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Building Climate resilient Health System
Building Climate resilient Health System
Preparing Pozhuthana Family Health Center for Future Floods
Preparing Pozhuthana Family Health Center for Future Floods
Background
Background
About Wayanad
About Wayanad
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About Pozhuthana Gram Panchayat
About Pozhuthana Gram Panchayat
Pozhuthana Primary Health Centre
Pozhuthana Primary Health Centre
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2018 Floods and its Impacts
2018 Floods and its Impacts
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Leadership of the Medical Officer at PHC in the immediate after
Leadership of the Medical Officer at PHC in the immediate aftermath of the floods
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Post Floods : Rebuilding the PHC:
Post Floods : Rebuilding the PHC:
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Flood Resilient PHC
Flood Resilient PHC
Compound Wall
Compound Wall
PHC Building
PHC Building
Walls of the PHC Building
Walls of the PHC Building
Outer Courtyard
Outer Courtyard
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2019 Rains
2019 Rains
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2020 Rains
2020 Rains
Resilient Health Systems Lead to Resilient Communities
Resilient Health Systems Lead to Resilient Communities
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Authors: Nitha Thankam George and Shweta Narayan
Authors: Nitha Thankam George and Shweta Narayan
Design : Subhashis Roy
Design : Subhashis Roy
CONTENTS
CONTENTS
For more details, contact: Healthy Energy Initiative India, No
For more details, contact: Healthy Energy Initiative India, No 92, 3rd Street, Thiruvalluvar Nagar, Besant Nagar, Chennai – 600090, India
CONTEXT
CONTEXT
CONTEXT
CONTEXT
Climate resilience refers to the capacity of a socio-ecological
Climate resilience refers to the capacity of a socio-ecological system to adapt, reorganize, and evolve to be better prepared for future disasters and climate change impacts. Kerala is home to 3.44% of India's population. The state has started witnessing the climate change and its impacts on various geographic regions and economic sectors. Rising temperatures, seasonal extremes in rainfall causing floods and water scarcity, accelerated coastal erosion have together led to failure of crops, drop in fisheries catch, increase in diseases, and sea level rise threatening the coastal cities. With Paris Agreement bringing in new climate regime, there is emphasis on integration of these climate action strategies in existing schemes and policies at sub-national level. The priority for the state has been to build resilient and low emissions society. The Sustainable Development Goals adopted in 2015 with the mission to leave no one behind identified addressing climate change as one of the goals besides also identifying other goals for areas such as water and energy access that are key to sustainable development and national government’s goal of inclusive growth. Strategies for poverty eradication (SDG1), food security (SDG 2), health (SDG 3), water and sanitation (SDG 6) will get affected from changing climatic conditions. The energy source (SDG 7), nature of economic activities (SDG 8), urbanisation (SDG 11) will determine carbon emissions. The SDGs are inter-twined with areas involved in climate change and will contribute immensely to the pathways of climate change adaptation and mitigation in the state and country. The SDG agenda 2030 provides an opportunity to direct development in a climate resilient, low carbon, sustainable and inclusive manner. It is therefore pertinent to integrate Paris Agreement on climate change with action on post-2015 Sustainable Development Agenda.
Climate Resilient Kerala
Climate Resilient Kerala
Kerala floods in August 2018 was one of the worst floods in nea
Kerala floods in August 2018 was one of the worst floods in nearly a century. In order to understand the role of the health sector and its response to the floods, a multi stakeholder survey was conducted in the months of November and December 2018. The aim of this study was to consolidate the experiences of health care systems, their experiences, challenges and learning during the flood relief work. The survey assessment delved into the role, performance, strengths and shortcomings of the health systems along with the perceptions and role of public health professionals in an event of an extreme climatic event. Pozhuthana Primary Health Center (PHC)* in Wayanad District was identified as severely impacted due to floods and was assessed as a part of the study. Since then, by keeping in touch and encouraging the Medical Officer (MO) to follow the recommendations made, several changes and retrofits were made to prevent flooding in the future and making their health center resilient. Preparation for facing future floods were carried out by ensuring building strengthening and paving, power backup, clean and dry storage for medicines and medical records. The following case study details the efforts taken by Pozhuthana PHC in transforming into a climate resilient health care institution.
