While the Maharashtra government was focussed on tackling COVID-19 pandemic in India's financial capital, Mumbai, neighbouring Bhiwandi district quietly saw a sharp rise in the number of cases.
The first COVID-19 case in Bhiwandi emerged on 12 April. On 12 May, there were 28 cases in the power loom township, and this increased to 734 cases by 19 June. As of 2 July, Bhiwandi has recorded over 2,000 COVID-19 cases and over 102 deaths.
Faced with this swift escalation in cases, Bhiwandi found itself completely unprepared, according to frontline medical workers.
Health Infrastructure Lacking
This lack of preparedness has resulted in COVID-19 patients being turned away by government and private hospitals due to insufficient beds and oxygen facilities. So far, Bhiwandi has had only one government hospital treating COVID-19 patients, the Indira Gandhi Memorial Hospital that consists of 100 beds. This hospital, too, is almost full.
“Occupancy rate is more than 80 percent each day. Other than that, we have private setups in Bhiwandi but most of the hospitals are very small. They are 25-bedded, 22-bedded, 30-bedded, so it doesn’t provide me that much of a scale,” said Dr Pankaj Ashiya, Commissioner of the Bhiwandi-Nizampur Municipal Corporation.
Dr Ashiya replaced IAS officer Pravin Ashtikar as the Municipal Commissioner on 20 June after the district began witnessing a steep spike in numbers. The civic body is racing against time to build designated COVID healthcare centres (DCHC) and designated COVID-19 hospitals.
“In DCHC, my occupancy is around 60 percent. So, 40 percent beds are available. We have around 200 beds, so around 80 beds are available with us. In dedicated COVID hospitals, that is the biggest concern. I have 180 beds available with me, but 145 beds are occupied. That remains the biggest challenge because even there, there are 35 beds available and ICU beds are not available.”Dr Pankaj Ashiya, Commissioner, Bhiwandi-Nizampur Municipal Corporation
Shortage of beds have even seen doctors running pillar to post to make arrangements for COVID-19 patients in a serious condition. Bhiwandi-based physician, Dr SD Jain spent over an hour on Wednesday, 1 July, looking for an alternate accommodation for his patient who needed to be admitted immediately.
“I have three patients admitted in Masina Hospital (in Mumbai) because there was no place. All the DCH setup was full. I have three patients at Wockhardt, two patients at Kurla, so we have to go through a very tough phase of looking up online about what are the admissions available, convincing people, shifting patients from Bhiwandi.” More DCHC setups are the need of the hour, he said.
Just having beds for COVID-19 patients is not enough. Dr Yasin Kazi, who runs a COVID-19 care centre in Bhiwandi, emphasises the need for COVID centres and hospitals to have adequate oxygen facilities.
“Most of the oxygen should be high flow nasal cannula motivated oxygen flow. To make it high flow, they would have to have not cylinders, but tanks to supply this oxygen. This oxygen should be given with the nasal cannula equipment, which makes it high flow.”Dr Yasin Kazi
All of this could have been avoided added Dr Kazi, “The civic body forgot that the lockdown was to be lifted and the people were going to migrate since Bhiwandi has a migrant population, which they were not quite focusing on. They just got happy with a hundred bedded setup. We have got a hundred bedded hospital, which was not sufficient, which was not complete, which was not having oxygen, which was not having ventilator. Unfortunately, it was vision that was lacking in their preparation.”
No Doctors, Nurses to Treat COVID-19 Patients
Like the BMC in Mumbai, another challenge that the Bhiwandi civic body is faced with is insufficient doctors and other hospital staff. “Staffing is a major issue and we are still trying to resolve that. We fall under the government of Maharashtra, not the BMC. If the BMC recruitment level was at 80 percent, government of Maharashtra was at 40 percent. There was a 60 percent deficit. Now, you want more patients to be handled and we don’t have staff for that,” said Bhiwandi MLA Rais Shaikh.
Acknowledging the immediate need for doctors and nurses, the BNCMC Municipal Commissioner said competitive salaries have played a huge role in prompting doctors to join hospitals in Mumbai over those in Bhiwandi.
“If we are offering Rs 80,000 to a doctor in Bhiwandi, the same people are getting more salaries in Mumbai. So, nobody is willing to work in Bhiwandi. We have asked for permission from the government to give additional incentive to people working in COVID hospitals. We will be getting that permission in one or two days, so we will be matching our prices with Mumbai also.”Dr Pankaj Ashiya, Commissioner, Bhiwandi-Nizampur Municipal Corporation
The civic body has also tied up with an external agency to outsource talent to treat patients.
The Way Forward
Bhiwandi’s close proximity to two COVID-19 hotspots – Mumbai and Thane – has emerged as a double-edged sword. On the one hand, this resulted in the spread of infection and on the other, it also meant access to more hospitals. Lack of awareness about the importance of using masks and social distancing also caused the infection to spread. However, doctors believe fear of being placed under institutional quarantine further stopped residents from seeking medical help once they contracted the infection.
“People were told it's an illness which is going to kill you probably and that is why they were scared of coming out and taking treatment. Unfortunately, this has led to COVID being within the houses, infecting more people in the same house, and then the people getting high levels of pneumonia, going into hypoxia and because of non-availability of treatment or oxygen, they ended up going into the casualties that have reached very high in numbers in Bhiwandi,” said Dr Yasin Kazi.
To combat this, the civic body is focussing on containment and surveillance. The BNCMC is now conducting door-to-door survey, obtaining information from general and private practitioners and attempting to contact trace infected patients. “We have to also engage with local religious leaders, community leaders and NGOs who are working in the field,” said Dr Pankaj Ashiya.
To carry out surveillance, the civic body has tied up with the NGO Ahtesaab Foundation, run by MLA Rais Shaikh, which will be roping in the Mumbai based 1 Rupee Clinic and fund the surveillance for one lakh people in Bhiwandi.
“From Saturday, we plan to survey one lakh citizens in containment areas and hotspot areas. Surveillance plus giving them medication for their ailments like fever, cold, give them vitamin tablets. When we are doing surveillance, now, Bhiwandi has 20,000 rapid testing kits.”Rais Shaikh, MLA, SP
Rais Shaikh further added, “We are the facilitators, 1 Rupee Clinic will do the surveillance and whenever there is a suspect, Bhiwandi corporation will then on spot conduct rapid test. I would say the test will take 15 minutes, but we are targeting same day report. We are expecting to survey one lakh people in the containment zones, in the areas where there are high number of cases reported.”
But where will the patients who test positive for COVID-19 go if they need immediate medicate attention? The civic body now has an uphill task to meet this demand.
“In the last 10 days, we have added 600 COVID Care Centre facilities in Bhiwandi. I have included three new hospitals in DCHC (Designated COVID Health Centre) category. Bed numbers have been 110. We have also added 120 beds (DCHC) in our community hall. It has 120 oxygen pipeline points. We will be starting this centre in one or 2 days.”Dr Pankaj Ashiya, Commissioner, Bhiwandi-Nizampur Municipal Corporation
“I was also planning to have a 200-bed COVID-19 hospital in Bhiwandi but this will take about two weeks because we have to set up a proper hospital. We have identified the building and everything is being done,” Dr Pankaj Ashiya added.
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