News Source: www.fd.nl . A covid patient in Ghaziabad, north-eastern state of Uttar Pradesh, is given oxygen by an employee of Khalsa Help International, a non-governmental aid organization. Photo: Sumit Dayal / Bloomberg
We don't have one CT scanner in the wider area, and not one ambulance with respiratory equipment. And that for an area with 500,000 inhabitants. Prabhat Sinha is exhausted. He was up at 4 this morning to arrange transport for medical oxygen for corona patients. "I get calls from patients day and night.
Sinha is not a doctor or a nurse. He works for the Mann Deshi Foundation, which specializes in financial services for rural women in a drought-stricken region in the southwestern state of Maharashtra. The second wave of corona to hit India has mercilessly exposed the limitations of primary health care in rural areas, turning countless people like Sinha into full-time caregivers.
Initially, Corona did not hit India and especially the countryside nearly as violently as it does now. The biggest problem last year was the lockdown, loss of income and return to villages of hundreds of thousands of unemployed migrant workers. Organizations such as Mann Deshi then focused on handing out food packages and education about the corona virus.
The first large wave of infections did not follow until September. Then Mann Deshi started making mouth masks together with rural women. They also repaired an old, empty government hospital and reopened it as a special corona hospital with 300 beds.
Yet they were not prepared for the current second wave, in which the number of infections per day has increased much faster since April than last year. Across India, at over 400,000 so far, this figure is four times higher than during the first peak in September.
In the Satara district, where Mann Deshi works, about 3,000 people are now tested positive every day of three million inhabitants. "But in reality there are many more," says Sinha. 'Not everyone can be tested. Or people die before the test result is there. In my own village, where about 30,000 people live, six or seven people die with covid symptoms every day. And when people die at home or without a positive test, they are not included in the statistics.
It is mopping with the tap open. 'All beds at the hospital are occupied by default, and at least fifty patients are waiting outside. We don't have enough oxygen. The doctors prescribe expensive and scarce medicines, such as remdesivir, of which we cannot find enough with a lot of effort.
The government has absolutely failed to prepare healthcare infrastructure for a second wave, Sinha says. 'But I also blame myself. The fact that we don't have any CT scanners is because I didn't see the importance of it before either. We only have one test lab. That should have been two or three.
Health experts say the government should have invested much more in the public health system. "After the initial lockdown, there were many plans and promises to expand the healthcare infrastructure," says epidemiologist Chandrakant Lahariya, who specializes in public health care.
He says it has remained with false promises, even though the authorities had warned of a second wave. And not only since the pandemic, but also in the years before, health care spending has fallen far short of promises and what is needed, Lahariya explains. More than 80% of doctors work in the private sector and Indians pay about two-thirds of health care costs out of pocket. "Four years ago it was announced that health care expenditure would increase from 1.2% to 2.5% of the gross domestic product," says Lahariya. "But it has barely increased since then.
It's this gap that Glocal Healthcare jumped into ten years ago. A clear shortage of care facilities in rural areas motivated founder and chairman of the board Sabahat Azim to set up a chain of affordable hospitals and digital clinics in north and east India, supported by telephone consultation hours of doctors across India.
Technology plays an important role. Glocal, which is part of UpHealth Inc, has developed a hospital protocol for the most common conditions, with artificial intelligence helping doctors with their diagnoses. The digital clinics are a kind of small cubicle equipped with a device developed by Glocal Healthcare, the LitmuxMX. This allows a nurse to conduct diagnostic tests, after which a doctor or specialist gives the patient advice via a video connection and prescribes medication where necessary. Those medicines are then rolled out of a vending machine in the same cubicle. The total package costs 300 rupees (€ 3.40). A considerable amount for poor villagers, but according to Azim something they can spare for the quality they get in return.
From the start of the pandemic, covid patients also ended up at the hospitals and clinics of Glocal Healthcare. Although they do not test for covid themselves, it is abundantly clear to Azim that the spread of the virus in the countryside is much higher this time than last year. Last year, the virus did not spread nearly as quickly as expected. Nobody knows why. But probably for that reason it was not expected that this would happen during the second wave.
Azim has also experienced a lack of preparation in healthcare. 'Access to testing is limited and even awareness of the necessary covid protocols, such as keeping your distance, is still a major problem. We need more beds for acute care and more intensive care beds. Primary care must become more accessible.
The latter could prevent a lot of coronal disease, Azim thinks. 'Many people only come to the hospital now, when they are already seriously ill. That is why we have now started a free helpline, especially for corona, so that we can advise people at an earlier stage about medicines or hospitalization.
According to Azim, there is only one real solution to prevent the same problems in the next wave: 'We have to vaccinate en masse. We also want to do that at our clinics, but that is not possible now. The government should have bought and ordered more vaccines.
That's what Sinha from Mann Deshi Foundation also says. Vaccination is the only option. We would like to help with this, but we don't have any vaccines now. ' When this changes, Sinha hopes to deploy ambulances to deliver the vaccines to the villages and vaccinate residents on the spot. With donations, the foundation plans to buy two ambulances and a CT scanner. The local government has no money for this, Sinha says. But money isn't the only problem.
'We built the hospital with the help of the government, and part of the money also comes from the government. But we had to convince the drivers to do it.
Azim also cooperates with local governments. The states of Orissa and Madya Pradesh are having Glocal Healthcare set up their local rural clinics. A number of large companies in mining and steel, for example, do the same for their employees. Money isn't everything, according to Azim. 'There is an absolute need to spend more on care, both public and private. But you do need to have properly functioning systems and processes before investing in them. It is important to innovate.
