[avatar user=”Chitra Ahanthem” size=”thumbnail” align=”left” link=”file” target=”_blank”]CHITRA AHANTHEM[/avatar]
In light of the global concern over Covid-19 and its entry nearer home in Manipur, it is interesting to see how some things change and yet remain the same. There are many parallels with the HIV/AIDS epidemic earlier, which had a long drawn out struggle to get health infrastructure in place, apart from the fear and social stigma factor. Another technical point binds the two: the PCR test and equipment used to detect Covid-19 infection in the state came in thanks to the HIV/AIDS activism for access to quality health care.
The Covid-19 outbreak has been traced to Wuhan in China from where it spread rapidly to the point that the World Health Organization (WHO) declared it a Public Health Emergency of International Concern on January 30, 2020. Following the announcement, some countries stepped up efforts centered around the three main goal posts of any public health crisis: awareness, intervention and rehabilitation/relief measures. Unfortunately, India has lagged behind (and continues to do so) on all three counts except Kerala where the three-pronged approach is being taken up.
Consider this: On January 29th, the Press Information Bureau (PIB) sent out a press release conveying an ‘advisory for Corona virus ‘ from the Ministry of AYUSH, Government of India. The advisory recommended that ‘homoeopathy medicine Arsenicum album 30 could be taken as prophylactic medicine against Coronavirus infections’(link to the press release https://pib.gov.in/PressReleasePage.aspx?PRID=1600895# ). Not only did this press release (with no medical proof whatsoever) flood social media overall but in Manipur, it was amped up by an official notification from the Medical Health Directorate. This was the real trigger warning signaling that India was failing to acknowledge Covid-19 as a serious health crisis that would lead to the situation we are now in.
Barring Kerala, the response to Covid-19 was almost a delayed and inadequate afterthought with mere documentation of international flight passengers and asking them to stay in home quarantine till they developed acute symptoms for the disease. International flight passengers had their temperatures taken, but in a confined space over a long duration of time, thereby increasing the chances of Covid-19 infection to those who were not infected then. At a time when more and more testing should have been the order of the day, along with raising awareness amongst the general public, the lack of a strategic response emerges from the testimonies of people who have tested positive to the infection. At the time of writing this article, only a total of 26,798 people have been tested for Coronavirus in India till March 27 (ICMR figures) as against 20,000 people being tested every day in South Korea (BBC report).
Aided by alarmist and uninformed news (fuelled further by the wide use of social media) and real news focusing mostly on number of infections and number of deaths, it is no surprise that there is widespread panic and fear amongst the common people. Notice also that most political leadership in Manipur use the term ‘dreaded disease’ (tamthiraba laina) instead of a more nuanced term like ‘epidemic’ (laichat) and one can see why Manipur’s social media erupted with shaming, name calling, rumour mongering and passing judgements over a 23 year old girl who tested positive. With more attention on the rise of infections, most miss the fact that globally, there are more numbers of people who are recovering from Coronavirus than those who are dying of it. (Here is a reliable monitor https://coronavirus.jhu.edu/map.html)
Belated as it may be, the political leadership in Manipur has made the right moves by appealing to the public to ensure they follow social distancing and stay at home during lockdown. The Chief Minister has also assured the public that medical staff at all State and district level hospitals have been given protective gear and that adequate arrangements are there in quarantine centers. This statement from the CM would need careful scrutiny to ensure the following:
As per a notification signed by an official of the Medical directorate, each district hospital and CMO received only 20 N95 masks units each. The figures for hand gloves are 200 units each except 100 units each for Kamjong, Pherzawl and Kakching. It must be noted that masks once used are to be discarded safely as per protocol. Ergo, a one-time supply is not the final solution.
The protocol for disposing of used gloves, masks, protective suits at JNIMS will be ensured by its inhouse bio waste management section. The same needs to be adopted at the quarantine centers for there may be Covid-19 carriers who are yet to be tested. If the waste (bio waste or otherwise) materials are not being handled by well trained staff equipped, that would be another disaster waiting to happen.
In relation to quarantine centers operating out from school premises, one major drawback is that toilets in school are in close proximity to one another. The ideal situation is for each person in quarantine to have access to his/her own bathroom facilities. In light of the fact that hotels are no longer operational across the country, the Manipur Government can make use of Hotel Classic Imphal which was leased out to the Classic Group.
The quarantine centers need a dedicated cleaning staff to take care of hygiene.
There needs to be a pool of doctors, nurses, pulmonologists, anaesthetists, radiologists and lab technicians at all health centers gradually but at RIMS and JNIMS now to begin with. This pool would take turns to share the work load/duty hours and be housed in isolation from their own family so they do not spread the infection inadvertently.
Roll out public service announcements through mass and social media: clear, crisp messaging without any drama or use of adjectives. It would do well to involve community leaders from the HIV/AIDS sector who have faced similar concerns around testing and social stigma.
An urgent stock taking for medical personnel who are trained and committed to isolation; protective gear needed for frontline workers; reagents required for operating the PCR machines at JNIMS and RIMS; ventilators, oxygen cylinders and nasal prongs etc. is required and all efforts to ensure that any gaps that emerge are filled in at the optimum level.
Social validation and financial insurance from the Government to the medical personnel who are involved at the frontline will be a major boost to their confidence and motivation.
Involve local/Leikai clubs to sensitize people in their locality on the need to follow social distancing when heading out to buy essential items through loudspeaker announcements. Each Leikai/club can compile a list of households and conduct a draw of lots for heading out of the house to the market by turns.
Each MLA and MP from the state can and must earmark funds from their annual discretionary funds. Each MP has an annual 5 crore ceiling) which each MLA gets 2 crore per year as local area development fund. The allocations can be used to procure the safety materials and equipment required by medical personnel and for their financial insurance.
All said and done, are the above measures the perfect solution? No. Not unless each person in Manipur wakes up to the reality that Covid-19 is easily spread and can be curbed just as easily. All it takes is to be responsible citizens and stay at home and stay alert to any pneumonia like symptoms. Every one needs to be aware that it is not just people who have a history of international flight travel who are at risk but even those who at any point in the last two or three weeks, undertook domestic travel where he/she might have been in contact with anyone who has been an international flight passenger. Because each of these potential at risk populations would in turn, have had social contacts with a vast network of friends, family and work circle, it is precisely why one has to maintain a careful distance from one another even within families. The most basic thing of course is to keep washing hands with soap under running tap water and clean the taps once you are done; to keep washing hands every time you touch something or return from outside.
It might help to turn attention to factual news and information before posting it on social media and not add to the panic. If you are at the receiving end of such mindless information that stray away from facts, consider leaving the group you are a part of or politely tell them off. Strange as it may sound, it has taken one virus to show that each individual is connected to societies and other parts of the world that we have never been to. Each one of us is responsible now, to look out for the best possible way to break the chain so that we, and others around us are safe.