OPTIMISING PUBLIC HEALTH CARE IN CORONA TIMES : VANAM JWALA NARASIMHA RAO

OPTIMISING PUBLIC HEALTH CARE IN CORONA TIMES

VANAM JWALA NARASIMHA RAO

THE PIONEER (06-07-20200)

The 1500 bedded Telangana Institute of Medical Sciences and Research Institute (TIMS) in Gachibowli, Hyderabad is being developed into a state-of-art facility for treating Covid-19 patients. The required manpower is being acquired on fast track. The sprawling TIMS hospital has all the facilities including ventilator support system. State Finance Department accorded permission to engage clinical and non-clinical staff in various categories. These include professors, assistant professors for General Medicine, Pathology, Microbiology, Radiodiagnosis, Anaesthesia, TB, Neurology etc. The authorities will also recruit staff nurses, hospital administration staff and other medical, paramedical and medical supporting staff.

Already Gandhi General Hospital, Government Chest and General Hospital and Fever Hospital have also been designated as Covid-19 specific hospitals. There are 17 ICMR approved testing Private labs and hospitals in Hyderabad following government guidelines.

Those approaching Basti Davakhanas or Urban Primary Health Centres with symptoms are being referred either to Sarojini Devi Eye Hospital or King Kothi Hospital or any other higher centre for further evaluation and management that may include corona tests. Telangana government has further identified 7 district hospitals as Covid-19 testing sites which will facilitate testing for 21 districts.

Medical and Health officials have made it clear that the government hospitals in the state have the capacity, facilities and equipment to treat Coronavirus patients regardless of the caseload. Gandhi hospital has facilities to treat 2150 Patients and there are 1000 beds with Oxygen supporting facility.

Telangana is better equipped to face any situation whether in terms of availability of PPE or N95 Masks or any such other requirement that is necessary for treating a patient. In all the designated government hospitals 3600 beds are ready with Oxygen supporting facility according to medical officials. Thus, enough of facilities seems to have been created to face the quantum of coronavirus situation.

Chief Minister K Chandrashekhar Rao has been reassuring people time and again, that, the government is ready to offer treatment to the Coronavirus positive patients whatever may be their number. Adequate test Kits, PPE Kits, ventilators, ICU Beds, beds, masks are available. Keeping in view, the spread of coronavirus the government system has also been augmented to provide adequate medical and health facilities by involving non-government and private medical and health facilities. These measures in a way are adequate to contain coronavirus to a greater extent.

However, it seems that there is still ample need for an increase in COVID­19 testing centres as well as hospitals. In Hyderabad to serve the population living in slums as well as outside the slums either an existing Aanganwadi Centre or a place which was used as a polling booth with minimum facilities may be designated as a Corona Testing Centre exclusively for those with symptoms and in exceptional cases for asymptomatic persons. Anganwadi worker and Asha worker may be made as a team headed by a Doctor to attend to the testing work there in shifts with full protection after imparting adequate training to collect samples.  

At the rate of say 2500 persons (all are however, not required to be tested) per centre for the whole of Hyderabad the requirement would be around 4000 centres. One doctor can serve two centres to work on average for about 8-10 hours. A maximum of 2000 doctors are required to cover all the centres. These doctors can be drawn from out of the in-service house surgeons in addition to few doctors hired temporarily for this purpose.

On an average every year about 3000+ admissions are registered in both Government and private medical colleges and even if two thirds pass out every year the number of house surgeons available for corona testing centres would be anywhere near 2000. Their job is to do a clinical general check-up and organize testing. This is in a way the primary health care referral centre. These centres may to begin with be concentrated in slums where there is nearly 40 lakhs population and later, they can be scaled up.   

The number of present urban health centres in Hyderabad may be increased substantially, with a qualified doctor, to serve as first referral centre. Specified number of corona testing centres may be attached to each urban health centre for an integrated approach. PG medical students of various private and government medical colleges on rotation should take care of urban health centres which are supposed to be for secondary health care and for appropriate counselling like advising the virus affected individual either for hospitalization or home quarantine as the case may be. On an average both private and Government hospitals put together there would be around 1000 PG students in Telangana. Later after the state is free from coronavirus, these could be converted as a first referral health care centre.

Both in the primary and secondary stages, that is in the corona testing centres and urban health centres, required sample collections may be taken-up and in the tertiary care further diagnostic tests as to whether the patient suffers from any other medical and health problem like heart, kidney, lungs, sugar etc. may be done. After the primary and secondary stage, the third stage is the tertiary care hospital. This could be done either in the government designated hospitals like TIMS, Gandhi, Chest, Fever etc. or on the 17 ICMR approved Private hospitals. There has to be an integrated approach to enlist NGO run hospitals like Andhra Mahila Sabha, Mahavir and Saint Theresa and similar others as well as large number of private nursing homes, RTC, Railways, even Military hospitals.  

Coming to rural areas the present structure is beginning with Sub-centres, we have Primary Health Centres (PHC), Community Health centres (CHC), Area Hospitals and then the District Hospitals.  There are also teaching hospitals. In addition, we also have Ayurveda, Homeo, Unani and Naturopathy Hospitals in the state. These may be integrated these for the time being to effectively and efficiently contain the virus.   

The services of all government doctors should be utilized optimally. The total bed strength and the total Anganwadi centres are to be optimally utilized all over the state. In every district with medical colleges coming up year after year the services of house surgeons and PG students could be effectively utilized at primary care, secondary and tertiary care that is CHC/PHC, Area/district and teaching hospitals wherever they are.

For the population living in villages the access to qualified primary health care is possible only either through Tele-Medicine or through FDHS (Fixed Date Health Services) scheme. FDHS Mobile Health Units are to be strengthened.

Probably, if a thought is given to these ideas it may be expected to have a new face of health facility in the state of Telangana during corona times. Why not give a trial?