~Dr. Kika Longkumer & Dr. Longri Kichu

The COVID-19 pandemic has created a global crisis with far-reaching social, economical and spiritual repercussions. Lives, social practices, working arrangements and the health sector will surely irreversibly change with the Covid-19 crisis in our society as well. Notwithstanding these facts, we must use this opportunity for us to reflect on our lives, our roles and responsibilities in society and build a long-term arsenal in the fight against germs.

Mankind have fought & survived against many germs. We must take a leaf from history and imbibe valuable lessons from public health battles fought and won.

  1. Community Engagement & Action

It is the responsibilities of Government to protect health, to guarantee access to health care and to safeguard people from the impoverishment that illness can bring. However, instead of total reliance, we must also acknowledge that health is a shared responsibility and engage in developing a common vision, shared ownership and sense of responsibility for the well-being of the community.

The concept & mechanism of Communization has been around since 2002. But its intention of fostering partnership between Government and Community for leveraging government resources and empowering the community for improvement of public delivery systems is yet to realize fully.

The current crisis has unlocked the opportunity to engage the rich and dense ‘Social capital’ of our society to address the problems of ill-health and poverty, to improve access to basic needs and undertake sustainable development activities to improve the quality of their own lives through community participation, empowerment and leadership.

  1. Health promotion 
  2. Community Engagement to bring about perceptible change in lifestyles- avoid spitting in open; being more careful and use more hygienic sense in using public restrooms; respiratory etiquette; avoiding touching of nose, mouth & eyes; etc
  3. Community Action in adopting “new norms”- use of face coverings in public places, touching of surfaces in public places, frequent hand washing, avoiding hand shake & hugging, social distancing, avoiding non-essential travels etc.
  4. Community Engagement to create mass movement to educate people on healthy life style.
  • Enforcing precautionary & preventive measures
  • Health advisories including wearing of Face Mask in public places, social distancing, banning of spiting in open etc.
  • Ensuring compliance to quarantine instructions, safe handling & disposal of wastes etc.
  • Ensuring provision of adequate hand-hygiene facilities at points of care/ service is available on all public places- Health facilities, Educational Institutions, Offices, Market Place, Hotels/ Restaurants, Bus/ Taxi Station, Churches, Sports venue etc.
  • Ensuring provision of WASH (Water, Sanitation and Hygiene) Services is all healthcare and non-healthcare settings.
  • Promoting sustainable development and securing health equity

Community can participate in various ways in delivery of healthcare services-

  • understanding and identifying local priorities.
  • building community capacity in order to meet their health needs.
  • improving the quality of service
  • facilitating delivery of services.
  • becoming active participants in the development process.
  • working together to improve their income, health, nutritional status and environment
  • undertaking sustainable development activities to improve the quality of their own lives.
  • monitoring to check accountability, transparency, absenteeism or shirking responsibilities by public servants.
  • tapping Government as well as Community resources to ensure every citizen is accessible to WASH Services.
  • ensure benefits under various welfare schemes of the Government reaches the beneficiaries.
  • Up-Scaling Secondary Services and developing appropriate Tertiary Services:
  • Presently, unlike in the private sector, secondary services in most of the disciplines are available in the district hospital. However, there is inadequate manpower and equipments. The strength of specialist doctor and nurses in the 11 district hospitals is at 27% and 25% of Indian Public Health Standard (IPHS). The community should impress upon the Government for creation of adequate posts and for providing necessary equipment.
  • Starting a Medical College with a Teaching Hospital would require about Rs. 500.00 crores in CAPEX and Rs. 150.00 crores per annum in OPEX. We may have the necessary financial resources, but it is difficult get the teaching faculties as the shortage is across the country. Further, UG Medical College is designed for delivery of Secondary Services, which can be delivered by a well equipped District Hospital.
  • On the other hand, actual requirement of referral outside the State is mostly for tertiary services.
  • Therefore, instead of aiming for a Medical College at the present juncture, it would be rational to strengthen and develop our District Hospital into a well equipped hospital for delivery of quality secondary care. At the same time, plan for development of tertiary care services based on the need of type of superspeciality discipline. This can be either incorporated with the district hospital under PPP model or partner with a suitable existing or upcoming private hospital.
  • Promoting Local  Products:
  • I am sure we have many good teachers, professionals in health and other professions. Developing a professional service is resource intensive and therefore comes at a cost. It cannot grow when we expect good quality but want it cheap and free at times!! Whereas, many of us prefer to procure commodities and services from outside. For reasons of cost and quality, it is understandable but many a time this fatal attraction and fascination of “products from outside” is for the “Name Tag” and for self glorification…………“I bought this from Jorhat/ My child is studying in outside Mokokchung and so on”. Such mindset and behavior is not only draining our economy but adversely affects the development of professionals locally.
  • Further, when we are outside, we stand in queue, we wait patiently for our turn to come, we become disciplined and polite, we don’t mind giving hefty tips for doing our errands or we don’t mind taking up any job. If same mannerism is replicated here at home, our place will be quite different!!   
  • Without market volume and buying capacity, no industry or economy will develop. Adopting and encouraging “Make in Mokokchung and Buy from Mokokchung” while ensuring quality product at reasonable costs, would definitely have a positive impact in our economy.
  • Promoting production and use of Local Products will be critical for sustainable development and progress of Mokokchung.
  • Promote innovative and impactful Social Enterprises…. business solutions to promote, encourage and make positive social impact.
  • Leveraging IT Services
  • Telemedicine for enhancing access to healthcare.
  • Change in work arrangements with greater reliance on technology-enabled webcast, conferencing, and supervision and will also reduced travel.
  • While we need to be informed of what is happening, we need not be obsessed with Corona. Endless and mindless circulation of unconfirmed information- “Infodemic” could add to the uncertainty and cause an upsurge of anxiety and panic.
  • Fighting Stigma in COVID 19- What do we do as a society to address this?