Health Sector in Climate Resilient Kerala
Health Sector in Climate Resilient Kerala
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Sambath, V. (2019). Building Climate Resilient Health Systems:
Sambath, V. (2019). Building Climate Resilient Health Systems: An assessment of Preparedness of Health Systems to Kerala Floods of August 2018 (pp. 1-27, Tech.). Chennai, Tamil Nadu: Healthy Energy Initiative - India
now designated as Family Health Center (FHC)
now designated as Family Health Center (FHC)
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Photo Courtesy: Laiju Stephen
Photo Courtesy: Laiju Stephen
Background
Background
Extreme weather events have become more frequent and intense gl
Extreme weather events have become more frequent and intense globally over the recent decades . In the last 10 years, India experienced over 15 extreme flooding events – 4 in Assam, 3 in Bihar, and one each in the states of Kerala, Tamil Nadu (Chennai), Gujarat, Maharashtra (Mumbai), Kashmir, West Bengal and Uttarakhand. In the aftermath of natural disasters for prevention of outbreaks and general health management, public health facilities are most essential. However, they are also the first to be crippled and rendered useless.
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After the 2018 floods in the Kerala, the directorate of health
After the 2018 floods in the Kerala, the directorate of health services estimated a loss of almost Rs.110 crores to government hospitals alone. In the worst affected districts of Ernakulam, Pathanamthitta, Thrissur and Alappuzha, several hospitals were forced to evacuate patients and suspend surgeries and critical care . Similar experiences have been documented in Chennai , Mumbai , Patna and Kashmir .
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Since the early 20th century to the present day, there is a sig
Since the early 20th century to the present day, there is a significant increase to the extent of “damages” caused by natural disasters like storms, droughts and floods. Only for the period since World War II the total average amount of damage per decade increased almost tenfold . A recent report by The Lancet journal shows a 46% increase between 2000 and 2016 in the frequency of extreme weather events . While there is an increasing acknowledgement of the link between poor urban planning, mal-development, deforestation and extreme weather events, the role of changing climate patterns and the imminent threat of sea level rise cannot be ignored. The risks of climate unpredictability are here to stay! The obligation to be prepared is on us.
IPCC, 2013: Summary for Policymakers. In: Climate Change 2013:
IPCC, 2013: Summary for Policymakers. In: Climate Change 2013: The Physical Science Basis. Contribution of Working\Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Stocker, T.F., D. Qin, G.-K. Plattner, M. Tignor, S.K. Allen,J. Boschung, A. Nauels, Y. Xia, V. Bex and P.M. Midgley (eds.)]. Cambridge University Press, Cambridge, United Kingdom and New York, NY Kerala floods leave several hospitals in disarray; many surgeries cancelled, doctors fear health crisis may worsen – First Post, August 17, 20 18 patients die in Chennai hospital, The Hindu, December 04, 2015 Rain floods Mumbai’s largest municipal hospital, patients moved to higher floor, Hindustan Times, August 27 2017 Heavy rain floods critical care unit at Indian hospital, Reuters, July 30 2018 Heavy rain floods critical care unit at Indian hospital, The New York Times, September 19 2014. Munich RE. 2005: Weather catastrophes and climate change - is there still hope for us?. Munchener Ruckhevchersirungs-Gesellschaft, Munchen, 264 p. ISBN 3-937624-81-3. Langhammer, J. et al. 2007A: https://doi.org/10.1016/S0140-6736 Government of Kerala. Wayanad District Official website [Internet]. [cited 2021 Mar 10]. Available from: https://wayanad.gov.in/ Climate South Asia Network. Wayanad: A case of Kerala’s environmental degradation [Internet]. Climate South Asia Network. 2014 [cited 2021 Mar 10]. Available from: http://climatesouthasia.org/wayanad-a-case-of-keralas-environmental-degradation/
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KERALA
KERALA
WAYANAD
WAYANAD
About Wayanad
About Wayanad
Wayanad is a district in the North Eastern part of the State of
Wayanad is a district in the North Eastern part of the State of Kerala. It is a picturesque plateau situated at a height between 700 meters and 2100 meters above the mean sea level nested among the mountains of the UNESCO world heritage site Western Ghats on the eastern portion of north Kerala and on the sides of Tamil Nadu and Karnataka States . The most part of this district is encircled by forests. The land is rich and fertile, fed by numerous mountain streams which merge into perennial rivers, chiefly among them, the Kabini. The mean average rainfall in this district is 2322 mm. Lakkidi, Vythiri and Meppadi are the high rainfall areas in Wayanad. Annual rainfall in these areas ranges from 3000 to 4000 mm. Lakkidi, nestled among the hills of Vythiri taluk, has recorded the highest rate of rain in Kerala. It is known to be the place with the second highest rain in the world, the first place being Chirapoonchi in Meghalaya .
