At the Lal Bahadur Shastri National Academy of Administration, the joke is often that the Disaster Management Module is a disaster, as officer trainees from various landlocked states are taught Tsunami response. Little did one know then that the future would bring a medical emergency like Covid-19 that would completely redefine the word disaster itself. Nothing in the handbook of district administration – if there ever was one – could prepare us for the unprecedented times of the Covid-19 pandemic. My team and I were already firefighting at all ends when the first wave of coronavirus cases hit Ranchi. However, detailed planning and the willingness to adapt to the evolving situation allowed Ranchi to develop a robust Covid response. It was based on the twin-approach of putting in place preparedness measures to respond to the pandemic, and solidarity measures to reach the under-served sections of the population.
Robust preparedness measures
Ranchi recorded its first Covid-19 case on 31 March, yet groundwork-insured district-level guidelines had been issued, and a district Covid-19 control room and helpline was set up. Task forces had started working on diverse aspects of the health emergency, such as perimeter surveillance; medical screening flying squads; health screening teams at district, block, and panchayat levels; supply and home delivery of food, LPG, medicines and basic necessities; procurement of medical equipment; training; etc. A key priority of the state was to prevent throttling of informal economies during the lockdown. To implement this in the district, products of small businesses and krishi mandis were linked to district-level home delivery mechanisms.
To fulfil the burgeoning demand for masks and sanitisers, the district was the first to start local production in collaboration with industries and self-help groups, at substantially lower prices than the national ceiling. This ensured unhindered availability, and helped avoid panic-buying. PPEs made of ICU-grade material approved by agencies empanelled by the Government of India, are being produced in-house at a cost of Rs 250-350, allowing us to assuage fears of frontline workers, as well as provide stock for the worst case scenario. PPEs, masks, and sanitisers are being supplied to other districts and states, as well as the Army, Indian Railways, and Airports. Local factories in Ranchi are producing over 1500 units per day, while employing over 100 rural women.
Instead of converting government hospitals located in population-dense areas to cater to Covid-19 patients, we privileged the continuation of non-Covid health services with appropriate triage facilities. It is in this context that the collaboration between public and private health infrastructure has been crucial. Regular consultation with private hospitals has not only helped in identifying infrastructure, human resources, and ambulances that could be utilised for the Covid-19 response, but has also resulted in the voluntary donation of medical equipment such as ventilators. This helped ensure that by the time the first Covid-19 case was recorded a 50-bedded district Covid-19 hospital, apart from Rajendra Institute of Medical Sciences (RIMS), was ready for operation by 25 March.
Ensuring necessities and inclusive social support
Maintenance of personal hygiene and social distancing – the twin pillars of Covid-19 control – remain a privilege few can afford in an aspirational district such as Ranchi. Handwashing may seem quotidian, but is key in controlling transmission of the virus. CSR donations and subsidised procurement of soaps enabled distribution of hygiene products to beneficiaries of the Integrated Child Development Services (ICDS) network, a particularly vulnerable group. Once the lockdown started, directions were issued against eviction of tenants and collection of house rent, and for payment of full wages irrespective of temporary closure or partial operation of workplaces. Popular campaigns to support paid leave for unorganised sector workers were started with the help of IIM Ranchi.
Things became especially tough for people residing in containment zones, who had to bear the brunt of severe mobility restrictions and temporary loss of livelihood. To alleviate their pain, over 15,000 Mukhyamantri ahar kits that contained rice, pulses, edible oil, flour, grams, sugar, salt, tea leaves, potatoes, onions, milk powder, soaps, masks, etc. have been distributed to all households in major containment areas. A team of trained volunteers have ensured no-contact delivery of essential items. PDS grain home delivery trucks, mobile ATM vans, vegetable and milk vans, and dedicated waste collection and area sanitisation vehicles have also been operationalised.
Support of the state government has helped in the setting up of the CM kitchen, which has served over five lakh meals till now, and additional dal bhat centres across the district, which ensure take-away and home-delivered meals to needy households. Close to one lakh free meals are being served per day, from over 400 kitchens running in the district, the combined effort of the CM kitchen, dal bhat kendras, additional dal bhat kendras, didi kitchens, and through volunteer-supported networks.
Civil society collaborations
The trust built in the administration through such proactive measures helped garner extensive, spirited, and sustained volunteer support. This helped devise and manage helpful strategies such as the hunger helpline (which has enabled ration distribution to over 10,000 families) and the Each One Feed One initiative (which has supported over 2000 families till now). The importance of such collaborations cannot be stressed enough, as they act as force multipliers in alleviating distress for the most marginalised sections of society. Helplines for mental health counselling, domestic violence, child abuse (in association with Bachpan Bachao Andolan), senior citizen support, and telemedicine have been set up. From helping a domestic violence survivor return to Ranchi from Chhattisgarh, where she did not have any support system and was hesitant to approach the police, ensure her safety and help her get access to legal support; to assisting a person with a mental disability to procure specialised medicines, these helplines have worked in tandem with volunteers. They have become the interface that connects the public to relevant government departments.
