Spreading rural awareness

 The following steps must be followed to set up the physical infrastructure required to create an FLTC:

·        Demarcate the isolation area as per the facility layout

·        Identify separate entry and exit points for patients and staff

·        Place the furniture and fittings as per the facility layout.

·        Set up enclosed Doffing and Donning areas

·        Set up an administrative office. The office must have a computer, a printer and one smart phone.

·        Set up a room for medical staff and non-medical staff each and a store room

·        Arrange for charging points both inside the isolation area for the patients and at the officer space outside the isolation area

·        Internet connectivity through Wi-Fi must be enabled both for the patients as well as staff

·        Drinking water must be made available in the isolation area

·        The electric lines and plumbing must be checked

·        Place signages to clearly establish a circulation flow for patients staff as well as stock

·        Place one smart phone permanently within the isolation area and the other smart phone in the administrative office outside the isolation area. This will be the primary mode of communication between the staff within the isolation area and the administrator stationed outside.

·        Seal the isolation area securely.

·        The building identified to be converted into a FLTC must have the following facilities:-

·        The Facility must be spacious enough to accommodate large numbers of patients easily.

·        It must be airy and naturally lit.

·        It must be a closed building so that the isolation area can be easily sealed.

·        The building must be ideally located away from hospitals and schools to protect the sick, elderly and children from any possible spread of the infection.

·        The building must be located within a short distance from a Taluk Hospital so that support can be sent from the Taluk Hospital in case of any medical emergency.

·        The facility must have separate entry and exit for patients and staff.

·        The proposed isolation area must have a partition to house Male and Female Patients separately (If the facility is open for both men and women)

·        There must be an adequate number of washrooms with at least one washroom per 4 patients.

·        There must be a dining area and a recreational area within the isolation area

·        There must be room outside the isolation area to set up the administrative office, area for staff and to set up a storeroom.

There must    be a secure storeroom to store the medical supplies and other necessary item

 There must be an ambulance bay and waiting area outside the 

There must be enough space to create Donning (putting on of PPE kits) and Doffing (Putting off PPE kits) areas for nurses and doctors.

A.RECEPTION AREA:

Most patients who reach the First Line treatment centers are Covid 19 cases who have mild symptoms. With minimum but efficient use of PPE, triage the patient into stable & unstable.

All patients should sanitize their hands & wear masks before entry.

If a patient is a direct entry case and not referred through the Telehealth Helpline Unit, then a screening questionnaire needs to be applied for initial categorization and admission to FLTC.

B.COVID CARE AREA

The isolation area should have 3 entry/eit points:

·        STAFF ENTRY

·        STAFF EXIT

·        PATIENT ENTRY/EXIT

The area is completely sealed shut at all other places to ensure that no unauthorised entry or exit takes place.

C. ISOLATION AREA:The isolation patient area should have

1.Nurse Station

2.Sample Collection Area

3.Utility Area (Dining Area and Recreational Area)

4.Cots should be kept at least 2-3 m apart

5.Separate personal properties to be given to each patient

D. DONNING AREA

This is for the staff to wear personal protective equipment (PPE). This space should have

·        One table and stool

·        Hand washing area

·        Disinfectant dispenser(preferably with Lysol, in 10% *dilution)

·        Hand sanitizer dispenser (containing 60-80% Isopropyl alcohol)

·        Micropore tape dispenser

·        Hanging Mirror (for checking proper positioning of PPE )

E. DOFFING AREA :This is for the staff to safely remove PPE to safely dispose of them later.

·        Stool

·        Laundry Bins

·        Disinfectant spraying units

·        Hand washing area

·        Wash rooms (For staff to take bath after doffing. Each wash room to be disinfected after every use.)

IMPORTANT POINTS

·        Ideally there must be CCTV cameras in the patient isolation area

·        A separate phone (ideally a smart phone with internet service) must be kept in the isolation unit to enable communication with the outside world

Inflow and outflow of patients

A clear circulation flow for patients must be set on the ground. The patients will be taken in the ambulance straight till the entry into the isolation area. If the FLTC also has a triage facility, then to the Triage Area.

Once the patient enters the isolation area, the door must be secured to avoid any unauthorised entry or exit

Inflow and outflow of Staff

Staff must enter the facility through the staff entry close to the administrative area. They must then wear PPE Suits in the Donning area before entering the Isolation area. While exiting the isolation area, they must first doff within the doffing area, bath in the washroom and exit through the separate staff exit only.

