Liver Foundation, West Bengal

aspire to take science to society

Covid Care Centre

 

TOTAL EIGHT FIELD HOSPITALS BEING RUN BY LIVER FOUNDATION, West Bengal

Initiated on

18.05.21 at Nagari & Labpur (Birbhum)

21.05.21 at Sainthia (Birbhum)

20.05.21 at Lakurdi (Purba Burdwan)

22.05.21 at Siliguri (Darjeeling)

31.05.21 at Taki (North 24 parganas)

12.06.21 at Dayapur, Gosaba (South 24 Parganas)

14.06.21 at Ailakandi (Bankura)

 

                                                                                        COVID CARE FIELD HOSPITALS IN WEST BENGAL

                                                                               Liver Foundation, West Bengal and Covid care Network initiative

 

Background

India is in the midst of a large upsurge in Covid-19 cases that has left many patients deprived of basic life support, hospital beds and oxygen. The state of West Bengal has—thus far—managed to avoid critical shortages due to advanced planning for the cities and urban areas, but it is likely only a matter of time before even the increased capacity that has been built up in the last 3 months will be overwhelmed: The current positivity rate, defined as the fraction positive of all cases tested, is 30%. This compares to a usual definition of moderate level of risk at 2-3%. We expect these cases to rise further and potential peak in the next 6-8 weeks, although the timing remains uncertain. Part of the reason for this expectation is that elections in West Bengal have just concluded, and the effects of these elections (which effectively prevented the government from implementing lockdown measures) will play out over the next month.

Through our work on Covid-19, both as part of West Bengal’s Global Advisory Board and our own presence in multiple districts around the state, we make the following additional observations about the surge in West Bengal:

1.      The problem in rural areas of the state may be particularly worrisome because the combination of less accessible testing facilities and hospitals implies that many people are accessing care only once the disease is in its advanced stage.

2.      At advanced stages, outcomes are likely to deteriorate as oxygen is scarce and many households in upper income groups have stockpiled oxygen cylinders (which is of no value if desaturation happens).

3.      During the first surge, we noticed that many patients chose to travel to Kolkata and other urban centers rather than visit healthcare facilities closer to their homes. This both delayed care and further spread the infection through travel.

 

Proposed Solution

The Liver Foundation IS setting  up multiple Field Hospitals in peripheral regions of the state that will dramatically increase accessibility and provide care to Covid-19 patients in the rural areas of the state. This will both improve the management of the illness at its earlier stages, that is, between home-based care and hospitalization and, by doing so, it will decrease the patient load on hospital beds, which can then be reserved for those who need it the most.

Our solution is guided by the previous experience of surge management around the world combined with our deep contextual knowledge of rural healthcare availability in West Bengal coupled with our belief in evidence-based policy.

First, doctors in Lombardy, Italy wrote as early as February 2020 that hospital-based management will only go so far in the middle of a surge and could not handle extreme situations like that in India. As Nachiket Mor has written in a recent article:

“A recognition that exclusive hospital-based responses, while necessary from a humanitarian perspective, will ultimately be overwhelmed no matter how strong they are. And, while the supply of oxygen and the availability of ventilators are proving to be the bottleneck, the rate-limiting step is increasing the availability of trained pulmonologists, intensivists, and anaesthetists, all of whom are needed to mount an effective intensive care response. This is likely to be a multi-year process and it is not yet clear that the Indian system even has the ability (or the need) to sustain this level of base capacity once the pandemic is behind us.”

The key knowledge gained from this surge was that the management of many patients could be shifted to providers with less training. In fact, one of the key lifesaving “drugs” is low-flow oxygen delivered through oxygen concentrators. These machines require less than 15 minutes training to use and only require electricity to run along with a transportations network to get them to required locations.