Vulnerability-mapping for various kinds of social support has been done through a combination of inputs from local representatives, diverse civil society representatives from over 50 organisations, frontline workers, and district-level officers, with the aim to help as many people as possible. This has aided us in reaching out to residents of old age homes/ orphanages/ remand homes/ prisons, wage-earning people, the elderly, transgender persons, sex workers, persons with HIV-AIDS, persons with physical and mental disabilities, etc. Shelter homes operated by government and non-government organisations have been helping guests by not only providing necessities, but also for organising yoga/ meditation sessions, and adopting measures to alleviate stress and anxiety during such a time. Apart from compliance with modified rules regarding mid-day meals/ take-home ration in schools and anganwadi centres, dedicated measures are being adopted to mitigate exclusion of children from early childhood development and education. Paper, pens, crayons, etc. have been distributed to children in vulnerable areas; and block resource centres have set up help desks to provide access to books, as well as remote education through online media, television, and radio. People from Ranchi who were stranded elsewhere in the country and were in need of ration support were also helped by getting in touch through the district administration’s Twitter account and leveraging civil society networks.
Challenges of optimising resources and creating balance
Leadership in crisis is like the act of walking a tight-rope — balancing competing interests and constantly weighing pros-and-cons while thinking ahead. Genuine concerns regarding community transmission had arisen regarding a large cluster outbreak area — the Hindpiri area, from which 70 of the district’s total 146 cases have emerged. A massive door-to-door screening exercise has been conducted, roughly 60,000 people have been screened thrice over a 2-month period, and over 3000 symptomatic persons and contacts of positive cases have been tested. Helplines specific to containment zones have been set up to resolve concerns locally. In light of issues reported by pregnant women, a dedicated 24×7 pregnancy helpline has been facilitating the coordination of passes, hospital and ambulance linkages. To cater to the many high-risk dialysis patients, especially in containment zones, a dedicated Covid-19 dialysis centre has been set up in which every patient is treated with the presumption of being Covid positive.
As a crucial transit point in the state of Jharkhand, Ranchi has received many migrants who were assisted by a round-the-clock ‘Tatpar’ helpline, which sought to ease the journeys of those trying to reach home on foot/ bicycles, or were abandoned mid-way by buses and trucks. They are being brought to a waiting area that is functional 24×7, with separate resting and breastfeeding areas for women. Security personnel are stationed round-the-clock, sanitisation teams are complying with Covid-19 norms, and medical teams have been conducting screening and providing first aid/ medical assistance. Everyone is served hot meals, fruit, biscuits, milk, and water. In case a bus is not immediately available, they are taken to nearby shelter homes for overnight accommodation. Over 80 per cent of those stranded are being provided conveyance free of cost on the very same day, while others are able to go home within 1-2 days. Around 18,000 people have been assisted through this helpline till now.
Hopes and persisting challenges
Currently, out of a total of 146 Covid-19 cases in the district, 22 active cases remain; raising the recovery rate to above 80 per cent. The fatality rate is 2 per cent — three persons with co-morbidities succumbed to the disease. Till now, only three Covid-19 cases in the district have been symptomatic, which attests to the efficiency of the contact-tracing process.
However, Ranchi is far from celebrating a premature ‘success’, and is preparing for fresh cases that are bound to come up. In this new wave, the focus is likely to shift to home-isolation of asymptomatic cases and hospitalisation of symptomatic cases, thus increasing the need to prepare well for co-morbidity management. For an aspirational district with a large rural area having Left Wing Extremist (LWE) presence, a multi-focal strategy is essential. Food security, access to quality education, and social support/ security concerns continue to be priorities. It is crucial to plan for what the new normal will look like in educational institutions, workplaces, and the economy at large. Screening and quarantine measures at the block level have been amped up, and employment-generation initiatives are being put into place to meaningfully absorb workers who have returned home and are here to stay. With four dedicated Covid-19 hospitals, 300 quarantine centres, dedicated screening and triage teams, down to the panchayat levels on standby, and a strong civil society network, one hopes that Ranchi can remain vigilant and prepared for what is to come.
The author is the District Magistrate, Ranchi. He is an officer of the 2011 batch of the IAS. Views are personal.
This article is part of the series ‘Districts Fight Covid’ that explores how India’s district magistrates and collectors have been fighting the coronavirus pandemic. Read all articles here.