COVID UPDATES
Asha Kiran Society COVID-19 Work - 1st Wave
Half-yearly Report July-December 2020
It is our pleasure to report on the Asha Kiran Society’s COVID-19 work for the months of July to December 2020.
The report covers four components namely
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Asha Kiran Hospital Preparedness
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Asha Kiran Hospital Staff Preparedness
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Asha Kiran Hospital Patient Subsidy
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Asha Kiran Society Community Mitigation work
COVID-19 Situation Analysis for Koraput District
Over the course of the second half of 2020 (the reporting period), the COVID-19 pandemic took root in the Koraput and Malkangiri districts.
We can see a clear increase in cases from the end of July 2020 when migrants came back from other parts of India and the government health programme started aggressively testing for COVID-19 in the general population.
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The number of officially recognized active COVID-19 cases peaked at the end of August 2020 and began to decrease from the end of October 2020.
This data is mirrored by the number of new infections reported for Koraput by the government over this time period. The highest numbers (over 150 per day) were reported at the end of August then returning migrants were being tested in the Temporary Medical Camps (TMCs).
This meant that there was a significant rise in the number of COVID-19 cases in the district, with the figure shooting up from 23 on July 1st to 537 on August 1st 2020. At this time, the Government issued various orders of containment in different villages where COVID-19 was found. The disease continued to spread at this point, with the overall number of active cases growing 5-fold to a peak of 2,487 by Sept. 1st 2020.
At the Asha Kiran Hospital, this has been confirmed with our COVID-19 care centre being fully used over these months. We saw a high of 543 people presenting at our special ‘Cough OPD’ where we screened all cough cases for suspect COVID-19 during September 2020. That month also saw us admit 49 people with respiratory distress in our COVID-19 referral centre, and also saw the first deaths of COVID-19 suspect cases with 3 people dying at our centre.
However, by Oct 1st 2020, the numbers of officially recognised active cases in Koraput district had come back down to 543, and since the end of October 2020, less than 5 new cases have been reported per day, which means that Koraput district entered into
the New Year of 2021 with officially only 43 active cases in the whole district.
We have not been able to get official data on testing rates, but our field experience is that there has been a marked decrease in COVID-19 testing done in the district, which is at least one factor for the lower rates of COVID-19 being reported.
At the same time, there seems to be a genuine decrease in the amount of COVID-19 in our communities as we have been seeing less ‘cough cases’ in our village Compassionate Surveillance, and the overall number of patients presenting at the Asha Kiran hospital has also followed the bell-curve of increases till September 2020 and then a gradual decline into the new year.
So in summary we can say that COVID-19 has hit Koraput district over this 6 month period. We are glad that the Asha Kiran Hospital was prepared for this (in large part through the help of the APPI) and that our Asha Kiran Society community initiatives were able to make a difference in our communities in a time of much confusion and challenge.
1. Asha Kiran Hospital Preparedness
The Hospital Preparedness component of the program involved:
a. Procuring of equipments for the treatment of Covid -19 patients,
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b. A rapid renovation of our existing training facility to serve as a dedicated COVID-19 Referral Care Centre for the care of suspect and confirmed COVID-19 patients and other infrastructure work to help protect staff and other patients from COVID-19 infection
Procuring much needed equipment
The following equipments were successfully procured for the hospital and pressed into service for the better management of COVID-19 at Asha Kiran Hospital
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Mobile X Ray
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CR System
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Piped Oxygen to the COVID-19 Care
Centre & HDU
4. Semi Fowler Beds
5. Defibrillator
6. Patient Monitors
7. Infusion Pumps
The Mobile X Ray and the CR System came in very handy for the COVID-19 care centre. With these equipments the patients were managed in the centre itself without having to mix them with the general patients.
The process of segregating patients from the triage centre to the discharge was successful do the X Ray and the CR system.
The COVID-19 Care Centre was also helped with the Semi Fowler Beds and the Patient Monitors, Infusion pumps and a Bi Pap machine which were used without it causing a difficulty for the rest of the general patients.