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Wayanad’s steep topography, small size, numerous waterbodies an
Wayanad’s steep topography, small size, numerous waterbodies and excessive variations in rainfall makes it unique and also most vulnerable to landslides and floods . In 2018, the district received incessant rains, floods and landslides not only in August, when the entire state faced the deluge but also in December making the recovery process even more complex.
A taluk consists of urban units such as census towns and rural
A taluk consists of urban units such as census towns and rural units called gram panchayats. There are totally of 23 grama panchayats in Wayanad District out of which 10 are in Vythiri taluk.
Wayanad Revenue District is divided into 3 Taluks and 49 Vil
Wayanad Revenue District is divided into 3 Taluks and 49 Villages. The taluks in Wayanad district are: Mananthavady Sulthan Bathery Vythiri
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Taluk and Village administration managed by the provincial gove
Taluk and Village administration managed by the provincial government of Kerala. Panchayat Administration managed by the elected local bodies and works with the provincial government of Kerala. Parliament Constituencies for the federal government of India. Assembly Constituencies for the provincial government of Kerala.
Wayanad District has four types of administrative hierarchies
Wayanad District has four types of administrative hierarchies .
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Government of Kerala. DISTRICT DISASTER MANAGEMENT PLAN WAYANAD
Government of Kerala. DISTRICT DISASTER MANAGEMENT PLAN WAYANAD- [Internet]. 2019. Available from: https:// cdn.s3waasgov.in/s3b73ce398c39f506af761d2277d853a92/uploads/2019/08/2019081721.pdf A taluk is a subdivision of a district; a group several villages organized for revenue purposes. Collins English Dictionary. Taluk definition and meaning [Internet]. [cited 2021 Mar 10]. Available from: https://www.collinsdictionary.com/dictionary/english/taluk Government of Kerala. Administrative Setup , Wayanad Official website [Internet]. [cited 2021 Mar 10]. Available from: https://wayanad.gov.in/administrative-setup/
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About Pozhuthana gram panchayat
About Pozhuthana gram panchayat
Pozhuthana gram panchayat is a panchayat of Vythiri taluk, loca
Pozhuthana gram panchayat is a panchayat of Vythiri taluk, located about 8 km west of district headquarters - Kalpetta town. The panchayat comes under the highland region of Wayanad district and consists of many undulating hills intersected by flat-bottomed valleys, three sides of the panchayat border adjoin forests. Pozhuthana river and its rivulets flows through the middle of the panchayat from south to north and drains into Kabini River. The panchayat area is moderately well drained and exhibits a dendritic drainage pattern . Depth of ground water fluctuates considerably with physiography, but generally remains between a depth of 5–20 m in the elevated areas and 1–5 m in the valleys. According to the census of 2011, the panchayat has a population of 20839 comprising of indigenous tribes, plantation workers and small-scale farmers. Main produce in the region is of coffee, rubber, tea, pepper, banana and cardamom. There are 2 major tea plantation estates in the region - Achoor Estate of Harrisons Malayalam Limited and Kurichararmala plantation of PV Abdul Wahab. For better administration a gram panchayat is further divided into wards. Elected representatives from each ward form the main administrative body of a panchayat. Pozhuthana gram panchayat consists of 13 wards. During the 2018 floods, Pozhuthana gram panchayat was affected by flood and landslides both. While all wards were flooded, landslides occurred mainly in Ammara area of Ward 4 and Kuricharmala Melmuri area of Ward 13.
