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Rural India and COVID-19: Pregnant women risk long travel in search of safe hospital

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Rural India and COVID-19: Pregnant women risk long travel in search of safe hospital

Rural India and COVID-19: Pregnant women risk long travel in search of safe hospital
For 21 year old Shalu*, the one and a half-hour car drive to cover 50 kilometres from Kalamb in Yavatmal district to a hospital in Wardha city and then further to Sevagram was an agonising one. She was due to deliver and was in labour pain. Her contractions had started, but this journey was crucial not just to safely deliver the baby, but to deliver in a ‘safe’ hospital.
Not that Kalamb lacked a government hospital or even private clinics to deal with an otherwise normal delivery. Shalu even had consultations with gynecologists in the town. Yavatmal district health center was also 20 minutes away, but the family wanted her to deliver the baby in a COVID-free city. Yavatmal is a red zone district with 79 COVID-19 cases. Wardha has not reported any cases so far.
By the time Shalu reached private Dutta Meghe Institute of Medical Sciences in Sawangi in Wardha, her water had partially broken. The doctors voiced  a possibility of cesarean section in case the situation complicated. The family not having enough money to fund a surgery in a private hospital then left for Mahatma Gandhi Institute of Medical Sciences (MGIMS) in Sevagram in Wardha district. All of this took more than three hours since Shalu first got her labour pain. She was rushed for delivery at MGIMS after triaging at the entrance and a throat swab for COVID-19 test. Fortunately, despite the travel jerks and delay in reaching a medical center, Shalu had a normal delivery.
“I was very scared if I would be able to reach the hospital. What if my pain aggravated during the journey? But I held on to it. We wanted to be safe in a place which does not have COVID infection,” Shalu said over a phone call. She has now been kept in a 14-day quarantine, having travelled inter-district. Her husband, who accompanied her is sleeping in the hospital garden and dependent on the hospital canteen for food.
It was the fear of COVID infection that prompted Shalu to risk travel during the pandemic and the nationwide lockdown. But she is not the only one.
Wardha with no COVID positive cases has become a safe haven between the affected districts of Yavatmal and Nagpur, particularly for maternity and orthopedic cases.
Dr Poonam Verma Shivkumar, Head of Obstetrics at MGIMS said the hospital has seen an influx of pregnant women in the last two weeks.
“We are seeing almost 3-4 maternity cases everyday from neighboring districts of Yavatmal and Nagpur coming to our hospital. We are not refusing anyone but are informing the police and following all required protocols of triaging and quarantining,” she said.
During the nationwide lockdown inter-district travel is barred, unless under extreme emergency and with authorized movement passes.
Dr Shivkumar said their initial consultations with these patients revealed the fear of COVID infection in government hospitals and those private ones that have COVID wards. Few families are getting referrals from their city hospitals or doctors and some others are travelling early in the day to avoid being stopped at district borders. “One family narrated their ordeal of traveling via villages to avoid lockdown rules on the main highways.”
A 30-year old woman travelled from Pune to reach MGIMS in Sevagram. She still has about a week to complete her term and says will be staying with her maternal relatives in Wardha before and after the delivery.
Aradhana*, another woman in her last week of pregnancy, travelled two hours by road from Nagpur to deliver in MGIMS hospital, Sevagram in the green zone district of Wardha. Aradhana was consulting gynecologists in Nagpur’s Government Medical College (GMC) during her pregnancy but towards the end decided against delivering there.
“There are COVID cases in government hospitals. We are scared, what if the new born catches the infection. All my relatives suggested we come to Sevagram as this is a safe place,” Aradhana told us over the phone.
Aradhana is still awaiting her labour. She has been kept in a quarantined ward and has been tested for COVID-19 as per the protocol. She says some private maternity clinics in Nagpur were closed and those functional were expensive. “Private hospitals charge more than Rs 20,000-25,000 for a normal delivery and much more for a C-section. We don’t have that much money. Plus, there is the fear of infection during and after the delivery,” she said.
Nagpur is a regional medical hub in central India with two large government hospitals, that have been partially converted into COVID centers. Both the GMC and Indra Gandhi Medical College and Hospital (IGMCH), together with nearly 3500 beds, are also running all non-COVID wards and services like child deliveries, dialysis and treatment for other illnesses. A senior doctor at IGMCH said while the OPDs have reduced significantly due to the lockdown, the hospital is performing all deliveries as per current medical and safety protocols. Nagpur also has over 650 private hospitals, over 100 are medium to large hospitals. Nagpur has reported 133 COVID positive cases so far.
Dr S P Kalantri, Director-Professor at MGIMS said, “Despite Nagpur having such large medical infrastructure patients choosing to travel inter-district during lockdowns says a lot about the fear factor. We are seeing an exodus of pregnant women from large cities to non-descript towns like Sevagram, because they are seen as safe. There are also reports of many private facilities not operating in the city.” MGIMS’s orthopedic department has also seen some accident cases being moved from adjoining districts.
Dutta Meghe Institute of Medical Sciences has also reported an influx of emergency orthopedic cases like fractures and accidents from neighboring Yavatmal district during the lockdown.
With two large medical colleges – aided MGIMS and private DMIMS – and a district hospital, Wardha has a capacity of over 2500 beds. Multiple private hospitals and nursing homes add to the health infrastructure in Wardha.
Abhay Ghodkhande a social worker assisting rural patients find medical care in the Nagpur-Wardha region said private hospitals and nursing homes in Nagpur staying closed during the lockdown has added to the fears.
“We have received many cases where private hospitals have refused patients," he said.
A 27-year old woman could not find a private clinic for consultation or even a sonography center in Nagpur. “She couldn’t afford big private hospitals and feared infections in government set-up, so traveled all the way from Nagpur to Sevagram,” he said.
MGIMS has set up a 100 bedded COVID facility and has also demarcated the entire hospital to avoid any cross infection to other wards.
Dr Shivakumar said a few patients, who were not due to deliver immediately and had no local stay facilities returned back to Nagpur after realizing the quarantining and police protocols. “We have a proper system in place. Every woman entering the hospital goes through a triage at the entrance itself. Non-COVID patients are are sent to OPD and if there is a suspicion, the patient is moved to a different ward so that we don’t mix with any other patients or staff. We have even divided other staff in 3 teams, provided quality PPEs, so that the entire hospital is not vulnerable.”
Non-COVID patients have been finding it difficult to access health services as many private clinics, nursing homes stayed shut for the fear of COVID infection. Hospitals say even healthcare staff are reluctant to work under fear. While there are triaging guidelines (to decide the order of treatment) for non-COVID patients, reports say many private hospitals don’t follow it.
On Thursday, Health Secretary Preeti Sudan in a notice directed essential health services to be made available by all government and private hospitals. “Many hospitals in the private sector are hesitating in providing critical service such as dialysis, blood transfusion, chemotherapy and institutional deliveries to their regular patients, either due to the fear of contracting COVID-19, or they are keeping hospitals/clinics shut.”
B.S AjaiKumar of HealthCare Global Enterprises told CNBC TV18 that such is the atmosphere of fear that every patient entering the hospital is seen as a suspect. Patients are hesitant to approach hospitals and transport woes are adding to the problem.
"The collateral damage for other diseases is going to be huge if we do not take measures to correct the situation. We have to convey to the patients in no uncertain terms that people who need medical attention should come forward and not fear the COVID-19. We have to address the issues of non-COVID patients in a way where they feel comfortable about  the hospital and even the doctors and healthcare workers should feel secure," Kumar said.
(*Patient names have been changed to protect identities)
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