During this time there was a heavy influx of general patients also as most of the other hospitals in the Govt sector were limited in their functioning. The increased work load was managed both with all these equipments and the extra staff that were hired during this time.
Piped Oxygen was the greatest necessity for the patients as many of the sick patients came in respiratory distress and needed high flow oxygen. With the earlier system of having cylinders with smaller capacity there was a need for trips every two weeks to refill oxygen cylinders.
Although orders were placed for cylinders with bigger capacity there was a delay in procuring it due to the demand for those cylinders. Cylinders were taken for hire and piping system done to ensure better use of oxygen and better service to patients. This came as a great boon for the patients and saved many a life and was cost effective to the hospital.
The purchase of the Industrial Washing Machine has been delayed due to the washing machine. The present laundry room is getting renovated and the order has been placed for the washing machine. The purchase of all reallocated equipments are underway and all installations should be completed by the end of February 2021.
Cost-savings:
A Bi-Pap machine has been gifted for the Covid work from a well wisher of the hospital and the money allocated for the Bipap machine and the money saved from purchasing a refurbished defibrillator was reallocated for other equipments as requested from and approved by APPI. It was decided to go for a refurbished Defibrillator to save on the costs considering the extend of use it might have for the COVID-19 care centre.
The following renovation works were undertaken during the period and are completed-
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Upgrading the Triage Centre at the entrance of the Hospital
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New shed for the front of the hospital and the extension of roof over the entrance of the
OPD so that patients can wait outside and physically distanced from each other
3. Strengthening of the Front Fence
4. Mortuary for COVID-19 suspect and confirmed fatalities
5. Alternate entrance for the hospital for staff use (partially completed) to reduce exposure
6. Exhaust Fans for COVID-19 Care Centre
7. Autoclave Room (Partially Completed)
8. Other minor modifications for the Care centre have also been taken up during this period.
The Triage centre which was set up in the entrance of the hospital has changed the way the hospital managed the crowds. Screening at the entrance and ensuring that patients were segregated at the entrance was a great help for the better management of COVID-19 and general patients. The entire area leading to the COVID-19 Care facility, although within the same campus, was screened off and segregation of the patients were maintained during this time.
Alternate entrance for the use of the Hospital staff meant that the entrance of the hospital was well secured and only patients were allowed into the hospital.
The COVID-19 Referral Care facility was itself modified and exhaust fans were set up in the facility. The facility which is the Training Centre of the organization was converted into a hospital in a short time due to the funds that were received from APPI. A separate mortuary was also set up for the COVID-19 Care facility ensuring that there was a facility available for use.
A proposal for making OP toilets with Government support is pending approval and the funds for making OP toilets are unutilized. Under the approved proposal, the plan for building a laundry room was submitted. Later it was found that renovating the laundry room was more feasible and the funds are presently used to make an autoclave room for sterilizing linen and consumables.
The renovation works have been generally slow due to difficulty in getting materials for the construction purposes due to various restrictions for movement of material not entirely caused due to COVID-19 restrictions.
The Block Administration was monitoring all movement of construction material across the block to prevent default of taxes and this caused a delay in the procurement of essential building material. Due to the harvest season in this area, continuing monsoon from July to September there was difficulty in getting labour force for the various works that had to be completed. We expect all pending work to be completed by the end of March 2021.
IT support was also arranged for the triage centre and the COVID-19 Care unit of the hospital under this project The IT support meant that part of the MRD was moved near the entrance helping in smooth registration of the patients at the entrance. A separate billing counter was set up in the COVID-19 Care facility which was also helpful for the smooth functioning of the facility.
2.Asha Kiran Hospital Staff Preparedness
COVID-19 has taught us about how important personal protection is for all our staff – and for protecting our patients and their relatives too. At the earlier stage of our COVID-19 preparedness, when no PPEs were available and govt. regulations impeded transport, our Asha Kiran Society staff got down to making our own PPE’s and masks. With the generous support from APPI adequate PPEs were procured for all the staff working in the facility.