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Pozhuthana Primary Health Centre
Pozhuthana Primary Health Centre
The current PHC is located on 1 acre of land and had 2 single s
The current PHC is located on 1 acre of land and had 2 single storey buildings prior to 2018 floods. One building had about 5 rooms and was used as a hospital while the other building had a mini hall. The PHC is built on low-lying land in the flood plains of the Anoth river and is about 100 mts from the river. The land was earlier used for paddy cultivation. There is a canal that flows through the hospital land and drains into Anoth river. The PHC is surrounded by paddy fields and banana plantations. The PHC has Out Patient Department (OPD) and no in-patient services. Power supply in the PHC is through the grid and there is a backup diesel generator for emergency. The well in the hospital premises provides drinking water for the PHC.
There are 3 main access roads to the Pozhuthana PHC. 2 of them
There are 3 main access roads to the Pozhuthana PHC. 2 of them - Kalpetta-Pozhuthana road and Padinjarathara- Pozhuthana road fall in the low lying area and are susceptible to floods. the third road, Vythiri- Pozhuthana road is at an elevation and is the only way to access the PHC in an event of floods.
A dendritic drainage pattern is the most common form and looks
A dendritic drainage pattern is the most common form and looks like the branching pattern of tree roots. It develops in regions underlain by homogeneous material. That is, the subsurface geology has a similar resistance to weathering so there is no apparent control over the direction the tributaries take. Source: http://www.wvca.us/envirothon/pdf/Drainage%20Patterns.pdf
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Photo Courtesy: Laiju Stephen copy
Photo Courtesy: Laiju Stephen
2018 Floods and its Impacts
2018 Floods and its Impacts
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Kerala experienced an abnormally high rainfall from June to mid
Kerala experienced an abnormally high rainfall from June to mid-August in 2018. This resulted in severe flooding in 13 out of 14 districts in the State. As per IMD data, Kerala received rainfall which was about 42% above the normal. Further, the rainfall over Kerala during June, July and 1st to 19th of August was 15%, 18% and 164% respectively, above normal.
Due to heavy rainfall, the first onset of flooding occurred tow
Due to heavy rainfall, the first onset of flooding occurred towards the end of July. A severe spell of rainfall was experienced at several places on the 8th and 9th of August 2018. The 1- day rainfall of 398 mm, 305 mm, 255 mm, 254 mm, 211 mm and 214 mm were recorded at Nilambur in Malappuram district, Mananthavady in Wayanad district, Peermade, Munnar KSEB and Myladumparain in Idukki district and Pallakad in Pallakad district respectively on 9 August 2018. This led to further flooding at several places in Mananthavadi and Vythiri in Wayanad district during 8-10, August 2018. Water was released from several dams due to heavy rainfall in their catchments. The water levels in several reservoirs were almost near their Full Reservoir Level (FRL) due to continuous rainfall from 1st of June. Another severe spell of rainfall started from the 14th of August and continued till the 19th of August, resulting in disastrous flooding in 13 out of 14 districts. As per the rainfall records of IMD, it has been found that the rainfall depths recorded during the 15-17, August 2018 were comparable to the severe storm that occurred in the year 1924 . Heavy rainfall resulted in landslides in several areas of Wayanad districts resulting in silting of rivers and aggravating the floods. All regions in the Pozhuthana panchayat were submerged for at least two days in August 2018. Pozhuthana PHC was one of the worst affected health centers in the entire district. The PHC lost most of its equipment, patient records, medicines in the flood. In addition, there were structural damages to the building itself, the floor of the mini hall had broken, and the boundary wall collapsed. There was no power supply as the grid was affected due to landslides and the backup generator was underwater as it was located on the ground floor of the PHC. The drinking water source for the PHC was totally contaminated.
