Mumbai: A few weeks ago global Scientists, epidemiologists and the international media were at pains to explain India’s mysteriously sharp decline in Covid 19 cases and deaths after September. Even though there has been a surge since mid-Feb, with an overall death rate of 112 per million people, we can confidently claim that we have fared far better than Europe and North America during this Pandemic.
One can attribute this to the heat, the robust immunity, the relatively younger population etc but let’s not forget very crucial elements which are, a dedicated workforce on the ground at State and Municipality levels and excellent doctors and health care workers, many of who are women. This should come as no surprise. One reads about women being the unsung heroes during the 1918 Spanish flu pandemic that claimed 50 million lives. They shouldered the burden of the pandemic because the virus disproportionately affected young men. Although the doctors treating the outbreak back then were almost universally male, it was women as nurses who became the primary caregivers.
On international women’s day we caught up with dynamic women Covid warriors from Mumbai South’s A-ward which covers Colaba, Churchgate and Navy Nagar, who were instrumental in containing the spread in that area.
This is just a small microcosm, but these women are representative of the indomitable spirit of our Covid sheroes all over the country, who sacrificed much to ensure a better outcome for India.
Dr Prajakta Amberkar
Medical officer of health for A-ward since 2019
The unstoppable 43-year-old health officer for A-ward was thrown into the deep end from day 1. Covid has taught her many lessons – personally and professionally. The biggest challenge was to stay firm even under extreme pressure. Overall she says it has made her tougher. She is determined not to let there be a second wave in A-ward, and continues to work tirelessly to prevent it, undeterred by her own bad attack of Covid last year.
You were very aggressive with your contact tracing, especially in slums. How did you go about it?
Of the population of 1,68,000 people, 1,00,000 live in slums. On 29th March we got our 1st case from a nurse hostel. I was under the impression that we would get fewer cases because it’s a VIP ward, but in April we started getting cases from Ganesh Murthi Nagar slum. They were not following covid appropriate behavior.
I was inspecting slum pockets through the day. We started visiting each and every case, taking their history. Finding out the source of infection and their high-risk contacts. I was supervising my staff to see that they are stamping people properly for quarantine. I didn’t want to miss a single high-risk contact. We found out if the patient had attended a marriage function or if they were travelling anywhere. etc. This was before the war room was established in June. From March to May all the work was done by me and my staff. We used to trace a minimum of 15 high-risk contacts. It was a big chain. We had to break the chain. My team also visited each and every house with Anganwadi workers in the slums and checked them with an oxymeter – incase they were hiding some patients.
What was the protocol once patients and their contacts were identified?
We didn’t allow home isolation at first. We set up Covid Care Center 1 (CCC1) for High-risk contacts and CCC2 for asymptomatic patients. We insisted on asymptomatic patients being admitted to CCC2, especially from slums. If they had comorbidities then they were shifted to a dedicated covid healthcare center (DCHC) to avoid rushing in the last minute. If their spo2 was 94, we would say it’s dangerous, you must go to the hospital. DCHC had oxygen, but not ventilators and ICU. We counseled patients a lot. They would say I am asymptomatic, why should I go to hospital or CCC2. We would take the number of the consultant at the center and keep checking on the patients. Shifting the patient in time was important. We did not have a single death in CCC2. Often we would be reporting till midnight.
What is A-ward’s fatality count?
A-ward had the lowest death rate amongst the 24 wards of Mumbai. 123 from March 2020 to now.
Being the health officer you had to shoulder huge responsibilities – how did you balance your family life with work?
I was worried because many in my family are diabetic. After working 12 to 14 hours a day I was afraid of spreading covid to my family so I stayed away for 3 months in a hotel. Then my daughter who is 18 was missing me and asked me to come home. I went on a Saturday and on Sunday I developed symptoms. I was sick for the entire month of June. I was isolated at home. I am asthmatic and my viral load was very high but I was worried about my A-ward work suffering. Luckily, my daughter and husband did not test positive.
What are the lessons this pandemic has taught you?
Corona has taught me a lot. I have learned to be really very firm. In the months of May, June there was a higher level of resistance from people in the slum and non -slum areas. I would get many calls from people asking, “why do you want to shift us. We are asymptomatic”. Or people asking me not to seal a flat or a floor in a high rise, or not to send their maid or security for quarantine, etc. People would talk to higher officials and they would call me, but I said no way, this is my decision because A-ward’s responsibility is with me. Unless I break the chain I will not be able to control the corona pandemic. Now no one calls to ask for this and that. People never used to trust us that even asymptomatic people can spread. I have only one aim – I have to control so please don’t interfere in my work, I said. I vacated the entire BEST chawl in Pasta Lane and shifted them in the month of August to CCC1 because when my helpers investigated they found that toilets were shared.
Which was the hardest decision you had to take?
One incident I cannot forget. There was a high outbreak in BDD chawl Worli. Two of the children from there were quarantined in my Tempo House facility. Their father expired. These two children were covid positive. At 6 am they called me and said, “madam please allow us to go to attend the funeral of our father”. I had to control myself. They were crying. I was not supposed to send any covid positive for funerals and even the body had to be sent straight to the cemetery. The kids were 16 and 14. I couldn’t control my emotions. I said, “Beta I can understand but I can’t allow you. The ambulance can come to Tempo House and you can see your father’s face before they take him, if the police allow but I cant allow you beta”. I can imagine how the children felt that they couldn’t see the father. Police didn’t allow the ambulance to come because of covid norms. I couldn’t help.
Currently what is the situation in A-ward – are you still working very aggressively on tracing and testing?
From October we had very few cases till Feb. 4,800 are my cases as of today – not including Nofra. Daily we have 15 to 20 from high rises. Slum pockets only have one or two cases. There’s no clustering. I don’t want a second wave in A-ward. I am studying each and every case. Whether they have travelled, with whom they have come in contact. We are still aggressively doing contact tracing and mapping. People don’t reveal whom they’ve met. So we take the history from the security guards also in high-rises.
We have many commercial complexes in A-ward so we are conducting camps everywhere including High Court, Air India building. We counsel them to test.
Even people with symptoms don’t want to be tested. They are afraid that their buildings and flats will be sealed. We are testing them free of charge.
In the slums I am still not allowing any asymptomatic person to stay at home. Even the high-risk contacts I’m shifting to CCC1. In high rises they have separate bedrooms and bathrooms so they can stay home. But for 10 days we track the positive patients who are home isolated. We take their numbers and check on them regularly. They get irritated but it’s my duty to track them. Right now it’s under control. People say I am being harsh but it’s important. I took the decision to seal Hem Prabha society in Marine Drive even though they had just 5 cases because the cases were helpers and drivers and they interact with each other in the building.
We can overcome any pandemic if we can overcome corona. We have to adopt covid appropriate behavior. People are relaxed now. They are walking on Marine Drive and attending marriage functions.
Right now I want to protect my senior citizens. We have started onsite registration for vaccines. We are appealing to people not to over crowd. I want three sections at vaccination sites: Health care workers, senior citizens and front liners. I have to plan it properly at Cama Hospital.