Community preparedness during Covid19
Building community -preparedness prior to the covid19 third wave in Masanapura gram panchayat in Yelandur taluk of Chamrajnagara district
During both the waves of the Covid19 pandemic, both the state and federal governments have been shockingly ill-prepared. Citizens paid with their lives for such omissions and commissions particularly during the second wave. It was devastating to say the least. People died in extremely cruel and undignified manner – outside hospitals, in car parks waiting for beds, oxygen and ventilators. Images of dead bodies queuing outside cremation grounds and burial sites have haunted and traumatized not just families of the dead but citizens across the world.
Apart from poor systemic response, the government has also not been able to build capacity of communities and citizens and seek their proactive involvement across the state. This is true not only of Chamrajanagara district but across the state. Lack of engagement of communities explains the continued high levels of stigma and consequent resistance to Covid 19 testing. This combined with poor adherence to Covid -appropriate behavior, ill-prepared health systems is a dangerous mix that has cost us dearly during the second wave.
In an effort to avoid mistakes of the past and ensure successful management of the third wave with as few casualties as possible, an intervention has been initiated in masanapura gram panchayat of Yelandur taluk of Chamrajanagara district. Chamrajanagara is among the most backward districts in Karnataka and has poor performance on the Human Development Index. On 2nd and 3rd may 2021, 24 Covid19 patients died in the district hospital following oxygen shortage. In the last week of May 2021, a family of four who had tested Covid19 positive committed suicide in H. Mukalli village of Masanapura gram panchayat. Media reports attributed it to poverty, disrupted employment due to isolation and incidents of discrimination of the family in the local community. These events in the district illustrate that Chamrajanagara district is struggling to manage the Covid19 pandemic both in terms of systemic preparedness as well as community engagement. Therefore it was decided that the present intervention will be initiated in Masanapura gram panchayat starting in H. Mukalli village where the unfortunate incident of suicide took place.
The two main objectives of the intervention were (1) to pressurize the government to step up preparation for the next wave- to ensure early testing, tracing and isolation/ quarantine activities and (2) to work closely with communities to facilitate their preparedness and proactive engagement.
During the initial visits, Spoorthidhama team met with the Panchayat level Covid19 Warriors from the village comprising two anganwadi workers, two GP members and one ASHA worker from the village, PDO of the gram pnachayat and two to three male volunteers from the village to discuss current problems in Covid19 appropriate behavior, Covid19 stigma and discrimination and related issues. Based on the concerns and needs of the community, the local team suggested that it would be good to provide nutrition kits to children, pregnant and post- partum women in an effort to ensure adequate protection against malnutrition and related health complications. Similarly, distributing cloth masks and sanitizers would also help to reiterate the importance of wearing masks and hand hygiene in Covid19 prevention, they suggested.
In response, Spoorthidhama team sent out an open appeal for donations towards purchase of nutrition kits for a total of 71 children and 11 pregnant and post- partum women. The nutrition kit was expected to be consumed over a period of one month. The following nutrition kit was put together in consultation with a physician involved in Covid19 interventions:
- 4 packets of groundnut chikki, each packet containing 15 small laddus = 60 laddus (for protein and Iron)
- 500 gm Milk powder (for Fat)
- 30 Eggs (for Protein)
Pregnant women were expected to consume one egg, two laddus and 3 heaped teaspoons of milk power everyday for a period of one month. In case of children, it was to be tailored as per the needs of the child. The cost of each kit came to about Rs.580/-.
The Appeal helped to generate a donation of of RS.40000/- in donations towards purchase of a total of nutrition kits. The remaining cost of nutrition kits was contributed by Spoorthidhama Trust to purchase a total of 82 nutrition kits.
Spoorthidhama team met with employees of NVidia a multi- national software company with offices in Bangalore requesting them to donate masks required for the people in Mukalli. Similarly, Refcoat Chemicals Pvt. Ltd in Bangalore was approached to donate sanitizer bottles that could be distributed to all the households in the village. In response, NVidia donated a total of 2000 three- layered cloth masks for both adults and children and Refcoat Chemicals supplied around 600 bottles of sanitizers.
Inauguration of the intervention
There was a lot of enthusiasm among the local team in the village. They organized a formal inauguration of the community preparedness program for which they invited the gram panchayat president and members, the Taluka Health Officer (THO), anganwadi supervisor, district president of the anganwadi workers’ union and district president of the Dalit Sangharsha Samiti. We were also joined by two employees from NVidia.