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Pozhuthana Primary Health Centre
Pozhuthana Primary Health Centre
Pozhuthana Primary Health Centre (PHC) which is now designated
Pozhuthana Primary Health Centre (PHC) which is now designated as a Family Health Centre (FHC) (refer to section below on FHCs), is one of the main health facilities in the panchayat serving 16,728 people. The PHC serves 11 out the 13 wards in the panchayat. The health center itself was built with support and contributions from the residents in the region. Prior to 2011 the health center was located in a Pozhuthana town area in a rented building. The panchayat with the help of contributions from local villagers including one day wage contributions from plantation workers at Harrisons Malayalam Limited (HML), bought its own land and constructed the PHC in the premises. The current PHC is located in 1 acre of land and has 2 single storey buildings. One building which has about 5 rooms is used as a hospital while the other building has a mini hall. The PHC is built on low-lying land in the flood plains of the Anoth river and is about 100 mts from the river. The land was earlier used for paddy cultivation. There is a canal that flows through the hospital land and drains into Anoth river. The PHC is surrounded by paddy fields and banana plantations. The PHC only has Out Patient Department (OPD) and no in-patient services. Power supply in the PHC is through the grid and there is a backup diesel generator for emergency. The well in the hospital premises provides drinking water for the PHC.
There are 3 main access roads to the Pozhutana PHC. 2 of them -
There are 3 main access roads to the Pozhutana PHC. 2 of them - Kalpetta-Pozhutana road and Padinjarathara- Pozhutana road fall in the low lying area and are susceptible to floods. the third road, Vythiri- Pozhutana road is at an elevation and is the only way to access the PHC in an event of floods.
Government of India. Study report: Kerala floods of August 2018
Government of India. Study report: Kerala floods of August 2018 (September 2018) - India [Internet]. ReliefWeb. [cited 2021 Mar 10]. Available from: https://reliefweb.int/report/india/study-report-kerala-floods-august-2018-september-2018
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Dr Sushma (in the center) and her team
Dr Sushma (in the center) and her team
Leadership of the Medical Officer at PHC in the immediate after
Leadership of the Medical Officer at PHC in the immediate aftermath of the floods
Dr. Sushma P.S. is the medical officer and the senior most person
Dr. Sushma P.S. is the medical officer and the senior most person at the Pozhuthana PHC. She has been the officer in-charge of the center since 2010. Over the years of her service, the health center had become her second home and her team like her family. The devastating impacts of the floods on the PHC completely shattered the entire team’s morale. However, Dr Sushma resolved not to give up in the time of crisis but be the anchor for her team in order to rebuild the PHC. “A leader should be always a leader. It is not just in the happier days but the test of leadership comes when there is a challenge”, said Dr Sushma. Dr Sushma single handedly documented the damage to the PHC and coordinated with the panchayat members about the situation at the PHC. The coordination and support from local administration was so timely that Dr Sushma was able to restart the health service delivery in the region from the moment the floodwater receded the next day. With the help of panchayat president, she arranged a panchayat community hall to start the medical camp. She coordinated with a local pharmacy to organize basic medicines like paracetamol, ranitidine, doxycycline, amlodipine and
metformin, and medical equipment like stethoscope, thermometer
metformin, and medical equipment like stethoscope, thermometer and BP machine and she started the outpatient (OPD) services. The PHC staff scheduled OPD in the morning hours and field visit in the afternoons. In the next few days, additional help came from district authorities, all the necessary medicines where provided, a team from district medical officer visited the site, more human resources were allotted. Some of Dr Sushma’s friend from the medical fraternity from the neighboring districts also volunteered in the relief work. Together the team worked hard to ensure that there were no epidemics that broke out in the aftermath of the floods. They provided preventive medication to avert the chances of leptospirosis and hepatitis A. Community health workers were trained to identify the symptoms, possibility of water stagnation areas, instructed to take water samples from wells and to give Oral Rehydration Solution (ORS). It was the collective efforts of the team and the farsightedness of Dr Sushma that no communicable disease outbreaks were reported from the region in the aftermath of the floods.
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Photo Courtesy: SEEDS
Photo Courtesy: SEEDS
Aardram Mission is one of the four missions under the ‘Nava Ker
Aardram Mission is one of the four missions under the ‘Nava Keralam Mission’ initiated by the government of Kerala, which aims at the same deliverables at the grass root level. It was launched with the objective to completely transform the public health sector in the backdrop of the Sustainable Development Goals (SDGs) 2030 of the United Nations (UN). Aardram Mission’s primary focus is on SDG 3, ‘Good Health and Well-being’. The health status of Kerala being different from the rest of the country, there was a need to redefine the SDGs in the context of the state as a part of which Mission Aardram was launched in February 2017. Kerala has set short-term goals to be achieved by 2020 and long-term goals to be achieved by 2030 as part of the SDGs. This was formulated by various expert committees who worked on health issues prevailing in Kerala.
