Editor’s note: This article is the first of a multi-part series which examines how the COVID-19 lockdown has impacted one of the most backward districts in Maharashtra and the most disadvantaged section of the society living on the outskirts of Mumbai.

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He may have the body and the age for it, but lifting jumbo oxygen cylinders every day is strenuous even for 22-year-old Omkar Bondre. He has sprained his right wrist carrying the cylinders that are just over four feet in height and weigh about 50 kilos when they are empty.

“It needs two people to carry one cylinder,” he said. “We have been doing it for the past two months or so. It is backbreaking.”

Bondre has to put in the physical labour because the Dedicated COVID Hospital (DCH) he works at does not have a liquid oxygen plant to keep the central oxygen system functional. They need at least 85-90 such cylinders a day.

Located in the taluka of Vikramgad in Maharashtra’s tribal district of Palghar – barely 100 kilometers from Mumbai – the concerned DCH, with the intake capacity of 200, is supposed to be the main facility to treat critically ill patients in the district. But the hospital lacks amenities, and the staff is overworked.

On 16 August, when the reporter visited, 155 out of 200 beds were occupied at the Vikramgad DCH, also known as the ReVera hospital. The specialists tending to the patients included a physician, a paediatrician, a nodal officer, an MBBS doctor, a BMS graduate and 65 staff nurses. “We are exhausted,” one of them said, requesting anonymity. “DCH facility is at the top of the hierarchy. Patients first visit fever clinics. They are then referred to Covid Care Centre (CCC). If the patients do not recover, they are referred to a Dedicated Covid Health Centre (DCHC). And DCH is the last option. We have to be on our toes.”

The Dedicated Covid Hospital in Rural Palghar does not have a liquid oxygen plant to keep the central oxygen system functional. They need at least 85-90 such cylinders a day. Parth MN

There are only two other DCH facilities in Palghar and they have a capacity of 50 and 30 beds respectively. The three DCH facilities between them are supposed to treat serious COVID-19 patients from Rural Palghar – the belt besides the Vasai Virar Municipal Corporation (VVMC), which has a population of 1.2 million. Rural Palghar has 1.8 million people – and just under 60 percent of it comprises Scheduled Tribe, which is well over Maharashtra’s 9.4 percent. Palghar in total has a population of 3 million people.

“We need more manpower,” the staffer at ReVera said. “We are working round the clock.”

Since the outbreak of COVID-19 in India, of the 28,703 samples taken in Rural Palghar, 5,672 tested positive and 99 have died – well below Maharashtra’s 6.5 lakh cases and over 21,000 deaths. Current active cases in rural Palghar stand at 1,422. However, the positivity rate is 19.76 percent and anything above a 10 percent is considered high positivity. For context, the positivity rate in Maharashtra stands at 12 percent.

The shortage of healthcare workers is visible across facilities and hospitals in Rural Palghar and not just at the DCH facilities. The vast divide between the number of staff approved to handle the COVID-19 situation and the actual appointments made, is self-explanatory.

Twenty-six physicians, 18 anaesthetics and 102 medical officers were approved for appointment in Rural Palghar. Not a single one of them has been appointed so far. Out of the 534 approved number of staff nurses, only 68 have been appointed. And merely nine of the 31 lab technicians and 81 out of 194 ward boys have been appointed so far.

It is no wonder then that Bondre, who is one of the 40 Class Four employees working at ReVera, has to put in at least 16-18 hours of work everyday when his offi cial duty hours are supposed to be eight. “We get Rs 400 a day,” he said.

Son of marginal Adivasi farmers in the taluka of Wada – 24 kilometers from Vikramgad – Bondre worked at a company that made water pumps. “I earned Rs 12,000 a month,” he said. “But I lost my job after lockdown. My parents have suffered losses in the farmland. I have to do something to keep the family afloat.” Therefore, he has been at ReVera for the past three months. “The authorities have made arrangements for all of us at a hostel nearby.”

However, Bondre and his co-workers end up spending little time at the hostel. Throughout the day, they serve the COVID-19 patients – starting from packing their food to disposing the packets, the staff take care of everything. They dust the hospital wards, clean the toilets and bathrooms notwithstanding the perpetual risk of contracting the virus. Six staffers at ReVera have tested positive for COVID-19 so far and they have resumed work after recovering. “My parents worry about me all the time,” said Bondre.

But the most challenging task is disposing off the bodies. Out of about 1,000 people admitted at ReVera so far, 26 have died. “There is no electric furnace here like you have in Mumbai,” said a staffer. “Which means the Class Four employees have to take care of the cremation as well.”

Bondre said it takes about 5-6 hours to conduct a funeral. “We first have to pile up logs of wood while wearing a PPE kit,” he said. “Then we have to ensure two family members of the deceased get into their PPE kits. The body has to be wrapped adequately before placing it on the pyre. After the funeral, we have to sanitise their PPE kits and ours. It is a long process.”

The three DCH facilities between them are supposed to treat serious COVID-19 patients from Rural Palghar – the belt besides the Vasai Virar Municipal Corporation (VVMC), which has a population of 1.2 million. Parth MN

The health infrastructure of Rural Palghar is inadequate even for normal circumstances, let alone a pandemic. The region does not have a single general hospital. It has nine rural hospitals and three sub-district hospitals with 27 ambulances and 30 hired vans that are used as ambulances. There are 46 Primary Health Centres (PHC) for a population of 1.8 million, which is one PHC for every (just under) 40,000 people. Ideally, it should be one for every 30,000.

Coronavirus reached Palghar late, compared to the other districts of Maharashtra. ReVera got its first COVID-19 patient on 15 May, when Maharashtra had recorded nearly 30,000 cases. About a month before that, an old and unused medical college in the village of Hatne – eight kilometres from Vikramgad town – was converted into the DCH facility. “There is no significant facility in Palghar where we could have built a COVID hospital,” civil surgeon Dr Kanchan Vanare said.

The authorities had to pick the abandoned college in a remote locality for a DCH. “Since this was already a medical college, much of it was already setup,” Vanare said. “We consolidated on that.”

Keeping the infectivity of coronavirus in mind, the consolidation predominantly included bed management, besides plumbing, electric work, civil work and installing doors and windows. However, even three months after receiving its first patient, ReVera, the foremost DCH facility in rural Palghar, is still not able to conduct CT and MRI scans.

The patients, therefore, are taken to Boisar – 50 kilometers from Vikramgad – to carry out these two tests. On a normal day, it takes over an hour to get to Boisar from Vikramgad. During torrential monsoons with slippery, potholed and muddy roads devoid of street lights, it takes over four hours to travel back and forth.

Healthcare challenges in the area are exacting under normal circumstances. With a deadly virus and relentless downpour, things get worse. “This is something we have never experienced before. Everyday is a new challenge,” said Bondre, when his senior interrupted him. He had to leave. There was something wrong with the generator.