Essential RMNCAH+N services in response to COVID-19 at Dumka Medical College, Jharkhand

Bringing back focus on essential RMNCAH+N services in COVID 19 pandemic – shifting SNCU & labor room back to the Dumka Medical...

Bringing back focus on essential RMNCAH+N services in COVID 19 pandemic – shifting SNCU & labor room back to the Dumka Medical College & Hospital by the district technical consultant– a story of relentless advocacy

With the unprecedented rise of the pandemic, health systems around the world went into a huddle and sprang back to tackle the issue head on. In India, the health systems underwent tremendous metamorphoses in all the states to face the challenge. Many hospitals were converted to COVID hospitals and resources were streamlined to plan for the eventual inflow of COVID patients. The Medical College & Hospital Dumka was one of such facilities which was converted to COVID hospital and private clinics and facilities were taken over by the district administration for shifting out of some services like labor room and Special Newborn Care Unit (SNCU).

It was during the second week of April 2020 when cases of COVID 19 were being reported from all across the country, a letter was issued by the district administration that the labor room and the SNCU was to be shifted to other private facilities as the Dumka Medical College & Hospital was to be converted to a COVID hospital. Although there was nothing wrong in transferring these units but the places where these were transferred was a concern. When the district technical consultant (DTC) of Dumka region, Mr. Vijay Dubey paid monitoring visits to these private facilities, he was disturbed to see,  judging by the haste and circumstances, that the decision of shifting the LR & SNCU to these private facilities was not as effective as was thought, “When I went to these places one by one, I saw practices which were not only different from the standard clinical practices, but was also frightening for me and for the health department as well.”

The labor room was transferred to a private hospital which had a single delivery table and with complete disregard to the infection prevention practices. The health staff of the private hospital had no clue of post-natal care practices, while the practice of giving oil bath to the babies, late initiation of breast feeding was rampant. The health staff transferred from the Dumka hospital were facing a lot of difficulties in coordinating their tasks with the untrained staff of the private hospital. There were other issues like mixing of post cesarean section patients in the post-natal ward with other patients, practice of flushing placenta in the toilet & overcrowding to make matters worse. There was no proper place of storage of drugs and as a result one of the staff nurse was always on the move to bring the drugs and supplies from Dumka Hospital. Similarly, the SNCU of Dumka Hospital had been shifted to a private doctor’s clinic which had a similar tale with nonexistent infection prevention practice coupled with crowding within small rooms that was offered as SNCU.

Mr. Vijay Dubey began to talk to the staff nurses of Dumka posted in these private facilities separately and asked them to convey their troubles to the Civil Surgeon (CS), the Medical Superintendent (MS), and the Deputy Superintendent. Simultaneously he also supported the staff of the private hospital for capacity building through use of safe delivery app and also helped them undergo the on line capacity building orientations that the USAID VRIDDHI team was conducting for the state. At the same time he met all the district health functionaries and conveyed them about the various issues of these private facilities in the month of April 2020 itself. He also floated the idea of shifting the Covid Hospital to the old hospital building and shifting back of the labor room and SNCU to the Dumka Hospital. This idea was well received by the Civil Surgeon, but nothing was in his control, as this decision had to be taken by the Deputy Commissioner (DC) of Dumka. Meanwhile maintenance work was started in old hospital building by the CS in anticipation of shifting the Covid Hospital there. Mr. Vijay did not stop there and continued his advocacy with the district health functionaries to make them aware of the issues by meeting them regularly and repeatedly.  Weighing the pros and cons of the issue at hand, the Civil Surgeon met the Deputy Commissioner and spoke to her about the issues in the private facilities and also shared the idea of shifting the COVID Hospital to the old hospital building. After 2 days, a trainee IAS paid a visit to the Dumka Hospital to see the possibility of shifting the Covid Hospital from the Dumka Hospital to the old hospital building who shared the feedback with the DC. After a few days the go ahead for the shifting was given by the DC and preparations for shifting was started.  The Dumka Hospital LR & SNCU were fumigated and sanitized properly as per norms and within a week the shifting was started by the end of May 2020.

The assiduous efforts of Mr. Vijay Dubey bore fruits and the shifting back of services to LR and SNCU was a big boon for the mothers and newborns as they would now get quality care as before. The health staff were also delighted at this step of the district health functionaries. At the same time the COVID 19 suspect cases were shifted to the old hospital building which had different entry and exit points and was a compact building where monitoring of the patients could be done properly. This came as a relief to the hospital staff and administration which earlier found it difficult to control the movement of the COVID 19 suspect cases within the Dumka Hospital building.

The shifting of SNCU was overseen by the DTC, Mr. Vijay Dubey at the request of the CS. Newborns were also shifted back and readmitted in the SNCU of Dumka Hospital. Mr. Vijay is seen directing the staff nurse, Ms. Scilla, to provide proper care to the 2 newborns who were shifted along with the equipment in the photo in the left and middle. In the right the mother of one of the newborns waiting for the newborn to be put under the radiant warmer after it has been immediately set up.


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