People-friendly Outpatient Services Re-engineering PHCs into F
People-friendly Outpatient Services Re-engineering PHCs into FHCs Access to comprehensive health services for the marginalised/vulnerable population Standardization of services from primary care settings to tertiary settings.
AARDRAM MISSION
AARDRAM MISSION
Main Objectives :
Main Objectives :
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Recognizing early that the disaster had left a deep emotional i
Recognizing early that the disaster had left a deep emotional impact on the health staff, Dr Sushma provided counselling, appointed a mental health counselor in the PHC to support the staff and community. Counselling was provided to the people in the camps. With Dr Sushma’s leadership and coordinated efforts of the local administration, the PHC was able to restore its vaccination services and monitoring of pregnant women within a week of the disaster.
Within a week of the floods, volunteers were organized to help
Within a week of the floods, volunteers were organized to help in the cleanup of the PHC and shift the services back to the premises after obtaining a fitness certificate from the Assistant Engineer of the panchayat. Detailed reports were prepared with the help from the engineers of National Health Mission (NHM) and State Disaster Management Authority (SDMA) to estimate the total loss in the PHC due to floods. Total estimated loss was at about INR 2 million. Majority of the funds for restoration of the PHC came from the NHM. The local panchayat too made a small contribution. The PHC renovation was done under the vision of Aardram Mission under the Nava Keralam Mission.
Post Floods : Rebuilding the PHC
Post Floods : Rebuilding the PHC
Government of Kerala. Aardram – National Health Mission [Intern
Government of Kerala. Aardram – National Health Mission [Internet]. [cited 2021 Mar 10]. Available from: /2020/04/01/aardram/
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The renovation of the PHC was completed by an external contract
The renovation of the PHC was completed by an external contractor agency – Nirmithi, who were contracted by the government. Engineers from the agency held several discussions and deliberations with Dr Sushma and her team and the members of NHM to capture their expectations in their plan. The entire process was completed under the guidance of the District Collector of Wayanad. In addition to the support by the State government, donations and support was also received from many social services, Non-Governmental Organizations (NGO). NGO SEEDS provided support to rebuild the compound wall of the PHC and toilets. Overall, it took 8 to 10 months to reconstruct the hospital and bring it back to the normal condition.
Flood Resilient PHC
Flood Resilient PHC
Given that the area is in flood prone low-lying region and it w
Given that the area is in flood prone low-lying region and it was difficult to shift the hospital itself, many aspects of the PHC were retrofitted to become flood resilient.
COMPOUND WALL
COMPOUND WALL
The compound was reconstructed to withstand the pressure of the
The compound was reconstructed to withstand the pressure of the water in the future. For this there was small metal grill placed in between layers of compound wall so that it could withstand the force of the water.
PHC building
PHC building
All the existing buildings were modified and new building with
All the existing buildings were modified and new building with the funds from district program was added; there are 3 buildings in the PHC in total. All buildings were made double storied, the mini hall in the second building is currently being used for OPD services. These buildings collectively host the pharmacy and laboratory services, public health and administration wings. All three building have their electricity backup inverters on the first floor to protect it from flood waters. The medical supplies store is also located on the first floor of the PHC. There are provisions to shift critical equipment, medicine and vaccine stocks and medical registers with patient records to the first floor of the building in an event of a possibility of floods.
Walls of the PHC building
Walls of the PHC building
Some of the walls of the PHC were tiled and partitions were mad
Some of the walls of the PHC were tiled and partitions were made using aluminum fabrication and painted, so that walls could withstand the pressure of the water in an event of flooding.
OUTER COURTYARD
OUTER COURTYARD
Concreting with cement and metal rods was undertaken in the fro
Concreting with cement and metal rods was undertaken in the front yard of the PHC. concreting in the backyard was avoided to preserve the greenery of the area.
