Coronavirus and Deficient Regional Health Infrastructure may lead to Community Outbreak in North Bengal

Abdul Hannan
It
is well-known fact that all the northern districts of the State of West Bengal
i.e. Cooch Behar, Jalpaiguri, Darjeeling, North and South Dinajpur, Malda,
Murshidabad etc. is considered to be unskilled labour supply zone in most of
the cities of India and the migrant laborers are engaged in various kinds of
urban services typically known as Unorganised
Sector
in economic terms. The region is also surrounded by national and
international borders and gateway of India’s North-East including Nepal, Bhutan
and Bangladesh. The mobility of people is relatively very high through land
ports and surface transportation system across borders. The recent outbreak of
coronavirus is likely to impact this region adversely due to sudden closure or
lockdown and return of migrant labourers from various parts of the country to
their native places for many reasons. 

Let us examine the following:
Pattern
of Regional Health Infrastructure
Having
this background in mind, let us look at the rural health infrastructure in
North Bengal in relation to the whole state of West Bengal. Table-1 shows
that average population served per rural health care
institution are very high in North Bengal as compare to rest of Bengal.
Although, the population density is low in the districts of North Bengal with
804 persons per sq.km as compare to 1029 persons per sq. km in West Bengal
(Census, 2011). This table also indicates that there are insufficiencies of
rural health infrastructure in North Bengal to treat majority of the rural
patients

Table 1: District/Region-wise
Health Infrastructure (Institutions) in West Bengal 
(As on 31.12.2016)
Number of Health Institutions
Average Rural Population served per Institution (Computed as per
Census, 2011)
Districts/ Geographic Regions
SC
PHC
BPHC
Rural
Hospital
SC
PHC
BPHC
Rural
Hospital
Darjeeling
230
22
3
9
4865
50857
372953
124318
Jalpaiguri
537
39
1
13
5237
72115
2812495
216346
Koch Bihar
406
29
4
8
6231
87229
632413
316207
Himalayan Region
1173
90
8
30
5508
71788.97
807625.9
215366.9
Uttar Dinajpur
344
19
3
6
7689
139206
881635
440818
Dakshin Dinajpur
248
18
1
7
5806
79999
1439981
205712
Maldah
511
34
0
16
6746
101388
0
215449
Murshidabad
832
70
10
17
6855
81473
570312
335477
Birbhum
484
58
4
15
6308
52637
763239
203530
Nadia
469
47
3
14
7950
79335
1242909
266338
Eastern Plains
2888
246
21
75
6931
81369
789033
266892
North 24 Parganas
742
51
4
18
5765
83875
1069405
237646
Kolkata
South 24 Parganas
1068
60
9
21
5687
101236
674910
289247
Southern Plains
1810
111
13
39
5719
93260
796293
265431
Barddhaman
765
105
13
22
6064
44183
356866
210876
Hugli
672
62
1
17
5046
54688
3390646
199450
Haora
448
43
2
13
3964
41300
887943
136607
Central Plains
1885
210
16
52
5202
46694
612862
188573
Bankura
564
69
3
19
5846
47781
1098967
173521
Puruliya
485
54
2
18
5272
47348
1278401
142045
Paschim Medinipur
858
83
4
25
6050
62539
1297693
207631
Purba Medinipur
706
51
9
15
6378
88297
500351
300211
Western Plains
2613
257
18
77
5950
60497
863757
201917
North Bengal
2276
161
12
59
6148
86914
1166090
237171
Rest of the Bengal
8093
753
64
214
5955
63997
752969
225187
West Bengal
10369
914
76
273
5997
68034
818199
227777

