ICU work in progress at the civil hospital in Assam's Tinsukia district Credit: EastMojo image

Tinsukia: Assam’s Tinsukia district is still lagging behind in health infrastructure, especially when it comes to intensive care unit (ICU) beds and ventilators. In fact, it has none so far.

Now, almost five months after Prime Minister Narendra Modi declared national “lockdown 1” on March 26 to boost preparedness to tackle COVID-19, the district is finally racing to build its first ICU facility with ventilator-driven beds.

The development also comes at a time when Tinsukia district has reported 48 COVID-19 deaths, most of whom to die were the ones who were referred to Assam Medical College and Hospital in Dibrugarh in absence of ICU facility in the district, making Tinsukia fare poorly in emergency preparedness.

Talking to this correspondent, Tinsukia district DIPRO Bhaskarjyoti Bora said that at present the district has no ICU facility as such. “However, preparation for a 20-bedded ICU facility is in progress at the civil hospital in Tinsukia town and shall be functional in four to five days,” he said.

The district has a dedicated COVID-19 hospital and 10 Covid care centres, accounting for 990 isolation beds. “However, there are no ventilators facility available in the entire district as of now,” Bora added.

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According to sources, the district administration has ramped up the number of isolation beds in the district from 180 in mid-July to 990 in mid-August following a steep spike in number of COVID-19 cases.

The district has recorded a total number of 4,513 positive cases of COVID-19, out of which 1,018 are active cases from a total of 24,252 samples collected so far. On August 21, another 37 cases were added to the tally.

Tinsukia, the eastern-most district of Assam, has a total population of 13,27,929, according to 2011 census.

The government has a network of total 30 government hospitals including primary health centres with a doctor force of 106 scattered in various facilities in the district and a fleet of 24 108 ambulances, an official said.

Civil hospital in Tinsukia

According to sources, the poor health infrastructure has posed a major hindrance in treatment and management of patients with slightest of critical condition or diagnosed with severe diseases, leaving no choice for the doctors but to refer them to AMCH in Dibrugarh, around 50 km from the district headquarter of Tinsukia.

The situation has worsened during the outbreak of Covid-19 as cases are piling day-after-day and the positive patients load seems to have a bearing impact on the poor health infrastructure in the district.

In April this year, centre flagged gaps in critical care infra in which Assam was named after Uttar Pradesh and Bihar in terms of states having worst shortages in critical health care.

The Centre presented a detailed account of infirmities in India’s COVID-fighting infrastructure, including specifically, the shortage of isolation beds, ventilators and ICU beds. “UP, Bihar and Assam had the largest number of districts with grave shortages of all these three kinds of equipment,” said a presentation made by cabinet secretary, in the meeting, attended by health secretaries of all states.

As per the data’s placed in the presentation, 183 districts across the country and fewer than 100 isolation beds, 143 and 123 districts across the country have zero ICU beds and zero ventilators respectively. “In Assam, 19 districts (out of 33) had less than 100 isolation beds and 17 districts (out of 33) without a single ventilator bed,” according to the presentation based on data upto April 23.

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Health infrastructure in the district

The district health infrastructure consists of one district hospital, three model hospitals (Mohkhuli, Kathalguri and Philobari), four First Referral Unit FRU (Doomdooma, Digboi, Margherita and Chapakhowa), one CHC and twenty one primary health centres.

Officials said, the district hospital is a 254-bedded hospital, while Model hospitals, FRU, CHC and PHC are 20, 30, 20 and 6 bedded health facilities respectively, taking total bed capacity to 580 beds. “These are general beds without ICU and ventilator facilities manned by 106 doctors and around 400 nurses including 312 GNM nurses.”

“Out of 24 108 ambulances, four are down while 12 are reserved for Covid-19 cases,” the official added.

Reaction time: 20 days ago and now

The unavailability of ICU beds and other upgraded health infrastructure in Tinsukia districts had compelled district health authorities to refer the critical and patients with co-morbid conditions to AMCH in Dibrugarh district.

Until first week of August, the reaction time for picking and shifting such Covid-19 positive patients from various places in Tinsukia district to AMCH used to be anytime between 6 to 8 hours depending upon case to case due to fewer ambulances, official sources said.

The owner of City Hospital, Dr JC Dey, said that the district administration had held a meeting with private nursing homes few days back. “In the meeting we learnt that due to constraints of ambulances there was a huge time lag in shifting of patients to AMCH in Dibrugarh.”

“The administration appealed us to help them with private ambulances,” Dey said, adding, “We have our own emergencies, hence, we will help them whenever there is a mass emergency, subject to availability of our ambulances.”

Admitting that delay in transporting critical patients can have an adverse impact, Dey said, it is important to note that only those patients who are critical or need better treatment are referred to Dibrugarh. “Critical patients need immediate treatment, hence any delay in response time can have detrimental effect on their health. Sooner they are admitted, sooner they can be treated, and higher are the chances of their responding to the treatment.”

Those critical or having comorbid conditions, needs to be transported only in ambulances, as it has the facility to monitor some important parameters of the patient besides supplying oxygen, he added.

Another doctor, who owns a private nursing home said, majority of cases are asymptomatic, but in case of symptomatic and co-morbid patients, delay in picking patients from various parts of Tinsukia district and shifting them to AMCH in Dibrugarh can be critical and needs to be addressed. He requested anonymity.

Talking to this correspondent earlier this month, additional deputy commissioner (health) Ayush Garg said, the response time in evacuating a Covid-19 positive and getting him admitted to COVID ward in AMCH is between 7 to 8 hours, which a cause of worry. “Hence, we have set a target to reduce this reaction time to maximum 2 hours.”

“We have requisitioned private ambulances and hired buses and wingers which will help significantly to improve the reaction time in the coming days,” added Garg.

On Saturday (August 22) Garg said, the reaction time in last few days has been reduced to a maximum of 2 hours. “We have kept one ambulance parked at each Covid care centre to avoid any delay in shifting patients to AMCH in Dibrugarh.”

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Positivity and mortality rate

Garg said, on a positive note, in last one week there has been a sharp decline in positive rate which has fallen by over 4%. “Around 10 days back, the positivity rate of Covid-19 cases in Tinsukia touched almost 10 percent.

Accordingly, we have also seen a decline in the mortality rate in last 10 day. Garg added, “Out of 48 deaths of Covid-19 patients, 24 deaths have been declared due to Covid-19 by the audit board while 17 have been declared non Covid-19 death. Seven cases are under audit.”

Highlights of deputy commissioner PC

The deputy commissioner of Tinsukia Bhaskar Pegu addressed a press meet on August 11 where he said that the district administration is building an ICU facility in civil hospital.

Pegu, joined by Garg, said, a 20-bedded ICU will be functional at the district hospital from August 17.

“All twenty beds are ventilator driven beds,” said Garg.

Need of the hour

According to doctor Dey, the situation is bad here with many government ambulances not functional. “There is an urgent need to upgrade health infrastructure in Tinsukia and add more 108 ambulance with paramedics,” he added.

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