Seema Mundoli, an author and senior lecturer, recently tweeted that her mother in Kerala had been waiting to get her second dose of the COVID-19 vaccine. It had been delayed because of the recent vaccine shortage in many states. On May 3, Monday, a ward councillor called Seema's mother and told her to go to the general hospital to get her second dose. Seema wrote that she was in shock that a councillor would call home directly and get this done.
Her tweet was in response to a thread by Chennai-based journalist PJ George. He had written about a proactive ASHA worker in Thiruvalla who was so sensitive about a girl who had a 'psychological episode' in her ward that she ensured that an ambulance, which was assigned to pick up a COVID-19 patient in the ward, arrived without sirens. The ASHA worker worried that the siren could be a trigger for the girl, who was already affected by the lockdown and deaths due to COVID-19.
"She called ahead and told the family that an ambulance will be coming and not to worry. She also got the ward member involved and they ensured that the ambulance arrived without the sirens. The hospitalisation went without a hitch. You need macro-level planning as well as micro-level dedication for a robust system. Also, the neighbours I am talking about are not well-off. These are BPL (Below Poverty Line) households. This care is available to them," George said in a series of tweets.
Ever since COVID-19 was reported in the state, local bodies have been a big part of the fight against the pandemic â€” councillors coordinating the work, ASHA workers checking on the patients and volunteers reaching homes with all aid. The second wave of the pandemic needed all of them to come together and do more. Ward-level committees were formed to tend to the infected persons in respective wards. The staff of the state health department and local bodies shares information with each other to keep track of every patient and their well-being.
An ASHA worker visiting houses in Thiruvananthapuram
â€śI tested positive for coronavirus on May 1 and informed our ward councillor, Dr Reena. Since then, I would get multiple calls every day â€“ from the health department, the ASHA worker, and sometimes from the officials of the Museum Police Station, who would arrive at my apartment building to ask if I need anything,â€ť says 56-year-old Abraham, an agriculturist in Thiruvananthapuram.
Perhaps since Abraham had directly informed the councillor, he has also been receiving a free kit of provisions, arranged by Vattiyoorkavu Member of Legislative Assembly (MLA) VK Prasanth.
Rapid Response Teams
Residents are asked to inform their ASHA workers as soon as they test positive for coronavirus, who would then inform the ward councillor and the health department, says Gayathri Babu, ward councillor of Vanchiyoor in Thiruvananthapuram.
â€śA rapid response team (RRT) is being formed in every ward under the Thiruvananthapuram Corporation. We have one in Vanchiyoor with 25 volunteers. These volunteers would be given passes so they could move within the ward to deliver essentials to COVID-19 patients even during the lockdown,â€ť she says.
Leaving food / ration packets at patients' home
It is not just the delivery of essentials such as food and medicine that the volunteers deal with. They also take patients who need emergency treatment to hospital and make arrangements when a COVID-19 patient dies.
Medical team visit homes
The ward-level management differs in different districts. In Thiruvananthapuram Corporation, for instance, a control room containing volunteers and medical volunteers function in the main office. The volunteers form teams of 25 in each of the 100 wards under the Corporation. â€śSo we have 2,500 volunteers in the Corporation limits. There are also teams of medical volunteers who will attend to COVID-19 patients at home â€“ this includes doctors, nurses and paramedical staff,â€ť says Thiruvananthapuram Municipal Corporation Mayor Arya Rajendran.
The arrangement was made when the number of patients began exhausting the hospital and treatment centre resources. Hospitals began running out of beds and first and second-line treatment centres were also fast filling up.
An RRT volunteer taking a patient to an ambulance
â€śWe are trying to save the resources as far as possible by taking treatment to the homes of patients who may not need hospitalisation but still need medical help. Whatever treatment can be provided at home will be managed by a team of medical volunteers. We have software to get a list of people who turn positive within the Corporation limits every day. There have been around 1,500 to 2,000 cases every day within these limits. We call each of them to understand their situation and see that they are safe. On the basis of our interactions â€“ either through our calls to them or patients calling us â€“ our medical volunteers take a call on going home with treatment,â€ť Mayor Arya explains.
New wave, new team
Last December, a new set of local body members got elected and within days, they had to learn the ropes and begin action. By March, the second wave of the pandemic had set in and cases began surging by thousands every single day.
â€śWithin four months, they formed panchayat and municipal committees for Health Jagratha and ward-level committees to do follow up. The focus before the surge was on the vaccination drive of the state government due to vaccine hesitancy at that point. So LSG (Local Self Government) members contacted eligible people, including those with comorbidities, and helped in the organisation of the drive. But when the surge happened and there was a shortage of vaccine, the drive had to be rolled back,â€ť says Saradha Muraleedharan, additional chief secretary of the LSG Department.
The attention then shifted to contact tracing, she says, to help in identifying those who could be positive for the virus because there would be a lot of asymptomatic people.
â€śThere are 150 COVID-19 patients in my division and three ASHA workers call all of them every day,â€ť says Bindu Devassy, councillor of ward 53 in Ernakulam Corporation. â€śDepending on their needs, the ASHA workers take food and medicine to each of their homes. Once an infected person tests negative, the house and the surrounding area is sanitised,â€ť she says.
Taking ration home, arranged by Ernakulam district administration
The Ernakulam Corporation has asked ward councillors to prepare a list of those who are completing 60 days of taking the first dose of vaccine. â€śPriority will be given to those taking the second dose than those who have not taken the first dose,â€ť Bindu says.
In Perambra of Kozhikode, ASHA worker Rathi Rajeev makes several calls every day to COVID-19 patients at home. Among other things, they ask after family members in the house, advising them to wear masks at home, connect pregnant women to doctors and so on. She and another ASHA worker manage the home-quarantined patients in the ward and drop off medicine near the house wall to be picked up later. â€śWe get data from the Taluk hospital and from private hospitals, and we also call up testing labs to find if there are any new patients in our ward,â€ť she says.
Dealing with hospitalisation, panic
The state government has arranged domiciliary centres for those who do not have facilities â€” viz. a room with an attached bathroom â€” to undergo quarantine at home. But people are not always willing to move out of their homes. Thycaud ward councillor Madhavadas remembers the case of a young man with COVID-19 who didnâ€™t have a toilet at home. He had to use a public toilet. However, he was reluctant to move to a treatment centre and had to be insisted. â€śIn another case, a middle-aged man named Sebastian was in a bad state, really exhausted and coughing, but there was no hospital bed immediately. We contacted the Collectorate and by 11.30 that night, we could move him to a hospital,â€ť Madhavadas says.
An ambulance of Ernakulam district administration
The reluctance in hospitalisation that Madhavadas mentions has now however given way to panic in the second wave, says Sarada.
â€śThere has been a certain level of panic because people have been hearing reports of oxygen shortage in other states. So, from the point where people used to hide that they were sick, now they go to hospital straight away as soon as they show symptoms (before informing ward officials added this). The LSG teams have to also address such concerns,â€ť she says.
Ambulances are also another service that several local bodies have been trying to provide. Mayor Arya is converting unused school buses into ambulances. Sarada said that local body leaders use their network of contacts to find if there are people willing to lend their vehicles that could double as ambulances.