Building Solutions for Resilience — COVID-19 and Beyond
As India went into lockdown on 23 March, hospitals and medical workers around the country stepped up their preparations to deal with COVID-19. The virus has presented new challenges to humanity and exposed the gaps in our health infrastructure. But many of the issues it has highlighted are not new: people living in poverty, the organisations supporting them and medical professionals have been raising them for years.
Energy access is a clear example of this. A reliable power supply is vital for hospitals and health facilities to run safely at any time. In a crisis like COVID-19, in which large number of patients need intensive care treatment, access to an uninterrupted energy supply is not a luxury. It is essential to save lives and enable medical staff to manage the situation effectively.
Hospital preparations in Bihar
In April 2020, Vistex Hospital in Masarhi village in the Patna district of Bihar was chosen by the state’s Government for COVID Screening and Management. The only hospital within a 25 km radius, it has the infrastructure and the trained staff able to deliver specialised care.
Vistex Hospital is run by Doctors for You (DFY), a not-for-profit organisation that works at the junction of disaster and health. DFY has provided emergency services across states of Bihar, Odisha, Assam and Kerala in the past few years, in times of cyclones and floods. As Dr. Ravikanth Singh, the founder of DFY, prepared his hospital for COVID-19, his experience in disaster management kicked in. “The first cardinal rule when operating in a disaster scenario is to always prepare for the worst,” he said.
Ensuring the hospital had enough beds, equipment and protocols for isolation was achievable. But Dr Singh was concerned about the disruption to other vital medical services — such as maternity — in the area. The reliability of the hospital’s power supply was another problem. With 15% COVID patients likely to require oxygen and 5% ventilator support, it could not afford to have power cuts. The hospital also lacked areas for doctors and medical staff to quarantine between shifts, which put their families at an additional risk of contracting the virus.
But what if Dr Singh could quickly expand his hospital infrastructure and allow for COVID-19 to not compromise the other medical needs? What if the hospital could have a reliable, uninterrupted energy supply? And what if the doctors could have comfortable staff quarters so they could stay at the hospital and not endanger their families?
Community testing in Tamil Nadu
In Gudalur Hospital in Tamil Nadu, Dr Nandakumar was also preparing for the pandemic. It was important that the virus was not allowed to spread to the indigenous communities in the Nilgiri forests. While the Gudalur Hospital prepared for COVID-19 and health workers raised awareness about the disease, Dr. Nandakumar insisted that the hamlets in the forest remained quarantined from each other and from places at risk. However, to access basic testing facilities (based at Gudalur Hospital) people from the communities would need to travel for 10 to 15 kilometres using public transportation, sharing space and putting others at risk. Accessing a testing facility was a risky affair.
But what if it was possible to take the tests to the communities? What if diagnosis could be carried out in the remotest hamlets of the Nilgiri forests?
Better quarantine facilities in Manipur
Until 15 May 2020, there were only five cases of COVID cases in the state of Manipur. In less than a month, as the lockdown started to ease and migrants started returning to the state, cases have passed 300. Ukhrul district, in Manipur, has one District Hospital and eight Primary Healthcare Centers to cater for the needs of the existing population of around 1.83 lakhs. The district has already seen a return of about 1,000 migrants and is expecting at least 7,000 more, according to local administration.
District administrations and civil society organizations are preparing the state by upgrading Primary Healthcare Centers for quarantine and screening. But the existing infrastructure is not sufficient to cope with the returning migrants — more quarantine centers are needed. The authorities have identified educational institutions and other public institutions to be temporarily converted into the quarantine centers. Each must have minimum facilities for housing medical staff, and medical equipment including thermal thermometers, stethoscopes and blood pressure machines.
In Manipur, the administration wants to ensure that all quarantine facilities also have basic amenities such as reliable and constant electricity and water supply, providing the smooth delivery of care and ensuring the comfort of people who are quarantined and medical staff. This will also ensure that people in quarantine are not tempted to leave the facility and go homes, putting their families at risk.
What if Ukhrul could ensure comfortable and well-equipped quarantine facilities to increase early diagnosis and break the transmission of the disease?
Finding solutions
At SELCO Foundation and the IKEA Foundation, we believe that decentralization and democratization of services are the key to building effective resilience for the families reeling under the effects of COVID-19. It is also the key to enabling families to cope with the climate-related disasters they face, sometimes multiple times in a year. Banking on the intellectual, innovative and entrepreneurial skills of the local communities, governments and other stakeholders, it is possible to build systems and models that can deliver all essential services in the most sustainable manner.
In Vistex Hospital, Dr. Ravikanth has upgraded his facility with Decentralised Renewable Energy network, ensuring that he is able to provide uninterrupted care to both COVID patients and his other patients. He has adopted modular, thermally comfortable and energy efficient construction technologies to add a new Out Patient Department, as well as medical staff quarters to provide a comfortable working environment during the peak summer.
Dr. Nandakumar has deployed mobile testing facilities in the remote hamlets of Nilgiris with a solar-powered mobile medical van and a portable solar-powered screening kiosk. This can be placed in a rotational manner in multiple locations with the same human resource managing it.
In the district of Ukhrul, reliable power means that the migrants find a safe and comfortable quarantine facility where they can rest, isolate themselves, get tested and avoid putting their families at risk.
The time has come to build long-term resilience, especially for families living in poverty across the world: the IKEA Foundation and SELCO Foundation partnership will demonstrate one of those pathways.
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