Staff who see patients in the COVID-19 Referral Care centre wear the full PPE when seeing patients in both outpatient and inpatient settings. Adequate Personnel Protective Equipments (PPE) (420 Nos.) & 610 N 95 Masks were procured for the safety of staff, patients and relatives in the COVID-19 Care Centre.
Two Watch & Ward staff was engaged for monitoring patient flow in different areas of the hospital. We currently have sufficient stock of PPE for the present. Future stock needs for PPE will be requisitioned from the funds of the hospital.
Mask wearing and appropriate use of PPE have now become the norm as we continue to serve patients in an age of COVID-19. By the grace of God, and through the judicious use of personal protection across the board – none of our Asha Kiran Society staff have tested positive for COVID-19 even in the midst of caring for so many suspect and confirmed cases!
2.Asha Kiran Hospital Staff Preparedness
This half-year saw Asha Kiran Hospital admit its first suspect and confirmed COVID-19 patients. Thanks to the help of APPI, we were able to develop a specific COVID-19 Referral Care centre (our Asha Kiran Training centre which was modified for this important task).
As COVID-19 started to work its way through our communities, the Asha Kiran Hospital saw a dramatic increase in OPD patients presenting at our COVID-19 unit, with the peak months being September 2020 (573 OP visits) and October 2020 (415 OP visits).
These months also saw a big increase in admissions for patients with severe respiratory problems and who were suspected to have COVID-19. Though the numbers of OPD patients has dropped in the last 2 months, we are still seeing very sick patients at our COVID-19 referral care unit.
While most of our patients admitted at the COVID-19 care centre were discharged healthy, we were sad to note that 16 precious people died over this period at our centre. A number of these were brought to us in a very late stage and died shortly after admission at our centre.
At the end of this period, the Asha Kiran Hospital has come to a point where treating patients suspected of having COVID-19 is a normal part of our work. We continue to see patients with acute respiratory conditions, and though our current numbers are less than in Sept. and Oct. 2020, we believe that COVID-19 is still present in our communities and so remain alert.
Having a base hospital with a dedicated medical and nursing team, which swung into action to care for patients has been a real blessing to the people of our community. Both suspect-COVID-19 patients and other patients and relatives have expressed how much they appreciate the fact that Asha Kiran Hospital did not shut down during the tough COVID- 19 lock-down days.
The Asha Kiran Hospital COVID-19 Care centre treated total of 1,912 OP patients and admitted 159 patients between July 1st and December 31st 2020.
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The Asha Kiran Hospital was able to give 100% charity to 63 COVID-19 suspect patients who were admitted at the COVID-19 Care unit. This amount came to Rs. 6,95,107/- which was subsidised by the
APPI. In addition, due to the challenging economic conditions brought about through the lock- down and other measures, the Asha Kiran Hospital was able to give a further 10% reduction in patient fees to 757 BPL patients. This further amount of Rs. 6,95,541/- was also made possible through the generous support of the APPI.
Total OP patients seen at COVID-19 Care Unit: 1,912
Total IP admissions at COVID-19 Care Unit: 159
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Total deaths at COVID-19 Care Unit: 14
4. Community COVID-19 Mitigation
The portion of the report covers the 3 community-focused programme activities which were part
of the 6 month proposal to APPI by the Asha Kiran Society: 4.1) Compassionate Surveillance in 140 villages 4.2) Masks for All Vulnerables in 150 villages
4.3) Caring Communities Initiatives in 150 villages.
4.1 Compassionate Surveillance
The core of our Asha Kiran Society COVID-19 Community Mitigation work over the June to December 2020 period is a monthly “Compassionate Surveillance” pulse outreach. This takes place over 3 common days across all the communities that we serve in the Lamtaput and Nandapur blocks of Koraput district and selected panchayats of Khairput Block in Malkangiri district.
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As an organization, the Asha Kiran Society runs community education through our 16 village centres, and are at the same time working with over 400 farmers in over 70 villages through the Adarsha Baghicha programme. We also have a designated Asha Kiran health outpost serving the Particularly Vulnerable Tribal Group (PVTG) of the Bonda in the Khairput Block of Malkangiri district. We designed the “Compassionate Surveillance” system to reach out to as many villages as possible during this time COVID-19 uncertainty.