Note: a) As per IPHS, one Sub-Centre established for every 5000 population in
plain areas and for every 3000 population in hilly/tribal/desert areas whereas
a Primary Health Centre (PHC) covers a population of 20,000 in hilly, tribal or
difficult areas and 30,000 populations in plain areas and each CHC thus
catering to approximately 80,000 populations in tribal/hilly areas and 1,
20,000 populations in plain areas.
b) Kolkata is an urban district in West Bengal which
does not have any rural health care institutions
Source:  Computed from Census of
India (2011), Health on March 2015-16 (Draft Copy), Directorate of Health
Services, Government of West Bengal
Table
2 shows the availability of beds in Primary Health Centre (PHC), Block Primary
Health Centre (BPHC) and Rural Hospital. Average population served per PHC,
BPHC and rural hospital beds are quite high in North Bengal as compared to the
state average and rest of the Bengal. Average population served per BHC beds in
North Bengal 87457 persons in comparison to 51604 persons in West Bengal. The
corresponding figure for PHC and rural hospital beds in North Bengal are 11267
and 7307 persons in contrast to 8919 and 6643 persons in West Bengal. This
reflects the unequal regional health infrastructure at the aggregate level. But
if we compare and contrast across districts and regions picture gives an
impression that Kolkata surrounding areas are better served than their distant
areas.
Table 2: District/Region-wise
Health Infrastructure (Institutional Beds) in West Bengal 
(As on
31.12.2016)
Number of Beds in
Health Institutions
Average Rural
Population served per bed (Calculated as per 2011, Census)
Districts/Geographic
Regions
PHC
BPHC
Rural Hospital
Total
Rural
PHC Beds
BPHC Beds
Rural Hospital Beds
Total Rural Beds
Darjeeling
170
60
320
550
6582
18648
3496
2034
Jalpaiguri
266
10
450
736
10573
281250
6250
3821
Koch Bihar
224
40
240
504
11293
63241
10540
5019
Himalayan Region
660
110
1010
1790
9789
58736
6397
3610
Uttar Dinajpur
132
40
180
352
20037
66123
14694
7514
Dakshin Dinajpur
180
10
210
400
8000
143998
6857
3600
Maldah
270
0
515
785
12767
0
6694
4391
Murshidabad
574
175
580
1329
9936
32589
9833
4291
Birbhum
478
105
500
1083
6387
29076
6106
2819
Nadia
354
30
455
839
10533
124291
8195
4444
Eastern Plains
1988
360
2440
4788
10069
46027
8204
4181
North 24 Parganas
416
60
580
1056
10283
71294
7375
4051
Kolkata
South 24 Parganas
444
125
730
1299
13681
48594
8321
4676
Southern Plains
860
185
1310
2355
12037
55956
7902
4396
Barddhaman
732
230
750
1712
6338
20171
6186
2710
Hugli
452
10
630
1092
7501
339065
5382
3105
Haora
387
30
546
963
4589
59196
3253
1844
Central Plains
1571
270
1926
3767
6242
36318
5091
2603
Bankura
506
50
670
1226
6516
65938
4921
2689
Puruliya
368
40
550
958
6948
63920
4649
2669
Paschim Medinipur
610
50
995
1655
8509
103815
5217
3136
Purba Medinipur
409
140
450
999
11010
32165
10007
4508
Western Plains
1893
280
2665
4838
8213
55527
5834
3214
North Bengal
1242
160
1915
3327
11267
87457
7307
4206
Rest of the Bengal
5730
1045
7436
14211
8410
46115
6481
3391
West Bengal
6972
1205
9361
17538
8919
51604
6643
3546



Source:  Computed from Census of India (2011), Health
on March 2015-16 (Draft Copy), Directorate of Health Services, Government of
West Bengal


Firstly,
the regional health care is always a kind of neglected areas of Government of
West Bengal since independence. The epicentre of regional health care in North
Bengal and only referral hospital is the North
Bengal Medical College and Hospital
which was set up in 1968. Till
recently, it is only Medical College catering health services in North Bengal and
its catchment starting from Malda (300 kms) in the South, Cooch Behar (200 kms)
in east of Assam, Darjeeling (80 kms) and Sikkim (120 kms) in North and
adjoining Bihar and Nepal in West. However, four Medical Colleges have come up in
recent past and these are situated at Malda (2011), Berhampore (2012), Raiganj
(2018) and Cooch Behar (2018).

Secondly,
as per ICMR notification dated 24.03.2020 there are four operational
laboratories for COVID19 testing in West Bengal. Out of which two are situated
in Kolkata only and these are: A) National Institute of Cholera & Enteric
Diseases Kolkata and B) Institute of Post Graduate Medical Education and
Research, Kolkata. The other two are: C) Midnapore Medical College, Midnapore
and D) North Bengal Medical College, Darjeeling. These two has been made
functional since 25.03.2020. The Cooch Behar Medical College and Hospital
(2018), the Raiganj Medical College and Hospital (2018), the Malda Medical
College and Hospital (2011) and the Murshidabad Medical College and Hospital
(2012) do not have COVID19 laboratory testing facility as per the recent ICMR
notification. The adjoining region of lower Assam is yet gets a functional
laboratory testing facility at Fakhruddin Ali Ahmed Medical College, Barpeta.
Similarly in north Bihar, COVID19 testing facility at Darbhanga Medical College
is yet made functional. The tiny hill state of Sikkim do not have testing
facility as per the ICMR notification dated 24.03.2020. Therefore, aggressive
testing facility is the only hope for identification of cases and we may be
delayed in getting reports of positive cases even after the 21 days
country-wide lockdown. So absence of adequate testing facility might cause
under reporting and community outbreak over period of time if precautions are
not examined thoroughly.