Pazhuthana PHC afer SEED’s intervention
Pazhuthana PHC afer SEED’s intervention
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Photo Courtesy: Laiju Stephen copy 2
Photo Courtesy: Laiju Stephen
There are also plans to make ramps in the buildings for the eas
There are also plans to make ramps in the buildings for the easy shifting of equipment and medicines in an event of water inundation. Finally, by making all necessary modification, in January 2020, Dr. Sushma was able to transform her PHC into a Family Health Center (FHC). The Pozhuthana FHC has a systematic token system for patients, seating area, drinking water facility, OP services from 9 am to 6 pm and work on most of the public holidays. As part of developing the PHC to FHC, hospital had necessary administrative upgradations and currently has 44 staff of which 23 are permanent and others are from NHM, COVID duty workers, ASHA (community health) workers, contract workers etc. The FHC’s footfall normally is about 400 patients per day, during COVID pandemic it was around 150-200. Earlier they used to have 400 patients per day and now 150 to 200 due to corona.
2019 rains
2019 rains
Dr Sushma has incorporated the experiences of 2018 floods in pr
Dr Sushma has incorporated the experiences of 2018 floods in preparing for the rains of 2019 and 2020. In 2019 the PHC was still undergoing renovations and was flooded once again due to the incessant rains. However, Dr Sushma and her team were prepared and had a better response to the DDMA’s warnings of floods. The community preparedness to flood like situation was done in advance and in the PHC all necessary equipment and medicine stock was shifted before the building was inundated. Hence there was minimal loss due to the rains in 2019 even though half the first floor was submerged in the water.
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2020 rains
2020 rains
The preparation for 2020 rains were complex, while the health c
The preparation for 2020 rains were complex, while the health center was renovated and possibly more resilient to floods, the threat of a disaster was right in the middle of an ongoing pandemic – COVID19. Dr Sushma’s team prepared in advance on the early warning signs from the District Disaster Management Authorities (DDMA). Lot of care was taken due to COVID-19 situation. Rapid response team were identified from each ward with the help of the health center. Volunteers were trained at the panchayat and the district level. Camps were identified early and stocked with necessary medicines. List of all people from the vulnerable category (children, elderly, pregnant women, COVID-19 patients etc) were prepared in advance. With COVID-19, the vulnerable groups were divided into 3 classification: a) those who were quarantined with symptoms, b) quarantined without symptoms and c) COVID positive patients. In addition to these, arrangements were made to shift patients to camps and relative’s homes in other regions. Counseling and rehabilitation facility were arranged for mental health support and steps were taken to prevent outbreaks of communicable diseases. prevention strategies were taken. District officials had also identified people living in the flood and landslide prone regions and shifted them to safer places. There were no incidents of flooding at the health center in 2020. Dr Sushma attributes it to three main reasons: a) there were heavy rains but not as intense as 2018, b) there were no landslides in 2020 in the region as a result the river was not silted and water levels did not rise as much as compared to earlier years, and c) the renovations at the health center helped in protecting it from any water stagnation or damage.
Resilient Health Systems Lead to Resilient Communities
Resilient Health Systems Lead to Resilient Communities
This story of Dr. Sushma P.S and her PHC at Pozhuthana village
This story of Dr. Sushma P.S and her PHC at Pozhuthana village is a statement of their collective determination, perseverance and collective resolve of people of Kerala during a disaster. Dr Sushma’s leadership and courage transformed the flood battered health center to a well-functioning Family Health Center and is commendable. The transformation is also a shining example of inter-departmental collaboration and coordination. The members of panchayat, local and state level health departments, Aardram Mission, DDMA and NGOs played a critical role in the process. This case also highlights the need to see health systems not merely as providers of healthcare, but equally as the basic foundation for preventive care and a department that adds to building resilient and equitable societies. As demonstrated, a truly responsive and responsible health systems would take a lead before disaster strikes by taking necessary measures, be prepared to manage disasters, and also point to the harmful and inequitable effects of developmental activities in their local context.
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Photo Credit: vivek vincent3047
Photo Credit: vivek vincent3047
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