For these monthly Compassionate Surveillance monitoring visits we relied mainly on local community teachers (who are participating in the Asha Kiran Society community education work as part-time helpers for their Village Education Committees) who were guided and augmented by some of our Asha Kiran Society staff.
The total number of our field-level COVID-19 response team was 66 (55 men and 11 women) who were supported by 15 supervisors.
On each Compassionate surveillance village visit, our COVID-19 team members met with village leaders
(elders, ASHA/ANM, Angandwadi worker, other village leaders) to understand the overall COVID-19 situation in their village. These key informants were then asked if there were any known Cough Cases. The team then went to the homes of these cases. The possible cough cases were then met outside their homes and if found to be currently coughing or to have any COVID-19 suspect symptoms, they were each given a face-mask, soap and education. Those
who had fever were given paracetamol and were asked to report any possible worsening of their
condition.
Health education on COVID-19 was also done by the staff at each home visit, and also on occasion for small groups in the villages. At times a short COVID-19 awareness video in Odia video (taken from National Health Mission, Odisha) was also shown to people in the village. Most of the time, portable flex posters in the local languages of Desiya, Gadaba, Odia and Bonda were used by the staff to help educate on prevention on COVID-19.
During this reporting period large flex banners (3 x
4.5 feet) were printed for the 24 Bonda speaking villages we cover in the Khairput block as well as for
the Desia speaking villages of the Lamtaput and Nandapur Blocks which are covered by the Compassionate Surveillance visits. These banners had basic prevention messages and were put up in a prominent place in each of the villages that we covered with the Compassionate Surveillance programme.
Compassionate Surveillance Results
From July to December 2020, the COVID-19 team members who were part of the Compassionate Surveillance conducted a total of 850 separate village visits. This was an average of 142 village visits per month – achieving our target of 140 villages to be covered.
In response to information gathered on these visits, our COVID-19 response team met 1,882 probable cough cases outside their homes and provided them with prevention education, advice and a face-mask, soap and simple medication when needed A total of 1,842 masks and 1,543 soaps were distributed in this outreach work over these six months through the Compassionate Surveillance village visits.
Out of the 1,882 home visits done to follow-up on potential cough-cases, a total of 1,345 (71%) were found to actually have a cough and given the proper treatment as per our protocol. Those who had any form of breathing difficulty were informed to come to a hospital should they have any worsening of symptoms. Those who were considered suspect for COVID-19 were referred to govt. health centres and the Asha Kiran Hospital. We noted that a number had colds, or fever, or their condition had cleared when our team visited the homes. As per the plan, the local Asha/ANM was informed about such a case and our COVID-19 team members would then follow them up within 3 days.
Overall, the response to our teams regularly visiting the villages for the Compassionate Surveillace work was very positive. A number of the villagers reported that they were happy to receive a home-visit and to be reassured with medicine and follow up when they were ill.
Food Security
COVID-19 cast a long shadow on our communities, and one core question was about whether there was enough food for all. Food security is important for our communities - and while our villagers are largely farmers, we wanted to check to see that enough basic rations are available in the homes. We thus had our COVID-19 team members do a quick house-hold food availability survey aiming to cover 5 homes per village as a simple food security monitoring tool as part of the Compassionate Surveillance monthly visits.
In the 850 village visits done between July and December 2020, our teams were able to visit 3,731 households to enquire about how much food grains they had stored. The results showed that on average the families had between 3.5 (just before harvest in October 2020) to 4.4 months (just after harvest in November 2020) of food stored.
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This year’s rains were decent, and the government also released PDS rice largely on time, so the average numbers of people having food grains remained constant. It should be noted, however, that a significant proportion of the population had only 2 months or less food stored (44% overall). When we look at the community break-ups we see that on average, households who were from scheduled castes had less food stored on average (3.3 months) than those from the Scheduled tribe communities (4.0 months on average).
