When ECHO India launched its COVID-19 tele-training series the morning of March 21, all 1,000 participant slots filled in less than five minutes with health professionals eager to learn about ICU care of patients.
The next day, for a training session on alternative medicine and COVID-19, it took less than a minute for those slots to disappear. The participants from India’s Ministry of Health and Family Welfare, ECHO’s partner on the series, had difficulty getting in.
Immediately afterward, ECHO India switched its hosting platform for COVID-19 sessions to webinar mode, which can accommodate up to 10,000 participants.
After launching Feb. 28, ECHO India’s COVID-19 program rapidly gained momentum as the COVID-19 cases increased at an alarming pace in India. Fifty-four of ECHO India’s 56 hubs suspended their other ECHO programs to concentrate solely on COVID-19; as of June, some were slowly restarting their non-COVID-19 programs.
Those hubs have trained providers across 318,000 spokes in COVID-19 response, on topics including infection prevention and control, COVID-19 care guidelines, ventilator management, mental health support and laboratory guidance and diagnostics. Many of these spokes had individual participants but some had multiple participants, e.g., staff at medical colleges. But even by conservative estimates the ECHO COVID program has trained more than 400,000 health care workers, from village health workers called ASHAs, who participated via smart phone or computer tablet, to doctors and nurses treating patients in urban hospitals.
“People understand the power of the ECHO model as a way to respond to COVID-19, and it’s gone viral,” says Sunil Anand, M.D., executive director of ECHO India. “We now have a force of 400,000 trained health workers who can log on to the ECHO platform when called out.”
It helped a lot that the Indian government had signed a partnership agreement with ECHO India in August 2019, making ECHO the government’s training platform for all health care workers. When the novel coronavirus surfaced in India, the government put the country’s 1.2 billion people on lockdown and ECHO India stepped up.
Educating and Preparing People in Rural Areas
Because of ECHO, thousands of ASHAs, auxiliary nurse midwives and child nutrition and health education workers have been knocking on doors in remote villages, educating residents on COVID-19 and demonstrating how they can protect themselves and their families. These village health care workers do not have any personal protective equipment — there isn’t any to be had — but they do their best to keep their distance and use hand sanitizer frequently.
“For the ASHAs, a lot of the training is on how to talk about COVID,” said Kumud Rai, chair of ECHO India. “Why do we need social distancing? How do we do handwashing properly? If COVID can be killed by soap, then why are you having such a difficult time with it?”
ECHO India has even trained tens of thousands government water sanitation workers to serve as public health messengers in remote villages. They walk the streets with loudspeakers and radios, blasting public health guidance and updates to residents and telling them how to get more information.
Meanwhile, doctors and other health professionals have learned about key COVID fundamentals like what to do with patients who present with a cough, how to deliver oxygen if necessary, when and how to connect a patient to a ventilator, and how to keep symptomatic or positive patients from spreading germs in the hospital. “Remember, nobody has treated patients with COVID before,” Anand said. “You have to explain how to implement best practices.”
As coronavirus continues to spread across India, it is on track to become the worst-affected country in the world.
At first, the government’s lockdown strategy seemed to work. India’s COVID-19 numbers were low compared to those of many other countries, given the size of the population, high levels of poverty nationally and crowded housing conditions in urban areas. But since the government lifted its travel ban in May, many migrant workers who had been trapped in cities without jobs are returning to their rural home villages. And now, cases are climbing in smaller towns and rural areas.
Whatever happens, ECHO India stands ready to serve.