Lessons Learned From Operating Covid Care Centres
Since the beginning of the spread of Covid-19 in India, we at HNF had been inundated with requests and cries for help. HNF-HECA has been at the forefront of the fight to overcome the pandemic. We set up Covid Care centers, provided ambulance services, distributed medical equipment and consumables, and distributed food to the needy in this difficult time. Our regular charitable activities, donation programs, and new initiatives for contributing any way we can to society also continued.
The Situation
By February, 2021, Covid fatigue had set in. Indians had let their guard down. We had had enough. Restrictions, where imposed, were not enforced. Restaurants were open to full capacity, offices were back to normal working hours, and large gatherings were becoming common. There was a general sense that normalcy was just around the corner. The momentum of social life had picked up. Exhausted Indians wanted to forget lockdowns and restrictions, even while experts warned against complacency.
It was in this milieu that cases of Covid-19 began to rise in Delhi in April, 2021. It took a few days for the public to realise that the worst may not be behind us yet. There was a sense of denial about what consequences may come.
It would not be hyperbolic to say that no one foresaw the return of Covid with such virulence. Except for a few medical experts, voices advocating prudence were nowhere to be heard. Preaching caution was no longer fashionable. Locking down entire cities once again was not an option. The previous lockdown had destroyed the economic viability of many businesses and families. Extinguishing the ray of hope that families and individuals clang to was the last thing any official wanted to do. Yet, by mid-April, the virus had overcome us once again. Delhi was forced into another indefinite lockdown, and much of the nation was under the grip of the virus and all its odious apparatus. Not only did the virus defeat our bodies, it also overpowered the fabric of our society.
Collaboration with Delhi Police
When cases began to rise rapidly in April, precipitating a healthcare crisis never before seen in India, one group went above and beyond the call of duty to take control of the situation. Delhi Police was not only at the frontline of the crisis, but they set an example of the chivalry and responsibility that was the need of the hour. Delhi Police helped patients who were stranded without transport to get to hospitals. They brought oxygen to those gasping for breath. They even delivered food to those left helpless and grounded by the lockdown. Through these and many other acts of heroism, Delhi Police lived up to its motto of Shanti Seva Nyaya (Peace, Service, Justice).
Their valour was not without its costs. Covid cases among members of Delhi Police and their families rose rapidly as exposure to the virus took its toll.
The Project
In view of the grim and desperate situation in Delhi, Hamdard National Foundation - HECA, in partnership with Delhi Police, set up three Covid Care Centres in Delhi for Delhi Police personnel and their families. A Covid Center, as opposed to a full-fledged hospital, is used to stabilize patients that are suffering but not critical. Critical patients are shifted to a hospital as needed.
The first centre came up in Shahadara police station complex. This is a 70-bedded centre with all basic equipment and amenities for stabilising patients suffering from Covid-19. An ample supply of medicines and oxygen cylinders is also available at the Centre. The Centre was ready for operation on April 24, 2021, only three days from the conception of the idea. Such quick execution was possible only because of teamwork and mobilization of all critical resources to get the Centre ready for operation.
The next centre to come up was at the Rohini police station on April 27, 2021. Again, this was set up in record time. From sourcing of medical equipment, medicines, consumables, and oxygen cylinders to tying up with major hospitals for tertiary care and mobilization of staff, it took only three days. Again the team came together with a zeal for service to the community and obstacles were removed by persistence.
The third Covid Care Centre by the group was established as a 50 bedded facility at Majeedia Unani Hospital in Jamia Hamdard, New Delhi. With the lessons learned and experience of the other two centres, this centre was operational from 22 May, 2021. The centre is open for Delhi Police as well as for teaching and non-teaching staff of Jamia Hamdard and their families.
The Commissioner of Delhi Police visited all three centres and commended Hamdard National Foundation and the entire team for setting up three excellent centres for treatment of Covid patients. At all three centres, regular duty doctors and nurses are from Jamia Hamdard.
When the Omicron wave hit in January, 2022, and cities were again faced with a lockdown, we sprang into action and mobilized the Jamia Hamdard centre within a week. Luckily, this time around the cases were not as serious and only one patient visited the Centre in January 2022, we were ready, and we stood by our conviction that it is better to be prepared for any eventuality.
The Lessons Learned
1) A diverse and unique team with individual skills can put together a project in record time. The need of the hour was Covid relief and our core group worked with focus and open channels of communication at all hours so that time was not wasted. With a right-minded group of individuals and open communication, there is no reason why centres for public medical service cannot be set up in quick time. The key was to put together a multi-disciplinary team with each member contributing towards the goal.
2) Do not wait for perfection when it comes to an emergency. When people’s lives are on the line, it is more important to start giving medical care immediately rather than wait for an absolute ideal set-up. Things improve quickly as we learn.
3) Rules and regulations for taking in patients can and should be broken when required. When a patient, gasping for breath and in need of critical care, comes to the centre for relief, parameters like oxygen threshold and other conditions for taking in patients at a Covid Care Centre, set by various authorities, lose meaning. At that stage, the job of the duty doctor and other functionaries at the Centre is to provide relief and save the patient’s life. That could mean putting the patient on oxygen and calling an ambulance to transfer the patient to a facility with more amenities. Refusing service is not an option.
4) Regular and clear communication can solve the most difficult of problems. The core team met every night on video conference during the implementation to discuss and solve problems, compare notes on special cases, and to volunteer tasks. Members of the team communicated multiple times during the day to overcome any obstacles.
5) There is no shortage of charitable funds in India. Foundations like Hamdard National Foundation and individual donors are constantly looking for funding opportunities towards a good cause supported by a strong team. Clearly defined projects with good intentions can attract ample funding. To attract funding for a humanitarian cause, it is important to have clear goals and organised ideas and to present them to a funding agency with clarity.
6) Strong project management skills are essential. Medical expertise is a prerequisite for organising a medical centre, but the role of project management cannot be underestimated. Managing inventory and staff, keeping track of agreements and permissions, following up with vendors, and motivating the team, all require quick decision-making and execution.
7) Grit and persistence among team members are as important as experience. In setting up infrastructure for a Covid Care Centre in an emergency setting, the project lifecycle shrinks. The obstacles and successes will both come at a faster pace than a normally-paced project. What will get you through obstacles is persistence.
8) This last lesson is related to public policy. It is understandable that fatigue sets in over lockdowns and mask mandates, and that any ailment looks distant until it affects you. Going back to a pre-pandemic normal may be appealing, but history shows that relaxation could have harmful implications not only for this pandemic but for the next one as well. Records are clear that cities and countries that implemented public health measures earliest and longest had the lowest death rates. It is essential to err on the side of caution.
After seeing the success of the three Covid Care Centres, Delhi Police has decided to expand one of the centres, the one at Rohini, into a full-fledged hospital with emergency and intensive care facilities. Plans to set up a new hospital and medical college under Hamdard National Foundation (India) - HECA have also been prepared and are awaiting funding.
Sajid Ahmed