Thoothukudi: The cry of the new born baby tore through the sombre atmosphere at the Kulathur primary health care centre in Tamil Nadu, even as patients quietly lined up for their Covid tests in another part of the rural centre.
Tamil Nadu’s storied reputation of having one of the largest and most efficient rural health care systems in India is on display here as the centre doubles up as both a maternity ward and Covid screening and vaccination facility.
“We were worried that we would have to go to different hospitals for delivery but the nurse assured us that it was safe to come here,” says Pechiyammal, 28-year-old beaming mother of the baby.
Staff nurse Femmi, who delivered the baby, says she’s delivered 11 healthy newborns in the month so far. “As soon as a woman conceives, she comes to the hospital to get herself registered. The PHC has all her information and the nurses ensure that mother and child receive adequate food and nutrition. Covid-19 has not changed that,” she said.
Situated deep in southern Tamil Nadu, Kulathur is a small village in the Thoothukudi district with a population of little over 5,000. Getting a strong cell phone network in the area may be sketchy but access to healthcare is easy access for all.
The Government Primary Healthcare Centre in Kulathur is open from 9am to 5 pm, all week. It has five medical doctors, one nurse specialising in child health and the other in maternal health. It also has a lab technician and one staff nurse dealing with patients who have non-communicable diseases. Due to the pandemic, three of the five doctors, on a rotation basis, are assigned duty at the Covid Care Centre set up in Vilathikulam district.
On the day ThePrint visited the center, Dr Muthukrishna Kumar, a general physician, was in charge. Dr Kumar, the second medical officer in order of rank, said, “This center acts as the first screening set up for suspected Covid patients. We collect samples based on the positivity rate. If there are more cases in the community, we collect samples of the second and third contacts as well. Currently, we are collecting about 50 samples a day. These are sent to the Thoothukudi Medical College for testing.”
The hospital has assigned a team of a doctor, staff and lab technician to visit areas in and around the village to find Covid patients and collect samples by contact tracing. The team also carries vaccine vials to vaccinate those willing. On an average the team is able to vaccinate about 10 people a day.
According to Kumar, Kulathur saw 60 Covid cases, 22 of which are currently active, in the month of April.
Showing ThePrint around the 30-bed facility, he said, “We have refilled three oxygen cylinders and kept them ready in case we receive any Covid patient in need of urgent attention. We also have one ambulance which is on alert in case a sick patient needs to be transported to the bigger hospital.”
A well prepared state
On screening for Covid, if a patient is asymptomatic, they are prescribed medication and asked to home quarantine. For those with mild symptoms, an ambulance takes them to the nearest Covid Care Centre, which is about 10 km away. Critical patients are immediately transported to the Thoothukudi Medical Hospital (about 25 kms) or the tertiary healthcare centre in Kovilpatti (about 30 km).
The atmosphere in rural Tamil Nadu gives a sense of alert doctors preparing for the incoming spread as opposed to the PHC’s in north India which are in distress due to high caseload coupled with lack of infrastructure and manpower.
The Kulathur center is one of the 1,000 PHCs in the state which were upgraded to 30-bed facilities in accordance with the National Health Mission (NHM)-Tamil Nadu, orders for which were issued in 2013-14. These hospitals offer round-the-clock deliveries and are involved in sterilising the population according to the NHM’s orders.
Tamil Nadu, which has continuously allotted a sizeable portion of its budget towards developing health infrastructure over the years, has historically performed better in this regard. In the early 1980s, there were only 400 PHCs and 4,000 health sub-centers across rural areas. By 1990, the numbers went up to nearly 1,400 PHCs and 8,000 health sub-centers. The national target is 1 PHC for 30,000 people and 1 sub-center for every 5,000 people.
Government data published in 2019 shows the state had a total of 1,885 PHCs.
The state government also developed and created an autonomous drug distribution system under the aegis of the Tamil Nadu Medical Services Corporation (TNMSC) in 1995.
The Universal Immunization Programme (UIP) of 1986 was also implemented efficiently and in full force. The state ranked first in the country in terms of the number of children immunised. By the late 1990s, about 85 per cent of rural and 91 per cent of urban children were fully vaccinated in the state.
Despite the significant progress made during the UIP, rural Tamil Nadu has been facing vaccine hesitancy during Covid-19.
A fear of the side effects has been fuelling this. The death of popular actor Vivek has made matters worse. Villagers are now of the opinion that the vaccine is life threatening.
District Collector Senthil Raj said the administration is having to make extra effort in order to convince people to take the vaccine. “We have implemented several measures to spread awareness regarding vaccination. We have had the local leaders vaccinated and published images of that in the local media,” he explained.
“We are taking vaccines to their door-step. A 15-day long drive has been organised where medical teams will visit villages and convince people to get vaccinated. Since they fear coming to the government hospital, we have taken vaccination to their doorstep,” he added.
Dr Kumar, who has been a part of this drive that began on 17 May, said, “I went as a part of the vaccination team today (Friday) and we were able to vaccinate 10 people. We go to villages, set up camps in the open grounds of schools and hold counselling sessions trying to convince them to get vaccinated. Despite this we have seen a low turnout.”
“The only one team which was able to get any success was our team of doctors who went to Kodangipatti on Wednesday. They were able to administer 40 vaccines during their visit,” he added.
(Edited by Manasa Mohan)