Visitors are not allowed at Manappuram, a village of the Savara tribe under the Seethampeta ITDA (Integrated Tribal Development Agency) in Andhra Pradesh, with a population of 1.5 lakh people. Krishna Rao, a resident of the village and a tribal activist working with a non-profit organisation, says, "We have barricaded the village to prevent outsiders from entering.” The 60-year-old adds, “COVID-19 cases have been reported in two neighbouring villages. There is a lot of fear among the tribal communities over contracting the infection.”
Since May this year, several villagers have fallen sick with fever-like symptoms at this village, “This is a season for Malaria, as it has rained. So everyone is treating it like Malaria,” says Krishna, “Those who fall sick avail treatment from Regional Medical Practitioners (RMPs) and bank on traditional herbal medicines to recover. But what if it is COVID-19? The nearest testing facility is far, ” he adds.
Suhasini is a village volunteer, one of the 2.6 lakh volunteers recruited by the Andhra Pradesh government in 2019. Initially created to help identify and enrol beneficiaries to government welfare schemes, the volunteer groups now assist in COVID-19 containment.
Suhasini is in charge of overseeing the health parameters of 50 persons in her village of 350 persons. Throughout the week, she stays in regular contact with staff at the nearest Primary Healthcare Centre (PHC) at Donubhai, 13.2 km away. “When I identify a person with fever, first I ask the person to isolate. I then alert the health staff who arrange for testing at the PHC. As our village is remote, the PHC staff may not visit every day. At present, one person in the whole village has fever symptoms,” she adds. The village has not yet reported any COVID-19 cases.
Andhra Pradesh has around 50 lakh tribal persons living across 13 districts. And for this population spread across seven ITDA regions, the state has just 159 PHCs. All cinema halls, residential schools, gurukulams, and guest houses have been converted into isolation centres.
“The tribal homes are mostly small, one room dwellings; there is no scope of isolating people there. So we move those who test positive to isolation centres. The food and accommodation is provided free,” says DN Murthy, State Senior Health Coordinator, Tribal Welfare Department, adding that the state is yet to tabulate COVID-19 cases and deaths specific to the tribal communities.
The state hopes to raise awareness about the disease and enrol tribal communities for vaccination drives. Despite a network of ASHA workers, Auxiliary Nurse Midwives (ANM) and volunteers, reaching out to all 16,000 tribal hamlets across the state has been a challenge for the ITDA and the health department. "Of the 16,000 hamlets, about 2,500 of them are situated in difficult or inaccessible terrains, about 800 of them cannot be reached on a two-wheeler, as there are streams in between and no proper roads. Several of these hamlets are in areas with Maoist activity. Our hope is to limit the disease at the mandal level and not let it spread further in the rural areas. Those who travel from urban to rural areas are the ones falling sick,” Murthy adds.
To get tested for COVID-19 in the Integrated Tribal Development Agency (ITDA) regions of Andhra Pradesh, people often have to rely on village volunteers. These persons help identify patients with fever and COVID-19 symptoms and report them to the health department. Officials say the system has helped trace primary contacts of COVID-19 patients with ease on several instances.
The state on Monday reported 1,89,367 active COVID-19 cases, Srikakulam district under which Manappuram village falls, reported 18,923 active COVID-19 cases. Which is why volunteers need to be vigilant now.
Sridhar CH, the program officer for Seethampeta ITDA, AP Tribal Welfare Department, is in charge of these settlements across 20 mandals. He says there are 29 PHCs in the ITDA region, apart from two Community Health Care Centers and area hospitals. “Srikakulam has a population of 29 lakh people and 120 PHCs, and I have under my jurisdiction 29 PHCs for 1.5 lakh people. Which is good, right?” says Sridhar. The officer says the village volunteer system has helped them detect cases sooner and help contain the spread. “If there is a positive case, tracing their primary contacts is easier,” he adds.
The officer says their focus has been on messaging. “We have travelled to each hamlet giving them awareness on COVID-19. We urge them to wear masks, follow social distancing and improve their sanitation. We met with church and temple heads asking them to stop all kinds of events. We reached out to traditional medicine practitioners asking them to not give any medicine for COVID-19 like symptoms. If anyone tests positive, health officials visit their homes every day,” says Shridhar. Those in-home isolation are given medical kits.
About six lakh tribal communities reside across the Paderu ITDA of Visakhapatnam district which reported 19,120 active cases on Monday. The program officer Dr Vishwaeshwara says the second COVID-19 wave has reached the tribal belt but has not resulted in deaths. “If a lot of fever cases are detected from a village, health officials carry out a camp to collect samples for testing. But mostly it’s Malaria cases which are being detected, which is a seasonal disease in these parts,” says Vishwaeshwara, before adding, “Fortunately there are not many cases from the deeply forested hamlets, most cases are limited to the mandal headquarters.”
Officers say they use the same network of volunteers to help identify those above the age of 45 to get them vaccinated. “But there are no vaccine doses available,” says Shridhar, “We now have several people who are due for their second COVID-19 dose.”