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 ahannansku@gmail.com
. 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.

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