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Public Awareness Drive
According to our plan, we planned to have fortnightly public awareness drives in market places and other publicly accessible villages. This entailed hiring an autorickshaw which we fitted with a public address system. The rickshaw had COVID-19 prevention banners on it and a staff member who would play a short audio clip of COVID-19 prevention which was recorded in the local Desia language (the most common local dialect). On the way to and fro the market, the autorickshaw also covered other villages en route.
By the end of the 6 months covered by this report, we were able to send out the loudspeaker- equipped rickshaw on 14 different days to do the public awareness drive. We were able to cover 167 villages in this way. In villages which were not covered by our Compassionate Surveillance, the team also put up banners to serve as long-term education about COVID-19 and where they can get help from.
4.2 Masks for all Vulnerables
To this end, Asha Kiran Society began the “Masks for all Vulnerables” approach where we went to every household in the village in two phases. First we made a map of all the homes and geotagged each one using a GPS device. Then we had our COVID-19 team members visit each home on the list and find out whether there are any elderly, known long-term
illness or disabled people in the home. Each such “vulnerable person” is given a face-mask, soap and COVID-19 prevention education inputs. A form with basic information was filled up for each person and since each home had already been geo-tagged, this information forms a basis for future follow-up and care. This includes the potential to do focussed vaccine coverage and also help guide long-term care for vulnerable populations.
After Asha Kiran Society began our initial Compassionate Surveillance outreaches in May 2020, we discovered that at that time very few people were being identified as ‘active cough cases.’ However, we knew that there were a number of COVID-19 vulnerable persons (elderly, known long- term illness or disabled) in each village.
Masks for all Vulnerables Results
The Asha Kiran Society set a target of covering 150 villages with the “Masks for all Vulnerables”
approach. We are happy to report that we have well surpassed this goal: the Asha Kiran Society team has in fact managed to cover all the panchayats of Lamtaput Block with the “Masks for all Vulnerables” campaign.
The 15 Panchayats of the Lamtaput block have a total of 188 revenue villages. Between July and December 2020, our “Masks for all Vulnerables” team did GPS geotagging of 218 villages/hamlets. This included a total of 13,805 households which were geotagged as part of this drive.
Out of these 218 villages/hamlets, our team was able to cover 203 villages with the door-to-door indentification of vulnerables and distribution of masks, soaps, and education to a total of 8,069 beneficiaries.
The team met a total of 8,069 people with vulnerabilities in the 203 villages/hamlets covered so far. There were slightly more female beneficiaries (54%) than male (46%).
As expected, the main bulk of the vulnerables were the elderly. The median age of the beneficiaries was 63, and 91% of the beneficiaries were in the over 60 year old (pensioner) category. Many of them expressed deep gratitude to the team as they were met in their homes and given masks and soap. The needs of the aged are very clear and those who are not completely fit find it hard as they are often lonely and feel neglected.
The next group of beneficiaries were people with long-term illnesses and comorbidities, of which our teams identified 471 (6% of the beneficiaries).
These included people with sickle cell disease, stroke, diabetes, liver disease, and cancer. People living with disability made up 2% of the beneficiaries. If our team found people coughing during the home- visits, a face-mask and education was also given to them. This accounted for 5% of the beneficiaries (393 people).
A small amount of people (11) identified themselves as having returned from migrant work. We expect that the true figure is a lot higher, but during this COVID-19 time, being a migrant has become something to hide.
In all, our team distributed a total of 7,825 face-masks and 7,825 soaps to the beneficiaries
along with hand-washing education. The community break-up was along expected lines, with 55% of the beneficiaries being from Scheduled tribes and 17% being from Scheduled Caste Communities. This mirrors the overall demographic make-up of the Lamtaput block.
4.3 Caring Communities Programme
The third component to the Asha Kiran Society COVID-19 community mitigation work was a plan to leverage the COVID-19 community interventions to help the Asha Kiran Society build a pilot 6 month long-term palliative/NCD programme.
