Covid19: Health System Plagued by Misgovernance!

By Zubair Ahmed

“Kuch nahi kar sakta… kuch bhi nahi hai wahan par… Na medicine hai…na cylinder teek se chaltha.. Jab tak Duty doctors ko thang nahi karta, kuch nahi chaltha wahan pe. Main khud apni aankhon se dekha… samjhake bhi dekhi… husband ka haalat itna behtar tha… unko tho yeh log maar daala sir. Chalkar gaya tha wo insaan wahan par…

The lady couldn’t control herself and cried her heart out narrating her experience of GB Pant Hospital’s Covid Isolation ward where she had witnessed four deaths before her husband collapsed in front of her.

“There were patients who looked fit and fine, but collapsed suddenly as oxygen cylinders aren’t changed or monitored timely,” She had informed earlier while calling for intervention and help.

In another incident, a daughter lost her mother. She was concerned when she learnt that her mother had tested Covid positive, as nobody would be allowed inside the Covid ward. Her mother was completely dependent for all her needs. As a nurse by training and profession she could gauge the situation of the ward.

She offered her services volunteering for all the patients including her mother, she begged profusely to the concerned health officers to allow her. Being aware to the mismanagement there, she could realise the ongoing. Worried she called to her acquaintance for help.

She was told that she could attend to her mother the next day onwards. But, her mother passed away inside the Isolation Ward within hours. She was inconsolable and her cries shattering the trust in the clinical care system of Andaman Nicobar Islands.

M Selvam, a 51 year old driver with PBMC, resident of Bhatubasti succumbed to Covid-19 at the threshold of GBPH due to lack of proper medical care. He was tested positive on 13th, and under home isolation. He was supplied medicines for ILI symptoms on 16th. And no oximeter was provided. He had issues of breathlessness, and when the ambulance was called today, it took 45 mins to reach. The ambulance had no oxygen cylinder inside. After the patient reached GB Pant, he was on the verge of collapse due to SpO2. The patient was kept outside the Isolation ward for 30 mins without any medical care. By the time, they took the patient inside the ward, he had lost the battle.

When a patient, due to breathlessness calls for ambulance, primarily, it should have oxygen cylinder support. And, without wasting time, the patient should have been given emergency critical medical care on arrival. Isn’t it a case of sheer negligence!

It’s learnt that a Central Team would visit the Islands to review the Covid situation prevailing here. And out of the blue, the number of cases has reduced in the last two days. Sheer coincidence!

No! Such coincidences have taken place earlier too. When a letter petition was filed in the High Court in March, many measures were taken prior to the hearing. When there was another PIL filed, before the hearing, a few more steps were taken. Unaware about the nature of PM’s interaction with his party workers, the Admn did wake up and act smart.

Such coincidences do trigger a few changes, but it doesn’t sustain. It isn’t the plight of the Islanders, but the concern of people at the helms is to keep their track record look shining, that matters.

Everything is controlled, managed and manipulated. Tests have been stopped. So, the number of cases is also low. It’s told that the Rapid Antigen Kits were defective and are being replaced. Meanwhile, crucial time is lost and many more lives too!

The GB Pant Hospital is the only referral hospital in the Islands and a dedicated block was used for setting up Covid-19 clinical care.

In reality this tertiary health facility which saw most of the healthcare professionals including doctors and paramedics getting infected by Covid lies today in tatters.

The Covid care already under duress and the Islanders scared to access other services only available there as it turned into a super spreader Covid hub, has deteriorated fast, manifesting its old sobriquet – the slaughter house!

Meanwhile, the Covid situation has gone beyond control in the Islands with the infection rates on a hike, thrice the national average ( and deaths on a spike and unmanageable. Every day, news of a near one’s untimely departure wakes up the Islanders. While official data reports only 29 deaths till 17/08/2020, the Islanders aren’t buying this count.

In a tweet by BJP Spokesperson , Dr. Jijith Rekh, 115 bodies were cremated in the last 16 days from 1-16 August at Junglighat crematorium alone, whereas the figures for last six months, January to July, does not exceed more than 50 each month.

This excludes burial of bodies from other communities and cremation in other parts of the Islands.

Even the data released through two channels – Island Administration and Health Bulletin have serious anomalies and duly noticed by the Islanders time to time. Moreover, why two different set of information from two sources are released also remains a mystery.

It’s more clearly comes out from the health bulletin issued by the authorities on 15/08/2020 and 16/08/2020. On 15th actual active cases should have been 1174 (5+224+945=1174), but it was mentioned 1145! Secondly, the total samples on 15/08/2020 and 16/08/2020 were 28209 and 28229 respectively. Only 20 samples added in a day? Reports were pending for 80 and 100 on 15/08/2020 and 16/08/2020 respectively. This literally meant, no tests were conducted on 15/08/2020, and the big question remains, if tests weren’t conducted, how come they received 93 positive cases on 16/08/2020? Is it just a matter of number game gone awry?