Flow of stock and consumables

The inventory management component of the CARE system is used in managing inventory within a FLTC. A secure Store room is identified to store all the durables.

The flow of goods must also be clearly laid out. The goods must be dropped off close to the store room near the reception area. The same must be transported to the store room. As per need this stock must be drawn while recording the same in the inventory management tool.If such goods need to be taken into the isolation area, the same must be done by a staff donning the PPE suit. The channel of entry and exit will be the ones marked for staff.

Data management within an FLTC:

Data Management may be done through any hospital/patient management software.

For instance, FLTC's in Ernakulam district of Kerala uses CARE as patient management tool. The data of each patient is recorded in the system at the time of admission. Subsequently, each consultation or daily round detail is also added into the system for the record.

Any Sample testing that takes place in a FLTC is also routed through the CARE system.

If the patient is shifted from the facility to another hospital or another healthcare facility, the patient details are transferred to the new facility through the internet using the CARE System.

The administrator of the facility is in-charge of entering data into the CARE system. This person must be trained in the use of the CARE system for the management of patients, sample and inventory. The training material to using CARE system is available at Care System 101

A FLTC with 25 beds must have the following staff:-

·        1 Doctor on call available 24 hours

·        6 Nurses ( 2 nurses working in 8 hrs shifts)

·        6 Cleaning Staff (2 Staff working in 8 hrs shifts)

·        3 Data Entry personnel ( 1 Staff working in 8 hrs shifts)

·        1 Administrative head (Nodal person)

·        1 Information Officer (the contact person for families of the patients).

The number of staff may be increased or decreased depending on the capacity of the facility.

HOW CAN YOU CONTRIBUTE?

"How can an individual contribute to the society or community?" is a question that can be best answered by oneself.

Every individual can contribute in various ways by innovating or finding solutions to fill the lacuna or sufficiency of the existing systems at the grass-root level of a community.

This process can only be started once there is a clear idea of the existing system that has been functioning to solve the problems and obstacles that have popped up in the past and present scenarios.

You can contribute in three ways.

Cooperate with courtesy and patience with healthcare workers in the smooth working of the public health system. Always cooperate with law enforcement officials and other public servants.

Communicate to your family and friends how our public governance system works. May this knowledge and awareness flow from you to many others.

Contribute your time and efforts by engaging with your local community to find unique solutions for the unique problems that your community faces. Engage with your locale panchayat/ ward level team to see where you can step in and contribute. Put your skills and knowledge to use within your own community.

Depending on your interest and skill sets there are umpteen number of ways in which you can contribute to making the system better and more efficient.

Every individual will definitely have a role or way in which they can contribute to this fight. Let us look at some examples of how people from various walks of life have contributed.

Software Engineer - There are multiple software engineers who have built systems to track or integrate multiple processes in the healthcare system/ambulance network to improve the efficiency of the existing system. Especially in the backdrop of COVID we have seen many software engineers come forward with smart and intuitive tools to revolutionise field like healthcare, law enforcement, communication etc.

Farmers - Many farmers have started giving advice to homemakers and youngsters about the basic steps and knowledge required to cultivate vegetables at home. Thereby promoting the concept of self-sufficiency. Today, micro-farms are trending and people have started farming in their own homes. Any farmer can contribute towards imparting knowledge of farming into the general population and may even get into supplying seeds, biofertilizers or any service relating to farming.

Artists - Creative illustrations have been made to improve public health awareness campaigns. Art plays a major role in influencing the public. Moreover, art as an activity also supports mental health. Therefore as an artist, you may be able to contribute by creating meaningful art spreading positive messages or important information among the public. You may even choose to contribute by spending a little time every day to teach children art.

The problems faced by our community are many-folds. Problems like poverty, unemployment, food insecurity etc are increasing because of the socio-economic impact caused by the Pandemic.

Our country already has a system to solve issues faced by the community. Just like any other system, this system is also far from perfect. It is upon us civilians to supplement the efforts of the state and work towards increasing the efficiency of the governmental projects.

There are various existing government programs for poverty alleviation, generating employment for the unemployed etc. A few of these programs are listed below:-

Ashraya:

In this scheme, families which are the weakest financially in a Panchayat or Municipality is identified. A clear criterion is set to identify the most deprived. Income, health, assets, etc. are factors.