Along with the panic that has set in the wake of the COVID-19 pandemic, the society is witnessing another disease- STIGMA, which will prove to be very detrimental in the fight against COVID-19. When there is Stigma associated with a disease, people do not come forward for testing or seek health care even when there are symptoms. Hence, undiagnosed cases will run amok in the society. We are still struggling with HIV-AIDS due to Stigma associated with the disease.

COVID-19 can infect anyone in a community. This must be understood by all. It does not discriminate. The community should ensure we do not ostracize positive patients / relatives from the society. Maximum support should be extended to such families.

QUARANTINE is for people who do not have the disease but may have been exposed to the pathogen. The community should not impose mandatory quarantine on anyone in the ward / villages, if the person has been released from a government facility, unless the village / community have been asked to do from the government.

Dead bodies of COVID-19 do not pose any extra threat to the society. The coffin is disinfected and body wrapped in body bags to ensure there is no threat of infection to the community. No burial should be denied to any COVID related deaths

Our own people stuck in the various cities and towns of the country and abroad will come back any day. They should not be stigmatized at any cost and only government approved quarantine /precautions should be imposed.  

  • A Collective Fight

The fight against COVID-19 will all prove to be futile unless the community and the government come together. This is one of the hardest lessons in the world from previous pandemics. This fight should be fought together across political lines, faith or beliefs.

This fight will surely be a disaster in the making if there is a trust deficit between the government and the Public. Both the government and the Public should do their won roles and find a way to stand together.

The world has to live with COVID-19. It doesn’t mean we let the virus spread in the community. All personal and community protection measures should become a part of our daily lives. Physical distancing, Handwashing with soap, use of sanitizers, respiratory hygiene and use of masks should be the new normal. This needs education, awareness, practice and discipline.

The community will always be the first line of defense against COVID-19

TURNING COVID-19 PANDEMIC CRISIS INTO OPPORTUNITY: HEALTH PERSPECTIVE

Dr. Kika Longkumer & Dr. Longri Kichu

Part-2: Social Behavioral Change Communication (SBCC) around COVID-19

Change in behavior do not come easy. It needs practice, the right conditions, logistics and discipline every day.  The main preventive and promotive measures around COVID-19 are- Physical distancing (social distancing), Handwashing with soap, Use of face cover / mask in public places, Respiratory hygiene and Disinfection of frequently touched surfaces.

What is the Science or Logic Behind such Measures?

