By Afra Abubacker
Celebrating twenty-five years of People's Planning, Kerala takes pride both in it's public health infrastructure and also for it's COVID management. The seroprevalence rate in Kerala today is 82 per cent, but back in June, it was just 42 per cent. Unlike other states, Kerala has increased the seropositivity through vaccination. As of December 5, Kerala had fully vaccinated 33.7 per cent and administered at least one dose to 56.7 per cent of its population. With the Omicron variant making its presence felt in the state, vaccination is only going to improve. The number of fully vaccinated people has already grown from 4.03 to 5.67 lakh.
Vaccination is usually administered locally by Asha workers and Panchayat members through "token booking". Very few people take the dose online, since slot booking is barely available and steps are cumbersome. "Since lockdowns are demarcated locally, local administration of vaccination via local bodies has its own merits," Dr Sandy from Porkulam Family Health Centre, said. A worker says there are other benefits of local vaccine administration. "Priorities can be given to patients with comorbidities, international travellers or students with examinations when a personal word is put along with proof", said Lekha, a Porkulam Panchayat member from Thrissur.
This has pitfalls too. At times, vaccination centres are blamed of favouritism shown in distributing tokens.
The state of Asha workers Kerala has proposed long-term measures for in-house vaccine research centres. A budget of Rs 10 crore has been set aside for setting up the Institute of Advanced Virology in the state. To enhance the state's oxygen capacity, the government has also proposed new liquid oxygen plants capable of 150 metric tonnes daily production. To meet the storage and supply of oxygen, a reserve of 1000 metric tonnes is also being set up.
Kerala with a high moving population with four international airports and a major seaport is vulnerable to epidemic and these future projects are welcome. The southern state makes the best out of its human resources, like Asha workers and its well functioning federal Panchayat systems, including the public distribution system.
Asha workers are equipped with tools like oximeters to conduct their work. But the government fails to equip them with the basic transportation facility or transport allowance. "Most of us walk all the way to the hospital and to patients' houses. Sometimes, we have to walk several times up and down delivering medicines," said Rabiya, an Asha Worker. Elaborating on the success story of Wayanad, Kerala's first district with full administration of first-dose vaccine, she said; "We went to them and never waited for them to call us. In fact, this is not only during COVID. It is the way we have always worked." She was referring to the long list of immunisation and campaign work that she has been doing over the last 15 years.
"We get a COVID allowance of Rs 1000. Our payment is honorary and not salaried," Rabiya said, adding that for the other work that she is engaged in like campaigning and surveying, she is paid a measly Rs 500 per work. "If you add all of this, the sum would add up to Rs 6000 per month (taking into consideration Rs 1000 as COVID allowance). But even this money is not guaranteed to us. If we happen to miss any of the listed work, we get paid less," she said. Primary Health Centres and Family Health Centres are poorly equipped
Primary Health Centres and Family Health Centres are poorly equipped
Speaking of healthcare infrastructure in the state, even after two years of medical emergency, the admission facility (for COVID patients) only begins from the Community Health Centre. The local Primary Health Centre (PHC) and Family Health Centre (FHC) are yet to be upgraded. These are mostly just two-room buildings or so and they act as store houses for registers and medicines. There is no scope for anything beyond normal checkups.
Unfortunately, even when doctors and other staff are available at PHCs, critical patients have to be taken all the way to medical colleges due to lack of proper medical infrastructure. To make matters worse, Primary Health Centres are not even equipped with an ambulance. They have to hire one on need basis or request for an ambulance from Taluk Health Centre to be sent, if available at the time.
"One day, when the pandemic was at its peak, Rufaiq (2) had a burning fever. He was diagnosed with COVID and had to be rushed to Thrissur Medical College for immediate assistance. But an ambulance was unavailable at the time and I had to personally arrange one through my friend, to save the kid," said Biju, Junior Health Inspector at Porkulam Family Health Centre. Parents of Rufaiq are relieved and satisfied. "We are happy that the child is back home and has completely recovered. Over two weeks of our quarantine, we received all kinds of support. Our medical and transportation expenses were covered. We got home-cooked meals delivered to our home for three days and groceries were delivered by Rapid Response Team," says Abdul Rasheed, a paint worker in Porkulam Panchayat. It all boils down to the funds that a state government allocates towards handling medical emergencies.
In Kerala, make-shift quarantine facilities and vaccine camps had been set up but due to lack of budget, doctors and paramedical staff were not available to tend to the patients. "Several medical and paramedical staff were hired on a temporary basis. Owing to the grim situation, even retired medical officials were approached if they can volunteer for COVID-related work," said Nazarudheen, a retired Health Inspector. Structurally the health infrastructure is more or less stagnant. Primary Health Centres and Family Health Centres are poorly equipped with minimum facilities that too only for out-patient services.
Moreover, the pandemic has also put a halt to other medical cases. People with lifestyle diseases were sent back without check-up. "Earlier, every Friday there were regular check-ups and patients' were monitored. Now, they are shooed away," says Nazarudheen. When a Primary Health Centre is upgraded to Family Health Centre, they work till late in the evening for out-patient service, as compared to the afternoon shift at the PHC. But in terms of infrastructure, both these facilities cannot be differentiated. The sub centres that work under PHC are mostly functioning out of rental buildings. Plans to upgrade sub centres as wellness centres with yoga classes is being discussed.
Hoping for a not-so intense third wave of COVID, Lekha expressed her concern, "If the third wave is as bad, I am worried about how long we can collect funds and find sponsors for the community kitchen, ambulance and other COVID-related charity." However, Shabeer from Kunnamkulam (he is the DYFI president) has many innovative fundraising methods up his sleeves. "Last Onam, we introduced the payasam challenge, Google Pay challenge and also convinced clubs to donate," he said.
Kerala has never turned a blind eye to COVID patients. The state has provided them with food and medical support wherever possible. Be it through Asha workers, rapid relief workers or Panchayat members, the government has always kept a communication channel open. The state even tried to discipline people into pandemic etiquette of wearing a mask and maintaining social distance. The COVID jagratha portal has got a dedicated page for reporting pandemic offences.
Recently, the government has denied free treatment to those who remain unvaccinated on non-medical grounds. Government employees and teachers are also directed to get vaccinated. If they fail to do so, they are advised to get an RT-PCR test done every week at their own cost. As Kerala completes a milestone today, it is the right time for authorities to introspect - whether there is scope to better primary health centres and promote primary workers.
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