On 12 October, a primary health centre held a COVID-19 testing camp in Fatuha, a satellite town in Bihar’s Patna district, which was to begin at 1 pm. By 2 pm, when I reached the camp, the camp had already wound up. The PHC had finished the COVID-19 testing and turned into a polio camp. The auxiliary nurse midwives, who are village-level health workers, told me that they had tested 130 patients for the coronavirus, of whom only one had tested positive.
The Fatuha PHC was negligent in following several COVID-19 protocols. None of the ANMs were wearing masks even though they were in close contact with newborns and infants during the polio camp. When I asked for sanitiser both at the PHC entrance and at the ward room inside, I was told it was not available. When I inquired about how 130 persons could be tested in an hour with all COVID-19 precautions being followed, I was asked to meet Brahmprakash, the PHC manager, who said, “We are doing tests every day, our staff has got in a habit to carry the tests faster by now.”
On my way to his cabin, I met Sugni Devi, an accredited social health activist, or ASHA worker. ASHA workers are designated community health workers who were instituted as part of the central government’s health mission, in 2005. “I frequently visit the PHC with people from the surrounding villages to get them tested for COVID and to get their kids polio drops,” she said. I asked her what protocol is followed when a person tests positive at the PHC. “So far, they ask me to instruct the COVID-positive patients on what medicines to take and what regulations to follow during home isolation which has to be 14 days,” Devi said. When I asked whether the PHC recommends that patients isolate in a nearby hospital, she answered, “Here, the PHC’s responsibility ends by letting the infected persons get guided on self-treatment through ASHAs.”
However, Brahmprakash told me that COVID-positive patients who are severely ill are immediately sent to hospitals such as AIIMS and other government hospitals, including Patna Medical College and Hospital and Nalanda Medical College and Hospital. Devi contradicted this information. “I interact will all the patients I bring with me to the PHC,” she said. “I never saw any patient being referred to the hospital from here.”
There were no stretchers or trolleys in the wards at the Fatuha PHC. Sanitation workers were disposing the swab samples taken during COVID-19 testing by simply burning them in the open, outside the PHC. “I pity the sanitation worker who disposes the materials used in testing,” a staffer at the PHC, who had initially informed me about the testing camp, told me on the condition of anonymity. “She is neither provided any safety gears nor is trained in what protocols to follow for disposing them. Even the PPEs”—personal protective equipment—“used here by the one carrying tests is not up to mark. While testing, the protocols for COVID precautions are also flouted. They don't even keep a sanitiser for disinfection purpose while carrying out tests.”