Updated: September 23, 2020 7:25:15 am
Since September 1, Satara has recorded 16,000 cases, with Karad as the epicenter. (Proceedings)
For three days earlier this month, 65-year-old Kashabha Kumbhar lay outside the Karad sub-district hospital while her family, who had come there from a village 20 km away, searched for a hospital bed. It was only when Kumbhar became critical that the hospital admitted him on September 10.
Karad’s hospital had been turned into a Covid facility in March, but as cases dragged on, it had come back to see other patients. Now, as the coronavirus spreads to rural areas, hospitals like Karad’s in Maharashtra are struggling. Again declared Covid-only this month, the Subdistrict Hospital has 45 beds and none in the ICU due to the lack of an intensivist and oxygen tank.
With 54% of the state’s 11.23 million rupee population, rural Maharashtra had only 16.5% of its coronavirus cases as of mid-July.
As the lockdown is lifted, the graph has been growing and now, with 4.02 lakh of cases, the rural regions of Maharashtra account for 34.4% of its numbers.
Since September 1, Satara has recorded 16,000 cases, with Karad as the epicenter. Dr. Sheela Khairmede, Karad Sub-District Hospital Medical Superintendent, says: “We did not expect the cases to increase so suddenly.”
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September has been particularly tough for Maharashtra, which has consistently had the highest number of coronavirus cases in the country. Of the nearly 2 billion new cases from India this month, 46% of them have been in Maharashtra alone. With Mumbai as the initial epicenter, the state’s efforts focused on the capital. As rural areas are affected, the system struggles.
Navi Mumbai Municipal Corporation staff along with Terna Medical College students wear PPE and ride a special bus to reach the door-to-door survey location in Juinagar, Navi Mumbai. (Express Photo by Amit Chakravarty)
Satara saw their rise in mid-August, and their total number is now 30,037, half of them in Karad alone. The district has 471 ICU beds and 1,154 oxygen beds for more than 8,700 active cases, including 22 private hospitals converted into dedicated Covid facilities.
“We desperately need the involvement of more private hospitals,” says Civil Surgeon Dr. Subhash Chauhan, as he discusses plans for a 300-bed “jumbo facility” with a 20-kilogram oxygen tank.
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At the private Krishna Medical College and Satara Civil Hospital, which have the district’s only Covid-19 dialysis beds, there is a two- to three-day waiting list. The Civil Hospital has seven beds of this type. “We need one more dialysis unit,” says Chauhan.
“I receive several calls a day to ask for beds, my own relative is looking for one,” says corporate Vijay Wategaonkar, from the regional Lokseva Aghadi party.
Dr Nagnath Dharamadhikari, in charge of Covid at Karad Sub-District Hospital, says: “Patients come panting, but I can’t get one patient off oxygen to help another.”
Satara residents have raised funds to purchase at least 80 oxygen concentrators for patients who cannot get a hospital bed. One of them is Poonam Badwe (29), who has Down syndrome and was diagnosed with Covid-19 on September 7. The family says they were unable to get a bed at five hospitals, even when Poonam’s oxygen saturation levels fell below 50%. On September 8, the family called for help via WhatsApp and the locals organized an oxygen cylinder at home.
Kumbhar had tested negative on a rapid antigen test. While regulations require that a symptomatic person be retested using RT-PCR, the government hospital did not follow up. It was when his condition worsened that his son took a test in a private laboratory, where he tested positive. Then the wait began on the grounds of the Karad Sub-District Hospital.
Hambirao Yadav’s son Satish also made rounds first at Karad hospitals and then Satara, after Hambirao contracted Covid-19 last week. Satish eventually took his father, the sarpanch from Yeravale village, to the Pune Military Hospital, 160 km away.
Satara picker Shekhar Singh says the district will increase 1,000 isolation beds in the coming days. “Every week we add more private hospitals.”
In Osmanabad district, locals raised Rs 1 crore to set up an RT-PCR laboratory in April. The district was in the green zone, meaning few or no cases, from March to May, during which, according to a senior district official, only Covid Care Centers for patients with mild illnesses were established. Since August 1, the district has registered 8,955 cases, 89% of its total, which is when the expansion of beds began. “The cases increased suddenly since the end of July,” says the district health official, Dr. HV Wadgave.
Osmanabad now has 1,010 oxygen beds and plans to add 580 more. However, he did not plan for oxygen storage tanks or ambulance demand (with a population of 16.6 lakh, he has 19 ambulances for Covid-19 cases).
Every day, the District Civil Hospital makes frantic calls to oxygen cylinder dealers. Its oxygen requirement is expected to increase from 300 to 550 cylinders per day by the end of September. Hasan Pathan of Goraj Gases, an oxygen distributor, says: “The demand is huge and the supply has not increased.”
Wadgave says a plan to install oxygen tanks at two government hospitals is awaiting approval.
Osmanabad collector Kaustubh Diwegaonkar says they are trying to speed up testing. “In 60 villages that contribute 35-40% of the burden, we are using primary health centers for early identification. We are also increasing the number of ambulances ”.
The problems caused by the pandemic further expose the gaps in Maharashtra’s health infrastructure. A 2019 Union Health Ministry report, published months before the state’s first coronavirus case, pointed to a deficit of 20% in PHC and 37% in community health centers in rural areas. The state allocation for health has stagnated at about 4% of its spending during the last two budgets, lower than the national average.
Public health expert Ravi Duggal says that at 1,400 rupees per capita, health spending in Maharashtra is among the lowest in India (the national average is 1,800 to 1,900 rupees per capita). In rural areas, he adds, almost 70-80% of the budget goes solely to the payment of salaries.
TOMORROW: Why Doctors Are Not Willing To Join Rural Hospitals
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