Care of Covid and Non Covid patients during pandemic by follow up, distributing medicines, and to ensure the pregnant women a safe delivery.

We have seen a lot of funding support has been for equipment, infrastructure and covid related medicine, treatment etc and not for regular medicines being provided. We have been providing this for 2months and plan to continue for another month or two at least.

ANC check up and admissions for delivery is utmost important and cannot loose sight of it during this pandemic.

Our COVID health care work in the 1st Phase

Gudalur Adivasi Hospital is NABH accredited at the entry-level and CMCHIS empaneled hospital. It is one of the two hospitals listed by the Government of Tamil Nadu to take care of Covid-19 patients in Gudalur. A panel of 6 doctors including a surgeon, gynecologist, and anesthetist along with 21 nursing staff are the pillars of GAH. The hospital is a referral care center for the Adivasis who require secondary level care. Apart from the Adivasis, GAH is also popular amongst the non-tribal population of this region for getting good affordable healthcare services. 25% of our beds are allocated for Covid 19 patient admission with all necessary equipment needed.

As our Community Health Programme (CHP) has always been the backbone of the work, we were able to take stock and respond quickly and effectively during the 1st wave of Covid 19 last year. Initially, the community was made aware of the symptoms of COVID infection and the precautions to be taken. A list of Health volunteers and contacts were made ready and communicated with all of them to watch for any symptoms and update HAs during the daily evening call. This is further communicated with the doctors and PHCs as needed and further steps are taken to initiate swab collection for Covid19 testing and if positive, to isolate them as per the Government guidelines and instructions.

During the lockdown phase, communication with the Village Volunteers, who acted as the point of contact for daily follow-up, was strengthened. Special permission from the Government was obtained to enable vehicles carrying food and medicine to go to the villages. The ambulance was busy all the time, transporting patients needing admission, blood tests, or scans to the hospital, taking the discharged patients home as well as serving as an antenatal checkup center.

COVID health care work in the Second phase

Home care for suspected or confirmed Covid 19

In the second wave, we are experiencing more mortality and severity of symptoms, we have restarted calls to health volunteers by HAs on a daily basis and Doctors are updated on the same. If anyone is identified with symptoms or tested positive for Covid19, they will be home quarantined or if an unused house is in the village it is used for isolation. We have listed out village wise isolation plans as certain villages have unused houses or shelter which could be used for this purpose.

Health volunteers will be provided basic vitamins and antipyretics at the village level. The next level of medicines will be stocked at the area center so that doctors can instruct the HAs when needed to dispense them at the village level. Heath animators, Health volunteers, and youth will be trained to use pulse oximeters with all precautions. Anyone with a dropping pulse below 94 will be brought to the hospital for further care.

To prevent non covid admissions of the vulnerable tribal and reduce the risk of infection spread and complication during this pandemic,

 Monitoring of people at village level and distribution of medicines

 ANC admissions and Operational cost

Rationale

Importance of providing regular medications and follow up

While we focus on Covid 19 through testing, providing medicines, monitoring and hospitalization when needed, we would like to emphasize the need of regular follow up and ensuring the availability of for patients with Chronic illness like Diabetes, Sickle cell disease, Nutritional supplements regular checkup and tests; also their admission for delivery is unavoidable. We have only one private hospital Gudalur. At GAH, 50% of beds remaining 20% for non Covid. Right now given the situation, the non-tribal population and we are the only hospital catering to tribal covid and non covid admissions. Even referral to higher centre 150 kms respectively from Gudalur. At this time availability of beds at higher centres are really difficult.

Tribals with co-morbidities are missing the medications due during lockdown, Fear of being affected by Covid and thus just stay within the village.

Knowing well that their poor health seeking behavior and added difficulties at present, also that visits to hospital/PHC itself might be exposing the tribals to Covid 19 and the limited number of beds available for Non covid admissions at this point warns us to take necessary steps are taken and ensure regular medicines are provided, regular check up and tests done at the village level.

ANC admissions and Operational cost

An average of 800 tribal patients seeks outpatient care, 110 inpatient care, undergo 20 surgeries and 25 deliveries every month. Tribal outpatient pay Rs.60 during registration as a contribution toward the medicine expense. Outpatient consultation, investigations and medicines for tribal patients are free. The Medicine and consumable expenses is a large expense and a major deficit in providing the services. The hospital also provides services to non-tribal population with poor financial background and charge a meagre fee for them.

Thus there has been a large deficit mainly in the Admissions for delivery and postpartum care. Our main objective is to ensure all pregnant women have access to safe environment for delivery and to ensure that there is no increased maternal morbidity/ mortality which also include referral to tertiary centres when needed. As a result of continued intervention 97% are institutional deliveries in which 79% were at GAH. We seek support in covering the gaps in continuing the maternal care and outpatient services to the tribals,

We have around 30 deliveries in a month and costing an average of 4.5lac

Reduce the number of people contacting covid 19 infection

Reduce the non covid complication ,morbidity and mortality during this pandemic

Reduce Infant and maternal mortality