How a collector foresaw danger, made tribal district totally oxygen-reliant  

At a time when there was utter chaos over lack of medical oxygen across the country, a tribal district in Maharashtra was seamlessly managing the situation without having any asphyxiation deaths, bed crunch or incidents of patients’ relatives running from pillar to post to procure oxygen cylinders.

Dr. Rajendra Bharud, the collector of Nandurbar district in Maharashtra, has been credited for averting the crisis by reading danger signs early and keeping infrastructure ready before the second wave struck. His plan, popularly known as the ‘Nandurbar Model’, was applauded by the Maharashtra health department and recently implemented across the state.

From setting up oxygen plants in hospitals as early as September 2020 to bolstering infrastructure to accommodate more patients to ensuring the optimum utilisation of oxygen cylinders through the appointment of ‘oxygen nurses’, Bharud knew how to guard his fort when the second wave hit.

In an interview with BBC, Bharud says he grasped the “pattern in the pandemic” early on and realised the need to plan and prepare beforehand. His MBBS degree and nativity to Nandurbar were additional advantages that helped him prepare better.

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“We saw cases peaking in India after they peaked in western countries. We had seen these countries being hit by a second wave and third wave. So we realized it could happen here as well,” Bharud told BBC.

He says, his administration refused to lower its guard when active cases in the district which hovered at 1,000 in September 2020, dropped to 400 by December-end.

Tapping oxygen, ramping up bed count

In September itself, Bharud’s administration began preparations for the second wave – from setting up quarantine centres to equipping hospitals with their own oxygen plants. By April 30 this year, when Nandurbar logged 7,000 active cases, the administration neither had a shortage of beds nor oxygen.

The first plant was installed in September 2020, while two others were installed in February and March. Another two were recently installed in Nandurbar city, taking the total count to five. The administration plans to set up two more plants Navapur and Taloda soon. A single plant can fill up to 125 jumbo-sized cylinders and all of these plants are producing 4.8 million litres of oxygen per day.

Now, the district shares the surplus oxygen with other districts including neighbouring Dhule.

The administration has also bought 30 oxygen concentrators for primary healthcare centres in the remote villages, to avoid pressure on the hospitals.

Located in a hilly forest, the district that shares borders with Madhya Pradesh and Gujarat is around 440 km from Mumbai. Having 70 per cent tribal population, Nandurbar is one of the poorest districts of the state with scant healthcare facilities.

With the tribal district having just two MD doctors against a population of 20 lakh, one of the first steps that the district collector took was to urge all private hospitals and clinics to open and start treating people. The collector also used his contacts and got doctors from Mumbai and Pune to work in the district.

Dr Rajesh Valvi, a doctor at the Nandurbar Civil Hospital told BBC that the hospital had just nine critical care beds and 80 oxygen beds.

However, the administration soon converted schools and hostels into quarantine centres, monitoring of which was entrusted to every primary healthcare centre in each village.

Patients with mild symptoms were treated on the spot and sent home where those with severity were admitted to the hospital. This system ensured that no infected person went unreported or untreated.

“When the first cases came (this year), there was no testing capacity in the district. Not a single private hospital was willing to start COVID treatment. We had a 200-bed district civil hospital, with 95 per cent occupancy at most times, since a bulk of the people of the district are dependent on government healthcare facilities. If we turned that over for COVID care, where would the non-COVID patients go?” the collector told legal website Article 14 in an interview.

“There was a hospital project whose construction had been paused mid-way from several years for a number of reasons. We worked day and night and finished it in three months, adding 200 beds. We requested private doctors to help us with setting it up, and we have also recruited about 200 doctors and nurses in the past year. So, that is how we spent the first three to four months,” he added.

Today, the district has 148 critical care beds and 556 oxygen beds. As cases have dropped, some 200 oxygen beds are vacant now, the BBC report said.

The famed ‘oxygen nurse’ and COVID dashboard

Bharud’s plan of an ‘oxygen nurse’ – a nurse for every 50 beds to check the oxygen saturation of COVID patients and administer it to them – worked like a charm in both managing the disease and ensuring optimal usage of oxygen.

“If any patient took off their oxygen mask, the nurse would insist that they wear it. If the patient’s oxygen level was decreasing, the nurse would increase flow from the cylinder. This ensured continuous monitoring of oxygen,” Bharud told India Today.

Unlike in other cities where finding a bed for a COVID patient or an ambulance to ferry them to hospital is a herculean task, the residents of Nandurbar were spared of the ordeal, thanks to the administration’s informative COVID dashboard.

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The dashboard has all information regarding COVID, from available beds in hospitals – both private and government – including ICU beds to contact details of hospitals and ambulances.

The reliable healthcare facilities in the district are drawing patients from not only the neighbouring districts of Jalgaon and Dhule, but also from Madhya Pradesh and Gujarat.

The district so far has recorded 38,000 COVID cases and 700 deaths.