  • The virus needs a carrier in the form of humans for transmission. When an infected person coughs / sneezes or speaks, infected droplets will land on another person. So, the minimum one-meter distancing, handwashing use of face cover and cough hygiene is important.
  • The virus can survive from hours to days on certain surfaces. The virus from an infected person can land on frequently touched surfaces like door knobs, tables, market places, or any surface. This is why disinfection of surfaces, transport carries, hospitals and public places are done
  • Handwashing is one of the most effective public health measures till date for breaking the chain of any disease transmission. In COVID-19, soap with water (any brand) destroys the outer FATTY layer of the virus and prevents infecting you. Your hands are very likely to touch an infected surface or a person with the virus (E.g. in a handshake, the infected person will have the virus on his hands if he touches his face. Your hands will then transmit the same to your nose / mouth/ face and get infected)
  • The fundamental law of PROTECTION: Consider everyone around you as an asymptomatic carrier and capable of infecting you. Consider too, that you could be an asymptomatic carrier capable of infecting all around you.  SO, TRAIN YOURSELF by using all your intelligence to neither get infected or infect others.’’
  1. Physical Distancing (Social Distancing)

This is the single most important intervention that needs to be assessed practically and implemented.  The strength of our society is the social capital- the social bond between communities, neighbors and family. The social bond can still remain strong with some practical physical distancing measures and the term Physical distancing is preferred. Some practical situations are discussed with action points:

         Situation     Practical IssuesAction points
Greeting people with handshake / hug Ingrained habit. Hard to change.Start from oneself. Educate the community on how a handshake can transmit the virus
Social gatherings / family meetingsWe are a society with very strong community bonds.  Avoid all gatherings till there are further advisories.  Or till the Pandemic is over. One member has the potential to infect everyone in a gathering. -People who have cough, cold, fever should not attend meetings/ Gatherings  at any costLearn to use technology- Phone conferencing, zoom, go-to meetings, skype etc. This can be done by everyone who has a smartphone or a laptop.  We can quickly adapt.
Unavoidable meetings that needs gatheringsThere are many meetings/ emergency situations where gatherings become unavoidableLimit the members to the minimal. Provide handwashing points or sanitizers. wear face cover. Disinfect any frequently touched surface with any available disinfectant / soap-water
Funeralswhile a dead body pose no additional threat, if more people gather, physical distancing and other precautions cannot be maintained.Government advisory strictly limits gatherings to not more than twenty at a funeral.Do not provide food at a funeral Provide handwashing points / hand sanitizers. Pray for the family in distress at your own home.
Church gatheringsThe Church is a way of our life. People who are used to attending church can have face distress / mental trauma when not attending. A normal church service will always have a big percentage of the ELDERLY  (High risk group)Churches can be open only when the govt advises. We can always use the example of patient 31 in south korea.Pastors can go online in youtube/ facebook as is being done by many.In many villages, sermons can be heard all over the village through a loud speaker.Handwashing points at points of entry to a church can be explored / hand sanitizers can be used. If people insist, seating arrangement can be done in a way that 1-meter distance is maintained after government advisories allow Disinfection of floors/chairs/ benches should be done before and after service.
Market Places/ Shops  A visit to a market is essential and cannot be avoidedLimit your visits to the market (Once / Twice a week)Elderly (above 60) , people with diabetes, heart disease, hypertension, cancer etc will not be allowed to go to the market as they are very high RISK. Plan should be there for colony wise markets and not a big common market. Do not go to another colony for marketing. This ensures that even if infection  happens, spread is limited in a small area and can be controlled.Clear markings for Physical distancing are needed in all places where public gatherings are expected At the entry and exit points or within the market, handwashing points with running water should be explored.Hand sanitizer should be available with the customer and the shopkeeper if hand washing with soap is not feasible.Always wear mask or face-cover in the marketWASH your hands with soap and water before you go and after you come back from the market.
Highway / Travel /Truckers by bus or taxiovercrowding at designated stopovers And at final destination Travelers should have designated places to stop where there is no or minimal human settlement. Should not be allowed to stop at points beyond theseTrucks usually have all India Permit and are potential sources of Infection.
  • Hand washing with Soap and Water / Use of Hand Sanitizers

Hand washing with soap is always recommended unless it is not feasible. Personal hand sanitizers should always be carried with us. Soap of any brand should always be used when doing handwashing. Without it, handwashing won’t be effective against COVID-19. This necessitates availability of running water and continued production of hand sanitizers if possible, locally.

When to do handwashing or use sanitizer?

-Every time you come in contact with a potentially infected surface / object/ another person.