Central to this part of the proposal was a strategy to recruit local-level animators from 5 clusters and then have them trained in the care of “people with long-term conditions” (palliative care / chronic disease cases). We the planned to link these animators with the cases that we find through the “Compassionate Surveillance” and/or the “Masks for all Vulnerables.” The plan was to train the 5 cluster animators, who would then in turn further train local volunteers and continue to follow these cases up in their villages. We also planned to develop an app which could track the progress of individual cases and help our animators and healthcare team follow up on long-term care in the villages. The Community Animators were to find and train local volunteers that we were going to call Community Partners to help out with their fellow villagers in need for 2-3 hours a week. Our idea of creating ‘Caring Communities’ is based on this thought - local people caring for their fellow villagers who need of long-term care to achieve a better quality of life.
As we look back over the July to December 2020 period, we see that though the Asha Kiran Society was able to make some positive steps to making a “Caring Communities” health programme, we were not able to implement all the plans put forward in the original plan submitted in June 2020.
Positive Steps in implementing “Caring Communities” health Programme:
a. Village Discovery Study
As Asha Kiran Society was stepping into new territory, we decided to conduct a rapid survey in July 2020 of 25 villages in 5 different clusters to understand their development status, poverty index, health seeking behaviour for major illnesses and their understanding of the work of Asha Kiran Society. The data collection included 247 house-hold interviews, 12 focus group / PRA exercises and 25 village profiles. The data collection team of 10 Asha Kiran staff was led by a recent TISS MPH graduate who had joined us in mid May 2020.
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The study report was given on August 4th and showed that most of the families in the villages that we serve are multi-dimensionally poor (70%) ranging from 60% in villages of Lamtaput block of Koraput District to 89% in Khairput block of Malkangiri District.
b. Patient Identification through regular Doctor visits to Bonda & Dasoput areas
Patients who were suspected of needing long-term care were visited in their homes and by an experienced doctor, a palliative care nurse and trainee nursing assistants. If on assessment the patient was found to be ‘dependent on others,’ in need of long-term care (including mental health care), and if the family members agreed for home-visits, the patient was enrolled into the programme.
The Asha Kiran Society was able to increase the frequency of doctor visits to the Dumripada Health Outpost in the Bonda Hills (Khairput block of Malkangiri dist.).
Since August 2020, our Family Medicine consultant has conducted 2-day visits on a fortnightly basis to the Bonda Hills. This has allowed her and the team to spend at least 1 day each visit to meet patients and families with the idea of gradually covering all the 24 ‘upper Bonda’ villages.
Patients who were suspected of needing long-term care were visited in their homes and by an experienced doctor, a palliative care nurse and trainee nursing assistants. If on assessment the patient was found to be ‘dependent on others,’ in need of long-term care (including mental health care), and if the family members agreed for home-visits, the patient was enrolled into the programme.
The Asha Kiran Society was able to increase the frequency of doctor visits to the Dumripada Health Outpost in the Bonda Hills (Khairput block of Malkangiri dist.).
Since August 2020, our Family Medicine consultant has conducted 2-day visits on a fortnightly basis to the Bonda Hills. This has allowed her and the team to spend at least 1 day each visit to meet patients and families with the idea of gradually covering all the 24 ‘upper Bonda’ villages.
Asha Kiran Society - Covid-19 2nd Wave Report - June 2021
COVID-19 is here in our midst here in Southern Odisha. We know that since mid-March 2021 the terrible “COVID-19 Tsunami” or the “second wave” of COVID-19 has crashed over much of India causing horrific deaths and immeasurable suffering. Given our remote location, the Koraput district was largely untouched by this ferocious onslaught until the early part of April when the official numbers of COVID-19 cases began increasing.
This steep rise in official active COVID-19 cases, with the 2,545 dwarfing the previous year’s
high of 950 was slowly reflected in our Asha Kiran Hospital patients.
We had our first cluster of 5 people with respiratory distress on Good Friday (April 2nd 2021) after not having any in-patients for 2 months and so reopened the Asha Kiran COVID-19 Care Centre on April 7th.
