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In Jharkhand dist with high caseload, people in rural belt battle broken infrastructure, inadequate resources

Health Minister Gupta said: “The 108 ambulance system has been outsourced to a private company and they have been given certain directions. But if it does not function properly we will have a re-look."

At 3.45 pm on May 21, Gurcharan Hembrom, 42, was brought to Baharagora Community Health Centre (CHC), 100 km from East Singhbhum district headquarters Jamshedpur, after he suddenly collapsed at his village in Balijuri Panchayat, some 22 km away. His oxygen saturation at 64%, he was put on oxygen concentrators on “full flow”.

The level rose only till 76%; Hembrom lay “comatose”, according to doctors.

At 4.15 pm, attendant Chandra Mohan Hembrom called 108 ambulance services to get the patient transferred to MGM Hospital in Jamshedpur, around 100 km away. The call centre staffer replied that an ambulance cannot be sent without a referral letter. Mohan got the medical officer, Dr Surai Mardi, to speak on his behalf. “I am the doctor here and his symptoms are of Covid-19. Send an ambulance,” Dr Mardi said.

The response, though, was unfavorable. Mohan was asked to speak with the district Civil Surgeon, who assured to send help. At this point, electricity went off at the CHC and the oxygen concentrator machine stopped working. It took more than five minutes to bring Hembrom back on oxygen support through cylinders.

At 4.45 pm, the ambulance, parked 100 metres away within the CHC premises, arrived near OPD and left with the patient at 4.53 pm. Asked about the delay, Mardi called it a problem with the “system”.

From lack of prompt services to inadequate resources and training, this in nutshell is the crisis unfolding in rural areas of East Singhbhum, state Health Minister Banna Gupta’s home district, and also the distridt one with second-highest caseload in the state, having reported 977 deaths and 3,012 active cases as on May 21.

Health Minister Gupta said: “The 108 ambulance system has been outsourced to a private company and they have been given certain directions. But if it does not function properly we will have a re-look. The 108 system is meant to cater to people in rural areas.”

He said the authorities are working to stop rising profiteering in private hospitals, and check whether the situation of government hospitals can be improved.

In Jamshedpur, both Sadar and MGM hospitals seem to be equipped with oxygen cylinders and concentrators and there was no chaos when The Sunday Express went there.

Asked about problems of rural areas, East Singhbhum Deputy Commissioner Suraj Kumar said: “We have provided resources to every level that we can. We are going aggressive on the last mile delivery…in addition to 108 ambulances we have given separate ambulances at block level and ordered for better coordination. As for electricity, I have asked all block CHCs to give me an update whether concentrators are plugged on uninterrupted power supply lines and whether they have generators…. With limited resources, we are keeping the morale of our workforce alive until the fight is over.”

Told about the problems, Chief Minister Hemant Soren said: “We are reviewing the situation constantly and will work on it. We will start a door-to-door survey by May 25. We constantly ask districts (officials) to be empathetic.”

A senior Health Department officer said a showcause notice will be sent to Baharagora CHC for problems faced by the Hembrom family.

On Thursday and Friday, The Sunday Express went to six of East Singhbhum’s 11 blocks and found multiple issues affecting infrastructure — as also a lack of empathy.

Around 80 km from Jamshedpur, in Chakulia block’s Kaliyam Panchayat, Barun Pramanik, 21, said his father had fever and was initially treated by a former CHC doctor at a private clinic. He said: “The doctor never asked for a Covid-19 test but advised a Typhoid test. Fever was gone a few days later, but the cough remained. Suddenly, one day, he was gasping for breath. I tried my best to call an ambulance but I did not get a response. I managed to get a vehicle, but the whole process took one-and-a-half hours.”

“My father died before we could go to Chakulia CHC,” Pramanik said.

He said the CHC did not give a vehicle to take home his father’s body.

The administration has marked Kaliyam village as a containment zone after 67 people tested positive for Covid-19 after Pramanik senior’s death.

While there are 10 oxygen beds available at Chakulia CHC, like with most other CHCs, many villagers said they don’t believe they would get help at the CHC level.

At Kokpara village of Dhalbumgarh block, a patient named Devanand Hena struggled for two days to get a diagnosis done and was tested negative for Covid-19 on May 11. But as his condition deteriorated, the family left for Bharipada in Odisha for further treatment.

He later died of Covid-19.

In the same block in Narsingarh panchayat, Sambhu Shah was gasping for breath, having recovered from Covid-19 recently, when The Sunday Express was there. As his mother, Janaki Bala Shah, lay in the ambulance, the nurse was still trying to arrange beds in the ward and putting a concentrator in workable condition. Sambhu said: “The ambulance drivers did not touch my mother. Gasping, I lifted her and put her in the ambulance.”

The ambulance driver said he was avoiding physical contact given the risk of catching the infection.

Asked about the lack of preparedness and the behavior of the ambulance driver, Dhalbumgarh CHC Medical Officer in-charge, Dr Akhori Gyanendra, said, “There are five oxygen beds available and we do what is required.”

He added that they take care of patients, check their oxygen, and refer them to MGM in Jamshedpur, when required.

In Musabani block of North Ichra Panchayat, deputy mukhiya Tulsi Bhagat lost his mother on May 17 — he said he could not arrange oxygen for her. The block has five oxygen beds in the CHC, and eight beds in the Uranium Corporation of India Limited (UCIL) Hospital in Jadugoda.

Bhagat said he went to a medical store and borrowed a pulse oximeter to record oxygen levels — he found it deteriorating, and rushed for help.

“I went to UCIL Hospital but they did not give me any bed,” Bhagat alleged. “I did not know if any services were available at the CHC. I rushed to Ghatshila and it took me three hours to get oxygen.

“But my mother passed away…. We failed to save her.”

On Bhagat’s allegation that UCIL did not provide a bed, Deputy Commissioner Suraj Kumar said: “We need to see if he had conducted any test on his mother. Why would UCL not give a bed when it is a Covid-19 facility? The CHC has oxygen beds, too.”

Asked about Bhagat’s assertion that the UCIL did not provide his mother a bed, minister Banna Gupta said, “If it is true, then it needs to be investigated.”

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