That very day, the village lost one more person to Covid19 complications. Therefore It was a somber gathering of about 25 women, children and community leaders (numbers were restricted due to Covid19). The death only reiterated the gravity of the situation in the village.
The gram panchayat members expressed their gratitude to the various donors and Spoorthidhama for the initiative. During this interaction, people complained about serious shortage of vaccines in the three PHCs close to them and that several people were yet to receive their first dose. The PDO assured the people that the GP will organize a vehicle to ensure people can visit the closest government facility where vaccines were available.
Street- wise open meetings
After the inaugural program, we started street- wise open interactions with the people about the third wave. We had a megaphone through which we reiterated key information about Covid19, the expected third wave, particularly the importance of protecting children, pregnant and post- partum women as the third wave is expected to affect children the most and following covid- appropriate behavior. Following Covid19 appropriate behavior, people stood at their own doorsteps and interacted with the team.
During our interactions we emphasized the crucial role of non-stigmatization and non- discrimination of persons with covid19 for their recovery and survival. Particular emphasis was placed on how they would respond if someone from their street contracted Covid19. We reiterated about keeping in touch with the family on phone, reassuring them about the future, expressing support, checking whether they have adequate rations and whether they need anything. This, we explained, would go a long way in communicating to the person with Covid19 that their neighbors and friends cared about them and by that contribute to their mental well- being during the isolation.
People pointed out that they needed to rise above petty quarrels and old animosities at this hour of need. There were complaints that people who had Covid19 were not following isolation and other precautions. They said that those who got Covid19 disease should be responsible and adhere to isolation.
A total of 82 nutrition kits were distributed to all the pregnant / post- partum women and children along with two masks each and 1 bottle of sanitizer. Each household in the village was given two bottles of sanitizers and two masks per person in the household.
Other emerging issues
During these interactions we found that the village had a large proportion of the elderly. Several elderly couples and individuals were living by themselves. Their children were in white collar jobs and had moved out to Mysore or Bangalore. A few seemed to have been also neglected by their villages and reported going for daily wage work. Several elderly persons reported health problems including severe mental illness associated with age.
We also found that caste – based discrimination was widely prevalent. This village has an equal number of dalits and lingayats who live in distinct, separate spaces and report having no social interaction with each other. There are two separate anganwadis, one for lingayats and one for dalits. Meetings have to be necessarily held in the anaganwadi, which was a “neutral” ground. If any meeting is held in one caste area, the other caste group does not participate. Similarly, lingayat women who sent their children to anaganwadi ensured that the cook was from their caste.
Work in H. Mukalli is ongoing and presently we are preparing to expand our work to other villages in the region. As a priority, we are initiating activities to strengthen the local government health facilities to respond to the needs of the elderly in this village. We are engaging the local youth to volunteer to get involved in health rights work in the coming days.
Health Interventions in Urban Low Income Areas
Health- related interventions were carried out in two low income communities in Bangalore city where the majority population belonged to the Dalit and Muslim communities.
Women in these two areas work as garment workers, sanitation workers engaged in sweeping the streets and garbage disposal, domestic workers, construction workers and so on. All three areas have government schools within the community.
The health care component of the interventions involved:
- Organizing Health camps
- Providing ration/ nutrition kits
- Providing medicines for certain chronic conditions
- Responding to emergency situations
About 180 women attended these health camps. Of these 115 women were given medicines for periods ranging from 5 days to two months. Additionally 66 elderly women with diabetes were given nutrition kits containing the following items: broken wheat, Ragi flour, wheat flour, cooking oil, green gram and tuvar dal. A nutrition demonstration was made using all the items in the diabetic ration kit to illustrate how healthy recipes can be not only easy to make but also tasty.
Health camps helped to understand the structural barriers to access health care and systemic gaps. Women in the health camps understood how having access to good quality health care is helpful for their own families and communities. This has also galvanized women in the community to strengthen the local PHC which has so far not been very helpful. The health camps provided a useful context to talk about their experiences in the government health system which is highly discriminatory, inconvenient in terms of timing, limited in scope of services provided. During discussions it was possible to help women understand how it is their own tax money which is being used to run all public services including health care services which essentially means it is owned by the community itself. All these health interventions together have helped create a good strong base to initiate the process of communitising ownership of the primary health center in these areas in a true spirit of democratic citizenship.