The objective of the scheme is to elevate them till they do not require the support and integrate them to the mainstream society. The scheme requires every Grama Panchayat to prepare separate micro-projects for each destitute household identified. These micro-projects are then integrated with the annual plans of the Grama Panchayats. This program is implemented through Kudumbashree. Kudumbashree updates the Ashraya List every year. Eligible families are identified by NHGs, verified by ADS, followed by eligibility checking at the CDS and finally approved by the Grama Panchayat Committee.

Multi-year projects are considered under this scheme. Three-year duration initially, extendable through projects for continued support to the needy.

The Panchayat must see to it that the benefit of any project or scheme must first fall upon this population. If there is a scheme by the Water authority, it must be made sure that the people under Ashraya have a priority. The same goes for any scheme under health, education etc.This project has been financed by central, State government support, contributions by District and Block Panchayats, and plan funds of the respective Grama Panchayats. Attempts to mobilize financial and other support from agencies and individuals may also be helpful. The existing schemes which are considered under the project are:

·        Land for house construction for the homeless by Grama Panchayat

House under   Indira awy was Yojana (IAY)

·        Electrification through Rajiv Gandhi Grameen Vidyutikaran Yojana

·        Drinking water through the special scheme of Kerala Water Authority (KWA) covering BPL families etc.

How can you contribute?

Students can contribute their time, effort and resources to support the implementation of this scheme so that the intended benefits reach the beneficiaries. You may work with the Panchayat, firstly by understanding how this scheme has been implemented so far. The students may also identify people who deserve to be beneficiaries of this scheme.

Employment Guarantee:

This has been one of the flagship schemes and includes programs under NREGA. Every ward has at least 10-50 people who participate in the scheme. It is not only the poorest section of the society, women from the middle-class are also seen to be participating. Even 85-year-old people participate. Anyone can work depending on their ability. This ensures them a minimum pay.

The objective of the Act is to enhance livelihood security in rural areas by providing at least 100 days of guaranteed wage employment in a financial year to every household whose adult members volunteer to do unskilled manual work. They may apply for registration in writing or orally to the local Gram Panchayat. The Gram Panchayat after due verification will issue a Job Card which is free of cost. A Job Cardholder may submit a written application for employment to the Gram Panchayat, stating the time and duration for which work is sought. The minimum days of employment have to be at least fourteen. In case, work is provided beyond 5 km, extra wages of 10% are payable to meet additional transportation and living expenses.

Wages are to be paid according to the Minimum Wages Act 1948 for agricultural labourers in the State unless the Centre notifies a wage rate which will not be less than Rs. 60 per day. Equal wages will be provided to both men and women. Permissible works predominantly include water and soil conservation, afforestation and land development works.

This scheme is sponsored by the central government. The central government provides the majority of the funds and the state contributes a small portion. The scheme has played a significant role in poverty alleviation in the past decades.

The funds flow through the Panchayats. The primary intention of the central government is only to disburse the funds to the unemployed population and if the workforce is made use of more efficiently, this could lead to more development of the community. There is scope for innovation to make the scheme more effective.

How can you contribute

Students may choose to research on the impact of the Project in their panchayat. The impact is of two-fold. Firstly, the aspect of poverty alleviation and secondly, the impact of work carried out by the beneficiaries of the scheme. Find ways by which the quality of work done through the scheme may be increased so that the whole community may benefit from it.

You may also choose to increase awareness about this scheme among the poor and unemployed.

A Job Cardholder may submit a written application for employment to the Gram Panchayat, stating the time and duration for which work is sought. The minimum days of employment have to be at least fourteen. In case, work is provided beyond 5 km, extra wages of 10% are payable to meet additional transportation and living expenses.

Wages are to be paid according to the Minimum Wages Act 1948 for agricultural labourers in the State unless the Centre notifies a wage rate which will not be less than Rs. 60 per day. Equal wages will be provided to both men and women. Permissible works predominantly include water and soil conservation, afforestation and land development works.

This scheme is sponsored by the central government. The central government provides the majority of the funds and the state contributes a small portion. The scheme has played a significant role in poverty alleviation in the past decades.

The funds flow through the Panchayats. The primary intention of the central government is only to disburse the funds to the unemployed population and if the workforce is made use of more efficiently, this could lead to more development of the community. There is scope for innovation to make the scheme more effective.

How can you contribute

Students may choose to research on the impact of the Project in their panchayat. The impact is of two-fold. Firstly, the aspect of poverty alleviation and secondly, the impact of work carried out by the beneficiaries of the scheme. Find ways by which the quality of work done through the scheme may be increased so that the whole community may benefit from it.You may also choose to increase awareness about this scheme among the poor and unemployed.