Thirdly,
most of the laborers from far off places could return home only between last
5-6 days during Janta Curfew and
countrywide lockdown announced by the Central Government. In fact many migrants
could not return to their respective places till date. All of them have
traveled through long distance train journeys and terminal point buses in a
crowded situation. But the point of discussion here is that the Blocks and
Districts where sizable migrant laborers returned of late, there was chaos and
huge cues for checkup at Block and Sub-Divisional Hospitals without knowing the
concept of Physical Distancing of each other. Majority of them have been sent
for home quarantine and asked to stay home in their villages. In many cases,
they would have one kutcha house and kitchen and the average size of households
would be roughly 4-5 persons. Therefore, home quarantine hardly has any meaning
full impact on public health in such conditions of living and safety in
villages.

Lastly,
a concerted effort is made by the Government of West Bengal and converting Kolkata
Medical College as COVID19 treatment Centre. But all these facilities remain
Kolkata-centric and this facility would have no meaning for rural mass and
labour supply zones of the State if facilities are not decentralized and
percolate down further. In fact, it is reported that 50 doctors of Raiganj
Medical College and Hospital, Uttar Dinajpur were on leave and stayed in
Kolkata till 24.03.2020. They were brought back from Kolkata with the
intervention Mr. Arvind Mina, DM Uttar Dinajpur and to work in the Medical
College (Uttar Banga Sambad: 25.03.2020, Page-1). The same situation is found
in North Bengal Medical College and Hospital, Darjeeling and reported that most
of senior resident doctors, Assistant Professors and Associate Professors are
on leave and stuck at Kolkata due to sudden lockdown (Uttar Banga Sambad:
25.03.2020, Page-3). It is also evident that all the newly established regional
medical colleges in the State, senior experienced doctors work only for three
days and rest of the days in a week, they remain in Kolkata. This not only
hamper regular treatment but lack of advisory and consulting facilities for the
upgradation of regional health care and peripheral regions in the State suffer
from proper guidance and planning. The North Bengal region is one of such
example.
Way
forward
Therefore,
the present outbreak of COVID19 must be taken with sincere effort and stimulate
the chain of Rural Health Care Network of Sub-Centres, Primary Health Centres,
Block Primary Health Centres and Rural Hospitals. The Block-Level planning and
identification of isolation and quarantine centres is first step and many cases
schools, colleges or community centres may be engaged for the purpose. So that
over-crowded migrant labourers do not contaminate the resident population in
the villages. At the next level, testing facility and sample collection of the
cases may be collected from these isolation and quarantine centres and sent to
nearby COVID19 testing centres for results and appropriate actions.

The
Rural Health Care Network is mostly relied of junior doctors and many a times
they are inexperience to handle pressure and emergency crisis. In such
situation, senior doctor practicing in private health care in adjacent towns
may be engaged in coordinating and advisory purpose in Rural and Block
hospitals since lockdown period the private hospitals are closed except
emergency services. Expertise of senior private practicing doctors may be
planned in a region-specific manner e.g. Siliguri has good numbers of such
medical consultants. I believe they would not hesitate to serve the people
during this health emergency and crisis if government ask them for their
support and services.

The
data and information received from Rural Health Care Network may be used for
all kind social security schemes and food subsidies either by Government of
West Bengal or Government of India. This can be effective if community based
organisations like mosques, temples, churches, gurudwaras, civil society
organisations etc. and Panchayat Raj Institutions are involved and sensitized
at the local level governance for health care and peoples support. Lastly, all
the Regional Medical Colleges situated in different districts must be equipped
with COVID19 testing facility, isolation ward, disaster response team and their
effective coordination with Rural Health Care Network may bring better result
for upcoming danger and community outbreak.
*The
author is working as Assistant Professor,
Sikkim Central University Gangtok. The views and comments are personal and can
be reached over email at [email protected]
. He further acknowledges the data support given by Ms. Farhat Hossain, Ph.D Scholar, Special Centre for the
Study of North-East India, Jawaharlal Nehru University, New Delhi.