Between mid-May and mid-June, the Uttar Pradesh government announced a slew of orders and measures in a bid to turn around the vast but neglected network of community health centres (CHCs) and PHCs (primary health centres).
Now, the work has begun statewide to improve them, make them well equipped and have their own oxygen generation plants. The government even asked all the MPs/MLAs, ministers, public representatives (such as mayors and corporators) to adopt CHCs and PHCs and pump in their development funds into this oft-neglected first line of health centres in the state.
There are a total 3,011 PHCs and 855 CHCs in the state.
Even in their present ramshackle state, many of these centres were turned into Level-1 Covid hospitals (CHCs) and Covid vaccination centres (both CHCs and PHCs) and served people in quite an unsung manner.
The doctors there worked long hours unnoticed in these CHCs and PHCs. They served the poor with Covid screening or other ailments. On Doctors’ Day, HT takes a look at some of the doctors who tried to make a difference in these trying times.
Scripting a turnaround
Dr Ashwani Chaurasiya, 38, resorted to multi-tasking at the Bhathat CHC in Gorakhpur and played a pivotal role in upscaling it. He took over as in-charge of the CHC in June 2019 much before the Covid pandemic set in.
At that time, people shied away from CHC located 25 km east of Gorakhpur as it lacked facilities and services, doctors and para-medical staff. These days, the Bhathat CHC is the most preferred destination of the patients residing in the rural areas of the district. Around 500 to 600 patients visit the OPD daily at the CHC that now has a battery of doctors and para medical staff. It also has an emergency ward.
“When the first wave of pandemic hit the country in March, 2020, the CHC worked as referral centre. The sample of the suspected Covid patients were tested at the Covid helpdesk set up in the health centre. The positive patients were sent to the level one facilities by the ambulance,” said Dr Chaurasiya. When OPD services resumed at CHC after the first wave, the health centre became even more busy,” he said.
Now when the Covid immunisation drive is on, the centre has become a major vaccination centre and overshot the target set for it by the district administration.
Tending to migrants
Then there is the Khandoli CHC in Agra and Dr Upendra Kumar there. In the first wave of Covid in 2020, the UP government turned this CHC into an L-1 category hospital. Dr Upendra Kumar had since been working long hours and without caring for weekly off and leaves. The CHC and Upendra attended to a lot of migrant workers, who were rushing back in panic during the lockdown last year.
“It was an added responsibility, but we cherished the trust exhibited in selecting our CHC as L-1 facility in pandemic times. We had 53 admissions at CHC and all were discharged, barring 10 cases which were referred to SN Medical College,” said Dr Upendra Kumar. “Kuberpur, the village where Agra-Noida Expressway ends, was within limits of our CHC and thus we had an important task of testing and treating the migrant labourers coming from the NCR (National Capital Region). We organised camps and thermal-screened these labourers. We had limited staff and thus working hours extended to 14 hours on average in a day,” says Dr Kumar, 41.
The CHC screened over 4,000 migrant workers and provided them treatment before sending them off to their home districts.
“We had made three rapid response teams (RRTs) for Covid and even went to cold storages to screen labourers there,” he said. Agra is part of UP’s potato belt.
“Among the migrants who we screened, about 1,600 were from Jammu and Kashmir,” he says.
Dr Kumar says his CHC is bracing up for the possible third wave of the pandemic. He is happy that the local MLA has adopted it for improving the centre.
“The MLA Ram Pratap Singh Chauhan has adopted it. Now, we have a 10-bed pediatric intensive care unit (PICU) and an oxygen plant is also coming up on our CHC premises,” added Dr Kumar.
Working without weekly off-days
Dr Ram Gopal Verma and his CHC in the eastern UP’s Prayagraj attended to patients in a similar manner.
Dr Verma, a 42-year-old Provincial Medical Services (PMS) doctor, has spent sleepless nights since April 2020 and worked without taking weekly off-days.
“Barring 15 days in September 2020 when I myself tested positive for Covid-19 and had to remain in home isolation till I recovered, I worked at the CHC every day and many nights. And during the intense phases of the pandemic, I stayed in the small quarter allotted to me on the campus instead of going home to my wife and kids at my residence in Kaladipuram locality in the city,” he said.
