The tribal areas had oxygen while the city was breathtaking


Dr. Rajendra Baldo

Dr. Rajendra Baldo, a district collector in Nandurbar, was praised for his efforts to tackle the second wave.

Some rural areas were able to avoid the crisis as Indian cities and towns struggled to maintain the breathing of Covid patients in a severe oxygen deficiency, BBC Marathi Mayank Bhagwat and Janhavee Moole report. I am.

“There are patterns in the pandemic, and it’s important to understand them,” says Rajendra Baldo, a collector or senior manager in the Nandurbar district of Maharashtra, western India.

He says he realized early on that he needed planning and preparation. And that decision certainly paid off: he is making headlines in India for what is called the “Nandurbar model”. Remote tribal districts, even Mumbai, the capital of Maharashtra and India’s wealthiest city, have been praised for increasing resources and managing their case roads in a devastating second wave. I will.

Why did this happen?

Predict the crisis

“I saw a case of peaking in India after peaking in Western countries. I saw these countries hit by the second and third waves, so I realized that it could happen here as well. “Dr. Bard explains.

Maharashtra, one of India’s largest states, has long been a hotspot for Covid. Official figures show that although the proportion of active cases has declined in recent weeks, it still accounts for about one-fifth of the number of Covid cases in India.

But in April, Maharashtra presented a disturbing scenario due to the rapid increase in case roads. Due to its large population, it added more cases every day than any other state. However, there was also a lack of life-saving emergency beds and oxygen, and the family realized that they were traveling the district in search of a bed to save their loved ones.

Dr. Bard, who learned to become a doctor, says his medical background helped him to see the text on the wall.

At the height of the first wave last September, there were about 1,000 active cases in Nandurbar. However, as in other parts of India, numbers fell sharply next month. It was below 400 by the end of December.

But Dr. Bard says his administration was vigilant.

India’s colonial epidemic disease law gives district collectors a lot of power to contain the spread of the virus-so he began preparing in September.

A healthcare worker moving an oxygen cylinder at the Covid-19 Care Center in the Shenai Banquet Hall attached to LNJP Hospital in New Delhi, India, on May 8, 2021.

Severe oxygen deficiency hit India in the second Covid wave

And even as the incident subsided, his administration continued to expand or build the infrastructure (from the quarantine center to the oxygen plant) that would help fight the virus.

And when the cases began to increase by the end of March, they were ready-by April 30, there were about 7,000 active cases in Nandurbar.

But they weren’t short of beds or oxygen-a well-known sight in India’s largest city.

Prepare for shortage

Dr. Bard says the fact that Nandurbar was his hometown helped. He personally knew the challenges ahead.

Nandurbar, one of the farthest districts in western India, is surrounded by hilly forests adjacent to Madhya Pradesh and Gujarat. It is approximately 440 km (270 miles) from Mumbai.

It is a relatively poor area with many tribal people with few medical facilities. Prior to the pandemic, there were only nine life-saving emergency beds and 80 oxygen beds for a population of nearly 2 million, says Dr. Rajesh Valvi of Nandurbal Municipal Hospital.

Early in the second wave, some patients in the border village went to Gujarat when they found it difficult to find a hospital bed. However, district authorities soon turned schools and hostels into quarantine centers. And they were monitored by the local primary health care center-there is one in each village.

As a result, patients with mild symptoms were treated promptly, and only patients with serious infections went to the hospital. As a result, the patient’s condition did not deteriorate due to delays in treatment, and the burden on major hospitals was greatly reduced.

They also added oxygen beds for both critical care beds-currently 148 for the former and 556 for the latter throughout the district. Then the case has fallen and about 200 beds are vacant.

The other thing the district did was to increase the oxygen supply. There was no liquid oxygen plant because it was not an industrial area. Unlike some other districts that could use nearby industrial resources to increase supply.

There was also no oxygen replenishment plant to supply critical gas to portable cylinders. Also, no hospital had a plant that could convert oxygen from air and supply it directly to the bed via a pipeline.

“I realized that I didn’t get enough oxygen in the second wave,” says Dr. Bard.

As a result, the district set up three such factories in two major public hospitals in September, February and March. Then followed by two private hospitals in the city of Nandurbar.

One plant can also be filled with up to 125 jumbo-sized cylinders to supply air to patients in other hospitals. These plants currently produce 4.8 million liters of oxygen per day. Nandurbar has excess oxygen that is sent to other areas.

Oxygen plant in a hospital in Nandurbar

The district has set up oxygen plants in three hospitals

They also purchased 30 oxygen concentrators to help out-of-breath patients breathe more easily for primary health care centers in remote villages to ease the burden on hospitals. did.

They also set up a centralized control room to train and monitor health care workers, including specialized “oxygen nurses”.

Neelima Walvi, the “oxygen nurse” at Nandurbar’s largest public hospital, says her only job is to monitor the oxygen given to Covid patients to reduce waste and leaks.

“If their oxygen level exceeds 95, I reduce the amount of oxygen given to them, for example from 5 liters to 1 or 2 liters, depending on their condition,” she says.

All Covid hospitals or centers were told to appoint such a nurse every 50 beds. The model was so successful that the state government ordered other districts to do the same.

What’s coming next?

Since the start of the pandemic, the district has recorded 38,000 Covid cases and approximately 700 deaths. The second wave reported the highest daily deaths from May 4-18.

Nandurbar, of course, is not an urban or densely populated area like Mumbai. However, according to experts, its success demonstrates the value of India’s vast decentralized bureaucracy, which is underutilized to combat Covid.

But challenges remain, officials and doctors say.

Dr. Abhishek Payal, who is treating Covid patients in a private hospital, says the number of cases appears to be declining, reducing some of the shortfalls he faced in March and April.

However, he added that patient follow-up is such a remote issue.

“Many of the people we treat come from very far away. Once discharged, they do not always return to a week or month of medical examination. Therefore, they face a long covid. Treating people is a big challenge. “

He is also worried that the infection is spreading in rural areas where vaccine hesitation is higher, especially among tribal communities.

“It’s not the job of a single person to fight Covid,” says Dr. Bard. “We are focusing on how to get treatments and vaccines in the village so that people do not have to travel far.

“The facility needs to be further improved to make sure it is ready to face the third wave.”

Additional report by Nilesh Patil

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