Asha Kiran COVID-19 Care Centre
After re-opening the 10 bedded Asha Kiran COVID-19 care centre, we immediately made plans to scale up our capacity since we could see how ferociously the 2nd wave of COVID-19 affected our colleagues in mission hospitals in other parts of India.
Thanks to the quick response from a number of friends, we added 5 beds almost immediately to the COVID-19 Care centre. As of mid-June we have been able to add a further 10 beds.
We now have a 25 bed facility with 20 beds having oxygen support with a new automated oxygen manifold, 2 Non Invasive Ventilation Beds and 3 Casualty Beds. We also have received 9 new oxygen concentrators and few more expected to arrive soon.
We have added an additional 2 multiparameter monitors and 10 bedside monitors to check on the patients’ vital signs. Our first ventilator is just about to be purchased – which would be the first working ventilator that is actually used by physicians in the district – and we have added a second Bi-pap machine to the one we are currently using. We are also just about to get a portable x-ray machine for our general ward to be able to do rapid bed-side x-rays for COVID-19 suspect cases as well as a needed new ultrasound machine.
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As we moved into May, we started seeing increases in COVID-19 suspect cases. Our COVID-19 Care team saw
390 outpatient cases, and admitted 44 for treatment at the centre. The first week of June has seen another 15 admissions, which would mean 60 admissions in June if the trends continue.
Soberingly, we see that the COVID-19 patients this year are far sicker than last year. We lost 14 patients already in the 2 months from April 7 to June 7. In addition, we had 3 patients dead on arrival (2 in April and 1 in May). We know that at least 2 patients who left against medical advice subsequently died in their village – because we have community work there.
Challenges in running the COVID-19 Care Centre
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Oxygen
Oxygen is the single most important tool to help patients with moderate and severe COVID-19 pneumonia. At Asha Kiran Hospital we have been able to purchase 25 big cylinders and have rented another 12. Our support team keeps moving between Jeypore (40 kms) and Vishakapatnam (175 kms) to get these vital filled. So far we have not run out of oxygen (we came close) but the struggle we face (many phone calls, much stress) means that we are exploring getting our own oxygen plant for any future eventualities.
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Access
COVID-19 is a fearsome disease for many. Because of last year’s heavy-handed actions by authorities, many patients
put off treatment until it is late – sometimes too late – arriving at our centre already dead.
We also know that our communities are suffering from multi-dimensional poverty and so the fear of hospital bills keeps many away from getting timely treatment. With this in mind we have introduced an aggressive system of giving charity for our COVID-19 patients. All deserving patients get 50% standard charity on their bills, and a number avail of even more if they have any difficulty to pay.
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Staffing
The Asha Kiran Hospital continues to provide curative services to the local community and is the only community-focused non-government hospital in the
districts of Koraput and Malkangiri. Our staff are divided between both the general hospital and our COVID-19 Care Centre – as we are managing both simultaneously. We have added staff to cope with the demand of manning both the general hospital and COVID-19 care unit. We are also providing structural modifications to that patients and attenders in the general hospital are physically distanced.
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Protocols
Our excellent clinical team has been refining various protocols, continually updating our COVID-19 treatment to be evidence-guided and locally appropriate. The nursing and other staff are then equipped through trainings in these protocols. We meet as an Asha Kiran COVID-19 Response team at least once a month to review progress and also to frame practical prevention policies for the Asha Kiran Society. All our hospital staff have been immunized and though a few have fallen sick, we have been able to treat each staff member successfully. This has allowed us to keep caring for COVID-19 and non-COVID-19 patients.
Help-line and Home Tele-Monitoring
Our team has set up an Odia language COVID-19 Help-line which provides information and counselling on issues around the disease, treatment and vaccination. We have also started a ‘home tele-monitoring’ process, where patients who are discharged from our COVID-19 care centre are followed up over the phone in their homes. Besides providing encouragement and guidance, we have already seen a number of patients who got admitted for treatment thanks to the phone-interventions.
