Mumbai: The Nandurbar district in the northwest corner of Maharashtra is ranked among the 20 poorest districts on the health index under the central government’s Transformation of Aspirational Districts Programme.
Nandurbar, which has a population of 16.48 lakh, of which 70 per cent is tribal, is usually in the news for alarming levels of malnourishment and the poor infrastructure at its primary healthcare centres.
However, amid the second wave of the Covid pandemic, Nandurbar is making news for quite the opposite reasons.
The district has stood out for its robust health infrastructure — oxygen plants, hospital beds, a central control room, and a plan in place to increase testing — all set up in anticipation of the second wave, under the leadership of district collector Dr Rajendra Bharud.
An IAS officer from the 2013 batch, Bharud hails from the neighbouring Dhule district, but has studied in Nandurbar.
When the second wave hit, while most districts of Maharashtra reeled under a severe bed and oxygen shortage, Nandurbar breathed relatively easier.
The district has managed to cut down its daily new caseload to an average of 245 cases over the past week, with a positivity rate of 14.59 per cent, from a peak of 1,160 new cases and a positivity rate of over 50 per cent on 7 April.
“The last few months have been very hectic. I would get to work by 9.30 am and there seemed no end to the days, Bharud told ThePrint. “Even now, we are working hard to increase testing and bring the positivity rate down to under 10 per cent. But, I am relatively relaxed now.”
Nandurbar has so far recorded 36,464 Covid cases, of which 5,757 are currently active.
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The ‘Nandurbar model’
One of the first steps that Bharud took was to set up oxygen plants with the aim of making Nandurbar self-reliant in the supply of the gas, a key resource in the fight against Covid-19.
Until last year, the district did not have a single oxygen plant, and there is no major industry in the vicinity to supply oxygen in case of an emergency.
Using Rs 85 lakh from the District Planning and Development Council, the district administration set up Nandurbar’s first oxygen plant, with a capacity of 600 litres a minute, in September last year. Before the second wave hit in March 2021, Nandurbar had added a second plant of a similar capacity using funds from the State Disaster Relief Fund and Corporate Social Responsibility. In April, after the district touched its peak in terms of the daily number of Covid cases, the district administration installed a third oxygen manufacturing plant.
All the plants run on a pressure swing adsorption technology, under which atmospheric air is first compressed and then purified to remove any impure particles such as dust, fuel or oil particles. The plant then separates the nitrogen from the oxygen, which is stored in an appropriate concentration and supplied to patients through a pipe.
“At present, with the proactive effort, the total oxygen capacity in the district is 1,800 litres per minute and by adding an additional 1,200 litres per minute from private oxygen producers and in-house resources, the capacity will reach 3,000 litres per minute,” a report compiled by the Nandurbar district administration said last month.
The report also highlighted how the district tried to rationalise the use of oxygen by making sure that patients are given oxygen as soon as the saturation levels start dropping. “This way, patients use only 30 per cent oxygen as against 90 per cent in the latter situation (when oxygen has dipped very low),” the report added.
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Control room, live dashboard, mobile swab collection
Last year, Bharud said, the district administration also put in place a lot of basic infrastructure that helped run the system of testing and bed allocation in an auto-pilot mode when the second wave hit.
All six talukas of Nandurbar have a 24/7 control room, with separate log books for calls received and action taken on them, and four separate helpline numbers. The control rooms also have a district-level officer from the Maharashtra Food and Drug Administration (FDA) to address any shortage of medicines and oxygen.
Similarly, the district set up a dashboard, www.ndbcovidinfo.com, where citizens can access their Covid test results and know the live status of vacant hospital beds taluka-wise. The dashboard also informs patients whether the beds are in government or private hospitals, if they have oxygen, ventilator support, or are ICU beds. Citizens can use the dashboard to access information on the availability of ambulances and the nearest vaccination booth as well.
The Bombay High Court Thursday suggested replicating Nandurbar’s system of giving real-time updates on availability of beds and oxygen in all districts across Maharashtra.
Last year, the district administration set up its own testing laboratory instead of having to rely on Dhule, and introduced 16 mobile swab collection vans, sensing the hesitancy in the population to get tested and the difficult terrain of certain talukas that made it time-consuming for people to reach testing centres. Nandurbar has been conducting about 2,000 tests a day, 50 per cent of which are RT-PCR, according to the district administration.
“In the second wave, because the system was in place, control rooms, websites, portals, SOS calls to collectors reduced drastically. So, though I was busy, I was not stressed,” the collector said.
The second wave
After the number of active Covid patients started declining as the first wave ebbed, the district took a policy decision of not dismantling a single bed set up for Covid care.
“We, in fact, decided to add more beds. We have three times the total number of beds now as compared with what we had in the first wave. The peak of the first wave was when Nandurbar recorded 190 patients in 24 hours. I was assuming that, in the second wave, this might double. But, it was actually six times worse,” Bharud said.
Despite Nandurbar’s preparation for a second wave, the going was not easy.
“We were not in panic mode like some other districts were, but we were definitely hand to mouth. Our hospitals were full. Sometimes, we had to accommodate patients in neighbouring districts. In a 200-bedded hospital, we were accommodating 240-250 patients, by putting a mattress on the floor and fixing it up with an oxygen cylinder,” said Bharud.
The district had about 800 beds in March this year, which it has increased to 1,252. As of now, 461 of these are vacant.
“We set up oxygen beds in two hostels and one marriage hall. In another case, we installed a roof over the verandah of a hospital and added beds,” Bharud said.
The collector courted controversy when BJP MP Heena Gavit alleged that he had “diverted” 1,000 remdesivir injections to the Rotary Welfare Centre, associated with local Shiv Sena leader Chandrakant Raghuvanshi, which “sold them illegally”.
Bharud, however, maintains that this allotment was done in line with state government norms.
In a live broadcast on Facebook Monday, the collector said, “A letter by the health department signed by Dr Vyas (Principal Secretary Pradeep Vyas), says that we can give a certain number of injections to certain organisations for distribution to private hospitals. The letter mentions only one organisation in Nandurbar, the Rotary Wellness Centre.”
The collector also uploaded documents related to the allotment of the vials, and the terms and conditions the administration imposed for their sale and use, on his Facebook profile.
Preparing for the third wave
Bharud’s immediate focus is to prepare the ground for a third wave, with a target of taking the bed capacity to 1,600.
“We are trying to equip all 12 rural hospitals in Nandurbar with 20 hospital beds each. We are setting up a 100-bedded trauma care centre. We are also identifying a few primary healthcare centres where we can set up oxygen beds,” Dr Bharud said.
Another immediate challenge is to address the vaccine hesitancy among the tribal population. “There are a lot of rumours about adverse effects of the vaccine and malpractices in the drive. People ask our officials to give them in writing that the officials personally will be held responsible if anything happens to them. This is still a challenge we have to overcome,” he added.
Nandurbar has so far administered 1,58,707 vaccine doses, according to data from the state health department.
(Edited by Sunanda Ranjan)
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