Learning is the process whereby knowledge is created through the transformation of experienceDavid A. Kolb
To learn from the best practices in tackling the second wave of Coronavirus, the Centre for Habitat, Urban and Regional Studies (CHURS) at Impact and Policy Research Institute (IMPRI), New Delhi organized a special talk on “Practitioners’ Experience in Tackling the Second Wave in the Union territory of Puducherry” on May 18, 2021.
The eminent speaker to discuss this pertinent issue was Dr T Arun, Secretary (Health), Project Director, Project Implementation Agency (PIA), Government of Puducherry; CEO, Puducherry Smart City Development Ltd. Former District Collector-Cum-Revenue Secretary, Puducherry District, Indian Administrative Service (IAS) Officer 2013 batch.
The Chairperson was Dr M. Ramachandran, Former Union Secretary, Ministry of Urban Development, Government of India. He initiated the talk by highlighting that during these unprecedented times, it is important that the fabric of the society should be united and the role of youngsters like Dr T Arun who are working relentlessly for the public is remarkable and should be appreciated. Nobody was prepared for this pandemic as it is an open-ended scenario and a hands-on approach with effective leadership is needed. There are no clear guidelines as to how to handle this huge pandemic, keeping that in mind, it is important to learn from best local practices.
Instil Hope in People
A bulletin of positive news is also the need of the hour. Stories of public support and calmness during these difficult times can provide a ray of hope to the people as we all are so overwhelmed seeing our country suffocating due to lack of oxygen and systemic failures. Public behaviour needs deeper attention and we need to reach out to the people in a constructive way.
Confidence building measures should be the focus area of leaders as trust deficit can make people more anxious and vulnerable. We can’t ignore any more of our failures. Constitution doesn’t list down provisions as to how to handle a pandemic of this vast scale, civil servants work needs to be recognised in this context as they are creating and evolving the best methods and health models.
Dr M. Ramachandran also pointed out an important learning from the LBSNAA that the reputation of the officer spreads even before reaching the place of posting. Therefore, Empathyand being considerate is very important. Commanding respect and building a real connection with the people can go a long way in handling a District effectively. Civil servants can no more remain anonymous entities for the people and be a “Baabu” of the district; they need to be at the ground level.
A brief PPT was presented regarding the Puducherry by the IMPRI Team. Puducherry was a French colony. It changed its name from Pondicherry to Puducherry on September 20, 2006. The areas of Puducherry district and Karaikal district are bound by the state of Tamil Nadu, while Yanam district and Mahé district are enclosed by the states of Andhra Pradesh and Kerala, respectively. Puducherry has an excellent position in socio-economic indicators. It is positioned 4th in terms of sustainable development index too.
Dr T Arun, Health Secretary, Govt. of Puducherry
He pointed out that on March 16, 2020; the first case of COVID-19 was detected in Puducherry. Subsequently, lockdowns, border checking, screening of tourists had begun. More testing centres were also opened to keep everything in control. They were able to achieve a 1-2% positivity rate from November 2020 to March 2021 but in April 2021, the cases have increased as reflective in the whole of India.
In the context of Puducherry, it is important to note that Tamil Nadu’s condition has ripple effects on Puducherry as there are more than 82 border points and Puducherry is an important hub for labour, commercial activity and industries, so people keep coming and moving out for various activities. There has been a 20-25% increase in positivity rate from the last 15-20 days; elections have also given rise to new mutations in Puducherry. According to Dr T Arun, the following points have been his focus area to contain the spread of COVID:
- Integration with IVR (Integrated voice response) system
- Collaborating with NGOs
- Tele calls and conferences
As a part of the solution, Dr T Arun highlighted that testing has been increased; it is 10,000 per day for a 15 lakh population. Micro containment zones are built to check the ground-level situation. More COVID focus centres and testing vehicles have been increased. Help from the police has been sought too.
Triaging is very important in Puducherry. It is basically to check whether the patient is suitable for hospital or home isolation by the health team at home itself. Dr T. Arun pointed that the Health department goes to the home and check symptoms for triaging as per ICMR guidelines.
IVR system and triaging with teleconferences have been really helpful in Puducherry and NGOs like Step One’s help has been instrumental in making it successful. To monitor patients, Anganwadi workers also go and check the oxygen levels of the patients for triaging. Thus, an integrated approach has given Puducherry a way ahead. They have also been awarded E-health awards for IT initiatives.
Ramping up of the infrastructure has been very significant; it has been increased by three times. In IGMC Hospital, 3 ventilators have been increased to 65 ventilators, 20 oxygen beds to 300 oxygen beds as part of the ‘Project O2 campaign’. The company’s corporate social responsibility and NGOs help have helped them in increasing the resources for PSA (Pressure Swing adsorption) plants and 560 oxygen beds have been increased to 1800 oxygen beds in total. Puducherry is also catering to 40% of Tamil patients which reflects the confidence people have in Puducherry’s medical infrastructure as all lives matter. E-passers too have been issued. Dr Arun concluded by asserting that we should target home isolation and have a patient-centric approach in the medical infrastructure!