Under reporting of active cases is a serious issue. Whoever maybe taking the decision for whatever reasons, it isn’t just about the numbers. It directly effects the clinical management of real Covid positive cases.

As per Administration’s own decision, medicines won’t be distributed to those, who aren’t confirmed and informed, because of under reporting. Apart from risking the life of individuals this tactic is open for more spread as the family has not been alerted on time.

Apparently on a day, when the number of positive cases touched 200, there was a deliberate move to just release cases below 100 and it continued for a week in 90s. By the time, there was a huge backlog of uninformed positive cases while the pendency of test reports had alarmingly reached over 900. A wrong move and the new Corona virus were ready for a checkmate!

Deprived of correct information, the system down below wasn’t ready for the required intervention. And, the battle was already lost.

This clearly indicates the reason behind spike in deaths in the last 15 days, which are obviously under reported. As per the Covid-19 Containment Protocol and Guidelines, every Covid-19 suspect/confirmed had to be put under clinical supervision. This very administration followed this approach till May end, and that’s how they succeeded to keep the Island Corona free for almost two months.

However, under pressure from certain quarters the Commander decided otherwise.

Lately, when the narrative of “Responsibility lies with Public” didn’t find many takers, the Commander in a haste decided for an indifferent lockdown in South Andaman District, which is further extended half-heartedly.

It’s learnt that a PIL filed before the High Court would have been the trigger.

Considering the overall situation, as the virus had its footprint in all three districts, the steps taken were too late, while the beast was already let loose, untamed!

The Administration, while putting all blame on people for the surge and spread of cases, conveniently forgot that everyone, including senior bureaucrats and doctors had cautioned to follow institutional quarantine for the stranded returning from mainland. Who put the hurdles in a marathon and why are questions lying unanswered in the minds of the Islanders.

The Unlock 1.0 started in a very relaxed mode while strengthening of healthcare infrastructure and preparations took a backseat, the consequences of which the Islands are currently facing.

A deeper diagnosis of the current situation can be attributed to the sick governance in the Islands that has plagued the health system.

Despite such a surge in the cases and the health infrastructure in doldrums, the Lieutenant Governor hasn’t taken a single meeting with concerned secretaries to get a reality check. In fact he relies on a single source – the Chief Secretary, who literally pushed the Islands into this abyss. It’s in public domain that since December 2018, he hasn’t called any meeting with the secretaries of Departments and took feedback or opinion on any issue. He barely met the elected representative or political parties, had very limited field visits and interactions with field functionaries.

It’s not in a day that the entire health system crumbled or it isn’t the result of the Pandemic.

With 23 IAS, 35 IFS, 20 IPS with a combined service experience of over 1000 years of service, if there is a reflection of trust deficit on Government machinery, there is something seriously amiss. These are officers with experience ranging from 35 to 6 years would have been bliss to the progress of the Islands, but due to policy of favouritism and vengeance the officers remained underutilised.

The team which actually worked and kept the situation under control during the first two phases were dismantled and destabilized. Two senior bureaucrats were shunted. The Secretary Disaster Management was also transferred.

In the latest reshuffle order issued today, the last member of the team, who shouldered the responsibilities, as the Deputy Commissioner, South Andaman have been conveniently moved out, sugar-coated as promotion!

With additional responsibilities, in a lost battle, the new Principal Secretary couldn’t get a grasp over the situation, as his large human resource of health workers and doctors were already found infected by Covid-19.The only way forward would be to focus on healthcare management, rather than data manipulation. Ground visits of the concerned officers will give a clear picture about the gaps in the system. Work from home or ivory towers won’t work!

Decentralization of Covid management with PHCs and CHCs empowered to carry out extensive testing and identification of vulnerable cases with the help of PRIs and elected representatives would ease the burden on the District Administration.

Instead of home isolation, all symptomatic cases with co-morbidities should be shifted to Covid Care Centres, with their health conditions monitored.

The Dedicated Health Facility, GB Pant needs proper management, with further diagnosis of critical patients inside the Isolation ward and treatment accordingly. Instead of focussing only on recruitment, healthcare professionals outside the system and volunteers can be also pooled in at this juncture. The needs and requirements of health workers shouldn’t get entangled in bureaucratic red-tapism and delayed.

Instead of waiting for piecemeal solutions after each precious life lost, the Administration should take cognizance of the overall situation through field inspections, counting on feedbacks from ground staff and plug the loopholes.

In fact, this isn’t time to control, but manage!