemic, the Collector of a remote, tribal district tells us how he set up five oxygen plants ahead of the second Covid wave.

New Delhi: In a hearing on 5 May 2021, the Supreme Court asked the Centre to, within a day, present a plan to provide hospitals of Delhi the 900 metric tonnes of oxygen they needed.

The ultimatum to the Narendra Modi government came after days of fatal sparring between the centre and the state over medical oxygen supplies to the capital: at least 57 hospital patients have died in India’s capital city due to a lack of oxygen, as countless patients and their families desperately hunt for medical oxygen. Following similar deaths in a hospital in Meerut, Uttar Pradesh, the Allahabad High Court on 4 May  likened deaths due to a lack of oxygen supply to “genocide”.

As India's Covid-19 crisis spirals into a catastrophe, it is clear that governments and hospitals did not prepare over the past year for an increased requirement of medical oxygen that would accompany a new wave of cases. This, despite clear warnings from a parliamentary committee and 4 high courts (see Article 14 story here) over the past six months to augment oxygen supply.

An example of heeding early warnings and preparing for a possible second wave comes from the remote, tribal district in northern Maharashtra. Nandurbar's example shows how an administrator in one of the most marginalised parts of the country has been able to avert the ongoing crisis of Covid-19 deaths and a desperate hunt for oxygen with foresight, planning and judicious use of state finances.

Rajendra Bharud, MBBS, Nandurbar’s 33 year-old district collector, hit the headlines recently for taking action to equip hospitals in the district with their own oxygen plants, starting September 2020. The district now has five oxygen plants and is self-sufficient in oxygen. The Maharashtra government is asking other districts to  follow the Nandurbar example and set up their own plants.

A Bhil Adivasi and the son of a farm-labourer single mother, Kamaladevi, Bharud is a first-generation learner who overcame hardship to study medicine and then join the civil services. The district he heads is located on the border with Gujarat and Madhya Pradesh and spread across nearly 6,000 sq km with forests and hills to the north, and scattered hamlets that still lack road access.

India spends no more than 1.5% of its gross domestic product on the public healthcare system and has among the developing world’s worst health outcomes. In Nandurbar, 60 primary health care centres and 290 sub-centres (as per 2020 district data) cater to a population of over 1.6 million, about 70% of whom are scheduled tribe communities.  

“Most of these centres do not have enough staff, well maintained buildings or staff quarters which affects service outcomes,” said a 2021 official note prepared by the district administration. While the district has augmented its Covid-19 medical staff over the past year, mostly with contractual appointments, officials say attracting and retaining public healthcare system staff who can serve in the district’s remote rural areas remains a major challenge.

Edited excerpts of the interview with Bharud:

* Can you describe the Covid experience of Nandurbar of the past year, and how you and your team approached it?

Last year, when the first cases were detected in April-May, people were very puzzled, and also scared about this new illness. Nandurbar is a largely rural district with the majority of our people from tribal communities, and things like masks and hand sanitisers were unheard of for most people. When the first cases came, there was no testing capacity in the district. Not a single private hospital was willing to start Covid treatment. We had a 200-bed district civil hospital, with 95% occupancy at most times, since a bulk of the people of the district are dependent on government healthcare facilities. If we turned that over for Covid care, where would the non-Covid patients go?

There was a hospital project whose construction had been paused mid-way from several years for a number of reasons. We worked day and night and finished it in three months, adding 200 beds. We requested private doctors to help us with setting it up, and we have also recruited about 200 doctors and nurses in the past year. So, that is how we spent the first three to four months.

During the first wave, the maximum number of cases in a day that we recorded was 190, possibly due to the fact that tribal settlements are scattered. Meanwhile the first wave was receding. But looking at other countries, like Brazil, we had realised this is a temporary reprieve, and Covid will come back in a big way. So, we thought we should use this time to prepare ourselves. When Covid began, we had no testing lab and had to depend on the Government Medical College in the adjoining district of Dhule. We set up our own labs, and today we can conduct 1,800-2,000 RT-PCR tests per day in the district. We have made 28 mobile teams for rapid antigen tests, [they] can go around villages and wards to take swabs from people who might not be able to afford coming to a centre to get tested, or might not feel safe. We have also set up 7,000 isolation beds across the district, and 1300 beds for active treatment across government and private hospitals.

We acquired Remdesivir worth 50 lakh rupees under CSR funds and distributed some to private hospitals too. I prepared public awareness videos and disseminated them about the prescription and use of this drug since it’s indiscriminate use can be harmful. Our current daily patient load is 200-250. About 10% of patients need it, so our requirement is 20-25 injections per day. So we are not facing any shortage of Remdesivir.

There was no liquid oxygen plant and we were dependent on Dhule and Surat (in the adjoining state of Gujarat). The question before me was that, in the future, if there is a shortage in those districts, and they cannot give us (oxygen), what will happen to us? Last year in September, we decided to build an oxygen generation plant at our government hospital, using funds from the District Planning and Development Council. I also convinced two private multi-speciality hospitals that you start your own oxygen plant and do not be dependent on anyone. As cases went up, we installed a second plant in the civil hospital in the month of February, which could fully meet the demand. Shahada (a tehsil town in Nandurbar) had no hospital. We converted a hostel building into a hospital, and also installed a plant there which can today cater to 100 oxygen beds.

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Image Courtesy: Article-14.com