Responding to the question of what should be the parameters of positivity and vaccination rate, Dr Arun pointed that now people are protesting at the ground level, patients are negligent. People’s response is too different in the second wave. Vaccination should be promoted as co-morbid and 45+ patients need it but their reluctance is a major issue. “Teeka Utsaav” in Puducherry has been successful in creating awareness. According to him, reluctance regarding vaccination needs to be addressed as soon as possible.
Doubling rate, positivity rate and hospital utilization need to be looked upon deeply. Surveillance should be active; people should go to the field. Active surveillance should be ramped up to check symptoms. Dr T Arun also pointed that a stock of 1.2 lakh vaccines is available with Puducherry for any kind of emergency.
Responding to the question of census testing posed by Dr Arjun Kumar, Dr T Arun said that in Puducherry, schools have been made vaccination centers. Door to door vaccination has increased. Puducherry has 30 to 40 PHCs at the ground level. According to Dr T Arun, mobilizing people is very important at this crucial point in time.
Dr M Ramachandran
Sharing information enhances confidence in people. It is important to note that in civil service, people come from different sectors and expertise. It is a service mix of varied experiences. People look up to the leader in turbulent times for support and assistance during these difficult times. Thus, transformational leadership is much needed!
Integrated command and control, war rooms and linking patient with a doctor has been really successful in Puducherry. According to Dr M. Ramachandran, we have to look for resources all cross as done by Dr T Arun.
In Puducherry, health infrastructure is remarkable. ASHAs and Anganwadi workers helped in creating awareness among the people. According to Dr M Ramachandran, Investment in health infrastructure is half battle won. Restrictions don’t work sometimes as borders are porous. We can’t have artificially defined urban limits anymore. The largeness of approach is needed. Tamil Nadu and Pondicherry’s planning needs to be linked. Peripheral areas need attention as there is no constitutional definition of these areas. Pro-active measures should be adopted for better outcomes.
Plus points and learning experience
Responding to Dr M. Ramachandran, Dr T Arun said that investment in education and health is at the core. Health infrastructure is really good in Puducherry. According to the government, there should be 1 PHC per 30,000 population. And in Puducherry, they have 1 PHC per 8,000 population, so automatically there is better coverage. Also, there are 8 medical colleges in Puducherry. Puducherry’s administration has also ensured that CHC (Community health centers) have oxygen plants as according to Dr T Arun we have to be prepared for the third wave by ramping up resources.
Responding to the question of Dr Arjun Kumar as how he is managing private out of pocket expenditure by people on the health and the effectiveness of Ayushmaan Bharat, Dr Arun responded that testing is free in government setup, we are replacing consumables. Patients are not paying for COVID treatment.
Small is Beautiful
Dr M. Ramachandran concluded that Puducherry is well placed as it has good resources and enlightened political leadership. At all India level, a holistic approach should be adopted. We are living in unfortunate times as people are dying outside hospitals due to a lack of oxygen beds. So, there is a question for research that is small state workable and viable to implement policies. The accessibility issue is really crucial here.
Dr Simi asked how Anganwadi workers are protected and are centralized decision making, fewer politics and streamline administration processes, a reason for Puducherry’s success. Are elections a reason for this upsurge and what are the steps to promote awareness among the youth regarding vaccination?
Dr T Arun responded to the question by asserting that training and orientation for Anganwadi workers were organized to understand the basics of coronavirus, there is a regular supply of protective kits, masks and sanitizer. Extra kits too are saved. According to him, Elections are a reason for the upsurge and surge invariants. Regarding vaccines, youth is coming forward for vaccines. Also, politicians visiting hospital wards with PPE kits give motivation to doctors. These symbolic measures are really important as it gives a message that“We are with you”.
Learn from Peers
According to Dr T Arun, every suggestion is good, it adds to the incremental value. In Puducherry, there are 30 representatives for 15 lakh people and their role has been instrumental as they have helped in the delivery of services. The leader’s role and ground-level action are very important. Political representatives have to become active. Good ideas need to be actionable.
Dr M Ramachandran highlighted that integrated approach, human factor and behavior of people during elections needs to be debated deeply. New technologies and techniques such as blockchain technology for voting procedures are the near future. Innovations and creativity like Buses to be used for supplying basic provisions in a lockdown can be useful. We have to learn from others; just an initiative is required to lead to victory. Be open to new learnings.
Dr T Arun believes that bureaucracy is managing this crisis and serving people at their best level. Districts are looking after the best examples and are doing their best. Everyone is on their job. He concluded by saying that “We will overcome this together”. Rebuild the nation and infrastructure.
Dr T Arun is a beacon of hope and what keeps him motivated is that “Actions lead to change”. It is a very tough time for all of us. Everyone has a team that is delivering service at the ground level which needs support from the local people.
Team India will overcome this battle together!