“War-Footing” Community COVID-19 Care programme
We know that COVID-19 is in the community and have started to see the first deaths. So as an emergency response, we have as of June 1st we have sent all our Asha Kiran community engagement staff and local resource persons out to cover over 250 village hamlets. We are monitoring the entire Lamtaput Block of Koraput district as well as 26 upper Bonda villages in Khairput block of Malkangiri district and a few adjacent village hamlets too.
We have designated the 72 workers and 11 supervisors into 11 teams and trained them in basic COVID-19 case detection and home-care. The strategy is for each Community COVID-19- Care Worker (CCW) covering 2-5 villages with every village to be visited at least 3 times a week for this surge period. Daily information sharing from CCW to team leader and then from Team Leader to our COVID-19 Case Manager and Community Consultant Doctor means that we have a rapid way of understanding the COVID-19 situation in our communities.
The main focus of this approach is to reduce COVID-19 mortality by having mild COVID-19 cases identified early in the village and treated at
home with simple medications and education on staying at home and having all members wear masks for mutual protection. Each mild COVID-19 case is to be monitored for any worsening on a daily basis and should any deterioration be seen, they are immediately referred to the Asha Kiran COVID-19 Care centre for further assessment and treatment.
Our Community COVID-19-Care Workers are constantly looking for the more serious supect cases of “COVID- 19 Pneumonia.” This is when the person is found to have higher respiratory rates, fever and cough persisting after the 7th day and / or low oxygen saturation levels.
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This is a serious condition and our CCW motivates them to come to the Asha Kiran COVID-19 Care centre for an x-ray and further assessment by the medical team.
If we find that a village has over 10 mild COVID-19 cases or 3 suspect COVID-19 pneumonia cases, we send a Rapid Response Team to support our CCW and Team Leader in seeing that any possible COVID-19 pneumonia cases are speedily brought to the COVID-19 Care centre for appropriate and timely treatment.
The young pregnant lady who we highlighted at the beginning of this report – the one who was found yesterday to be COVID-19 positive at the government health centre – this lady was visited by a rapid response team today – and her village which has 14 other mild cases has been covered and is being monitored by our Community Teams.
In the first 10 days of our programme, we our teams have already identified 1004 possible mild COVID-19 cases in our communities and 32 suspect COVID-19 pneumonia cases. We are in the process of following
up these precious people and our hope is that we will be able to save many lives. We also hope to build a non-coercive, people- friendly way of helping our village communities deal with the challenges of this disease and so fulfill the Asha Kiran vision of seeing “just and compassionate communities, choosing and celebrating life.”
We have sought to include other local volunteers in this community care process and have done 2 trainings at the Asha Kiran Academy as well as an on-line training for Community Partners to further equip our communities to address the grave challenges of the COVID-19 2nd wave.
Vaccinations
We know that vaccinations offer a bright hope to addressing the COVID-19 challenge in our communities. Our Asha Kiran Society leadership is currently talking with government health officials about our dream of having every eligible person in Lamtaput block fully vaccinated against COVID-19. We hope to build an effective vaccination strategy based on the intensive village/hamlet coverage that our “War-Footing” Community COVID-19-Care programme is laying in the month of June 2021.
But we have already become involved in partnering with the government’s vaccination drive in the Khairput block of Malkagiri district. The district administration is particularly
interested in vaccinating the Bonda Community. The Bondas are a Particularly Vulnerable Tribal Group (PVTG) of which about 7000 only are left living in 26 upper Bonda villages.
Coverage for COVID-19 vaccination was very poor when the government health workers went to the villages – partly based on the experience of actions taken in last year’s COVID-19 testing drives.
The Asha Kiran Society offered its services to the district administration, and we are happy to report that we are seeing good initial responses in villages where the Bonda community are familiar with our staff. We have a Health Outpost manned by a nurse and also have locally trained health assistants and education workers from the Bonda community serving with us.
Our staff stay in the Bonda Hills with the community and have learned the Bonda language, which allows for better community mobilization. Our hope is that all the Bonda people will accept this valuable protection tool and that we will build new levels of trust between them and government health authorities.