Second, over the last decade The Liver Foundation has followed an evidence-based and pragmatic approach to solving the healthcare problems of rural West Bengal. We realized early on that the majority of providers in villages were Rural Healthcare Providers, or RHCPs with varying degrees of medical training. We therefore instituted a training program with these providers in the district of Birbhum, which was independently evaluated by Abhijit Banerjee (Nobel Prize in Economics) and his team and published in the top medical journal Science. Based on this evaluation, the government decided to scale-up the training scheme and as a result we have developed a close connection with more than 100,000 RHCPs through the state of West Bengal. It is this deep contextual awareness that we will leverage in the construction of the field hospitals.

Field Hospitals: What are they, what will they provide and how will they work

The Field Hospitals are temporary facilities designed to provide care for Covid-19 patients in proximity to the community. The facilities at these field hospitals will allow us to stabilize moderately infected patients, who can then be triaged to a central facility if necessary, once a bed is available. Through this strategy, the field hospitals will both avert deaths and decrease the patient load in the central facilities.

At the same time, we wish to be very honest about what the field hospitals can achieve. The care at field hospitals will ascribe to the highest ethical standards and scientific knowledge, but we have to acknowledge that these will never become institutions that can provide top-of-the-line care. Specifically, the field hospitals will have the following basic Covid care arrangements.

A.      We will target 25 beds in each field hospital, and scale them up as funding becomes available. The budget we have prepared shows that we can operate a single field hospital for one month at $20,100, which translates to a cost of $26.8 per patient per day.

B.     The field hospitals will be staffed with on fully trained Covid-care health-worker (a doctor) who will oversee multiple nurses and paramedical staff as well as housekeeping personnel.

C.      It will also have the minimum level of lifesaving drugs, such as steroids, but will not dispense of prescribe drugs that are being widely used in India but have questionable efficacy for Covid-19.

D.     The hospitals will provide additional support to workers through a telemedicine system that Liver Foundation has worked on.

E.      Finally, the field hospitals will have an oxygen supply through the use of concentrators/ cylinders as based on availability .

We are already moving ahead with this plan and initiating 5 centers by 12th/13th May, 2021. Of these, 3 will be in the district of Birbhum (where Liver Foundation has a strong presence), 2 in Purulia, 1 in Burdwan and 1 in Siliguri. These are all districts where initial reports are suggesting a surge. Our plan is to scale up to 50 such field hospitals, catering to more than 1000 patients within a month, depending on funds and human resources.

What support do we need?

1.      Material Support Required:

a.      Food

b.     Waste disposal

c.      Patient Beds

d.     Drugs, oxygen masks

e.      Water Supply

f.       Electricity generator set

g.      Oxygen cylinders and concentrators

h.     PPE

i.       Pulse oxymeters

2.      Human Resources  Availability

A.     Two doctors per center (1 allopath and 1 Homeopath)

B.     A secondary school educated technical Health worker who will handle oxygen and attend patients. We plan to have two such technical health workers per shift, and we plan to operate 3 shifts and retain 2 spare workers for a total of 8 workers per center. We will draw heavily on our deep ties to the RHCPs in West Bengal to act as technical health workers.

C.      4 Nurses per center

D.     4 housekeeping staff per center.

We highlight that there are continuing challenges in obtaining oxygen concentrators (although the situation is improving) and fear among frontline healthcare workers. We are working on both these issues.

What are the regulatory requirements?

The clearance to operate these field hospitals will be obtained from the Chief Medical officer of each district. The entire process will be closely aligned to mainstream government enterprises, and by doing so, we will also ensure that people who need critical care are efficiently triaged into suitable care.

Who organize this effort?

The Liver Foundation, West Bengal is West Bengal’s premier NGO working in public health and human development areas since 2006. In addition to our public health work with rural healthcare providers and the building of a surveillance system in Birbhum, we also developed the Indian Institute of Liver and Digestive Sciences (www.iilds.in) in 2016 . IILDS has been operating as a covid care facility over the last year. We work in close association and overlap with Covid care network(www.covidcarenetwork.org) – a NGO that had been carrying out community linked services, helpline, supplies and almost every potentially area that serves people with Covid.

With Generosity of 

Association for India's Development
BSE Limited
Bandhan
SBI Foundation
West Bengal Industrial Development Corporation 
Cipla Foundation
& Many other Individuals