Keeping Kerala healthy

45-thomas-isaac Care and concern: Kerala Finance Minister T.M. Thomas Isaac at a relief camp.

ON AUGUST 15, after rains had started lashing the state, the medical superintendent and critical care and emergency department heads of Rajagiri Hospital in Aluva, Ernakulam district, met to prepare for a potential disaster. The hospital stocked up on essential commodities like diesel for the generators, oxygen cylinders, food and water. In the ensuing days, medical help was provided to more than 18 camps. An emergency department was set up at the relief camp in UC College, Aluva. Patients from flood-affected hospitals were shifted to Rajagiri. Doctors and medical staff from the hospital took care of around 20,000 patients in various camps.

Many states, especially Maharashtra, Tamil Nadu, Karnataka and Andhra Pradesh, have been very cooperative by lending us their doctors and medical staff. - K.K. Shailaja Kerala health minister

Rajagiri’s is not an isolated case. Many of the hospitals in Kerala, some badly affected by the floods, kicked into action to meet the medical challenges and provide free treatment to patients. “This was a phenomenal example of unity in times of difficulty when both government and private hospitals joined hands,” said Dr Harish Pillai, CEO of Aster India. Pillai says the relief efforts were extremely well-coordinated. A control room was set up in the directorate of health services and the district medical office which channelled the medical efforts. A common pool of medical staff from government and private hospitals was created. Because of efficient use of mobile technology, communication between the district administration and hospitals was very efficient. The list of critical supplies that were needed was constantly updated. A common fleet of ambulances was maintained, commanded by the DMO’s office. Hospitals came to the aid of each other to overcome oxygen shortage.

“The health department has come up with a micro-level action plan for the next 30 days,” says Kerala health minister K.K. Shailaja Teacher. “The most important aspect is ensuring clean drinking water and distributing bleaching powder and chlorine tablets. This is being procured from other states. One health squad will be deputed to ensure chlorination in every 100 households. Isolation wards have been set up in every taluk hospital to prevent epidemics from breaking out. Many states, especially Maharashtra, Tamil Nadu, Karnataka and Andhra Pradesh, have been extremely cooperative by lending us their doctors and medical staff.”

Dr Sulphi N., state secretary of the Indian Medical Association, says that the real problem will begin when the flood affected move back from the relief camps to their homes, which will be dirtier and more infected than the camps. The cleaning process is paramount. It is extremely important that water is boiled, food is fresh and toilet hygiene is maintained, he says. But more than the spread of infectious diseases like leptospirosis, malaria and typhoid—he feels enough measures have been taken to stop it—the difficulty is going to be in dealing with the long-term effects like controlling non-communicable diseases like hypertension and diabetes. People have lost all their medicines and they will have to be replaced. One of the reasons Kerala has a high health index, he says, is because of the economic status of the patients. Most of them were able to afford basic health care. This will no longer be possible for many who have lost all their savings. Another problem is going to be dealing with post-traumatic stress disorder. “We have seen the emotional state of the people in the camps who have lost everything,” he says. “The moment we ask them anything, they immediately burst into tears.”

Selfless service: Dr Najeeb and his wife Nazeema have been working tirelessly in relief camps | Josekutty Panackal Selfless service: Dr Najeeb and his wife Nazeema have been working tirelessly in relief camps | Josekutty Panackal

Dr George Joseph Chakkungal, senior consultant psychiatrist at Rajagiri Hospital, says that any natural disaster affects the mental health of people in various stages. The first is the pre-disaster stage, characterised by worry and uncertainty. Then, when the disaster strikes, there is a feeling of shock, depression and helplessness. When emergency help starts pouring in and they are moved to relief and other camps, there is a sense of camaraderie, when people share each other’s grief. The disillusionment starts when they go back home and the extent of loss fully strikes them. “But what we have realised from past disasters like the tsunami is that people are extremely resilient,” says Chakkungal. “Almost all recover within 30 days. Only a very small percentage fall victim to long-term distress and require treatment.”

He says that children and the elderly are particularly vulnerable to mental health problems after a natural calamity. Children are unable to comprehend what has happened and to express their distress. Many don’t want to hurt their parents so bottle up their grief. “It is important to be honest with children about what has happened and involve them in the cleaning of houses and the rebuilding process,” he says. He feels social workers are doing commendable work in relief camps, offering psycho-social support to the victims. They should be given training to spot people who specifically require medical help. In the acute phase, these people display severe psychological or behavioural disorganisation. After a few days, this might settle into persistent gloom, sleeplessness, refusal to eat and uncommunicativeness.