SituationPractical IssuesAction Points
At hospitals for health workers and patientsMany hospitals do not have running waterLack of elbow operated taps Lack of clean towels /tissues for drying handsHospitals need to have running water 24 *7ELBOW Taps are advised to ensure there is no touching by the hands HANDS need to be dried by a disposable tissue or a onetime use towel/ which can be autoclaved/ disinfected Logistics come at a cost All villages/ councils/ colonies should first ensure this facility is available in the nearby hospitals and find ways to make it available. Especially of running water.
Public places / market placesUnavailability of handwashing pointsUnavailability of hand sanitizerunavailability of clean towels/ tissues to dry handsLack of IEC Materials / posters on handwashingStrategic locations need to be identified to provide handwashing points. Like markets, churches, panchayat halls and offices.Explore ingenious ways like bamboo handwashing points Provision of soap (brand of the soap doesn’t matter)Explore innovations to ensure we can open the tap and close it without our hands touching it. Elbow taps, leg operated etc.Clear instructions on handwashing at such points.Provision of tissue paper/ instruction to individuals to carry the same with them. A common towel cannot be kept at any costIf HANDWASHING IS NOT FEASIBLE, hand sanitizers should be compulsorily kept at shops (both by customer and the shop keeper)
Highwayslack of running waterDesignated stops at highways should have running water. Such stops can be designated at places where there is good running water.Public should ensure availability of bamboo poles for running water where there is natural flow of water
IEC on handwashingSteps of handwashing not followedThere are 7 steps to handwashing as per UNICEF protocol. Such protocols/ protocols need to be displayed in consultation with Health department All surfaces of the hands should be washed properly taking at least 20 seconds.
Schools/ Anganwadi Centers / OfficesNo provisions for such facilitiesSchools are where habits start for life. Running water for handwashing should be advocated in schools and colleges. Teachers should teach the importance of handwashing and its steps, online or as and when schools open A handwashing point at the entry point is advised in all offices. Office goers can even contribute and plan the same. Online classes should teach handwashing, social distancing and other protective measures Hand sanitizers should be kept at all designated points in an office.  
At homes / residential placesThere is no piped water system at homes.Scarcity of water.Handwashing basins to be arranged outside each home so that handwashing is done before entry when someone goes outsideTemporary handwashing/ permanent handwashing sink can be arranged. Conservation of water, rain traps can be started for the long run. 
  • Use of Mask or Face Cover in Public Places

Face cover /Mask limits transmission of the virus in the community by ensuring droplets do not escape when someone infected cough, sneeze or talk or even breathe. When you wear a mask, you protect people around you. Similarly, you are protected when people around you use a mask. The concept is clear; everyone should use a face cover to protect everyone when you are out in a public space.

SituationPractical IssuesAction Points
When in public spaces, offices, markets.Non availability of masks in the marketLess production locally Use of medical masks by the public irrationally. -Unaware of how to use a maskLocal reusable masks to be produced for use in non-medical situations.Everyone should be mandated to use a face cover / mask, preferably hand made in all public places.Training and awareness on how to use a mask Do not touch face / the part that of the mask that covers the nose mouth with hands. Wash hands frequently / use sanitizer along with use of masks. 3 Reusable masks to be washed with soap and water and dried in the sun every day. Do not readjust your mask once you wear it leading to unnecessary touching of the face Medical masks have to be discarded after every use. Rational use of face masks is crucial in the long run. N95, surgical masks are intended only for health workers or in medical related situations. Surgical mask can be used only when instructed by a medical health worker under certain conditions.
  • Respiratory Hygiene:

Droplets from an infected surface can land on a person or any surface when someone coughs, sneezes or spits.  There should be strict instructions on not to cough / sneeze without covering one’s mouth. Spitting should be strictly prohibited.

         SituationPractical Issues Action points
Public places, officesChewing pan / Gutka and spitting is a habit ingrained Coughing/ sneezing without covering mouse and nose is also very common.Non availability of tissues to cough intoThese are habits which have been cultivated over timeStrict fines be imposed by the when someone spits in public. Fines for spitting from running cars / anywhere should be strictly monitored. People should be encouraged to use tissue when they cough or sneeze or into the elbow but never No spitting signs should be put in public places coupled with other innovative mechanisms.Gradual ban on smokeless tobacco be considered