He is in-charge of the Mauaima CHC located around 35km from Prayagraj’s trans-Ganga area. The onus of catering to the medical needs of a large chunk of the population, including the Mauaima village comprising 18-odd hamlets with a combined population of around 25,000, lies on his shoulders.
Amidst the pandemic, his task of personally seeing the patients, ensuring fellow doctors and staff attend to the needy coming to the CHC and managing the CHC has changed dramatically.
“Now I am also overseeing proper receipt of Covid-19 vaccines and their administration, availability of medicines etc, identifying suspected corona cases and overseeing their treatment through home visits as well as distribution of medical kits etc among the needy, besides handling emergency cases like deliveries which are attended to 24×7. The big task is also to meet villagers, allay their fears and convince them to take the jab,” said a smiling Dr Verma, a qualified paediatrician and a pass-out of the prestigious King George’s Medical University (KGMU), Lucknow.
Then there are online meetings with officials, besides face-to-face review meetings that require travel to the district headquarters.
Dr Verma, who joined PMS in 2006, has stayed modest about his work and challenges.
“All my colleagues are doing the same thing,” he said.
The health centre was originally a PHC till recently and upgraded to the CHC status. With the infrastructure and manpower of a PHC, Dr Verma and the hospital worked as CHC. He also has been visiting 6 to 10 homes each day in nearby villages to see Covid-19 positive cases in home isolation in both first and the deadlier second wave of the pandemic.
Reaching out to far-flung area
In Sonbhadra, a backward district in eastern UP, Dr Shishir Srivastava, 36, medical officer-in-charge of Myorpur CHC, did extensive work in this far-flung area during Covid-19’s second wave. Dr Srivastava’s CHC is around 80km from the district headquarters.
“On an average, three to four patients with oxygen levels below 80 came here daily. We gave them the prescribed primary treatment, oxygen support and, once they became stable, sent them to L-3 (Level-3 Covid hospital) hospital.”
The CHC already had four oxygen cylinders and once the second wave hit, it (CHC) got five oxygen concentrators as well. Dr Srivastava said his team conducted awareness drives in the villages, appealing to the symptomatic people to get their Covid test done at the CHC.
“Thereafter, many locals who had fever, cough or cold, came forward and got their test done. The non-symptomatic people, who were tested Covid-19 positive, were given medicines and asked to stay in home isolation. The team monitored their health condition for 14 days. Consistent team efforts help us manage Covid-19 situation in this far-flung district,” said Dr Srivastava.
His team and he did not take a breather when the cases began declining.
“We started visiting all the villages in our area and began motivating villagers for Covid vaccination. There were many myths and apprehensions in their minds to be busted.”
Around 1.46 lakh people of various villages in this area were given the first dose of vaccine (at various vaccination centres) so far.
Engaging social influencers
In a remote CHC in Meerut’s Hastinapur, a doctor experimented a bit by associating social influencers for identifying patients of Covid-19 in villages and providing them treatment. The effort by Dr Ankur Tyagi and his team was widely appreciated.
Dr Ankur Tyagi is in charge of rural-based Hastinapur CHC( Meerut district) which provides health facilities in 91 villages.
“I was made a model officer of three urban PHCs ( Nanglabattoo, Jai Bheem Nagar and Rajendra Nagar) for implementing the similar model for identifying active corona cases and sending them for treatment,” said Dr Tyagi.
He said initially it was very difficult as cases of Covid-19 were on the rise and CHC had limited staff to visit the villages for identifying symptomatic patients.
“Villagers were reluctant for tests and isolating symptomatic patients was essential to prevent other villagers from getting infected,” said Dr Tyagi who then decided to seek the help of social influencers ( mainly unqualified doctors in villages) and formed a WhatsApp group of 50 persons including influencers, CHC doctors and health workers. These social influencers are quite popular among villagers and also enjoy their trust.
“All of this helped us penetrate even the remote villages and CHC’s ongoing Active Corona Search campaign yielded good results,” said Dr Tyagi.
He then also ran a campaign to distribute ayurvedic kaadha (medicinal brew) along with medicine kits to villagers and patients in more than 70 villages.
His team and he administered vaccines to the 1,442 people in the 45-plus age group in a single day.
