[Long Read] By May, Meerut Had Become The Worst-Affected District In UP—And Then It Fought Back

Earlier this month, Om Pal, a panchayat representative fighting against the spread of Covid in rural Meerut was in one of the villages. It is home to the Sapera and Kalandar communities. He saw that residents, assuringly above 50, were wearing masks but younger men around them were not. It was time for some piercing communication from Om Pal.

He approached the group of young adults and said, “Did Bauji (the elders) and their generation have 4G network and mobile phone during their days?” To this, the young adults laughed and said "no". Om Pal spluttered: "They neither had 4G nor know social media, yet they are wearing masks. Who is more intelligent -- you or Bauji?

It worked. "The elders were harsh in words to the young lot and soon their masks came up," Om Pal adds. Such open communication is part of his work on a daily basis. His goal is to bring the curve down, whatever work or communication it takes in rural Meerut.

Meerut was one of the worst Covid-hit districts in Uttar Pradesh around 11 May. The disease had spread to the rural areas. Among the 12 blocks in rural Meerut, Saroorpur, Mawana, Daurala, Kharkhoda, Hastinapur, and Bhawanpur were among the worst affected.

Om Pal is one of the small units in the unseen team of people working to contain the spread of the Chinese virus. The collective efforts of this team spread across 12 blocks has helped bring the curve down and continues to work and fight against the disease in rural Meerut.

The Spiral And Response

The period between April third week and May second week was a test of grit, patience and nerves. One intriguing event which seems to emerge during this period, as phone conversations with front line workers (FLWs) indicate, is that fear from Covid in residents would come after seeing infections rise, and this fear, eventually, would led them to make better changes in attitudes in the fight against the spread of the virus.

A senior doctor leading the fight against Covid at one of the blocks tells Swarajya over the phone that a trend emerged that people who were returning from bigger cities from different work backgrounds wanted to come to their villages. He says, "They either became positive in those bigger cities, or faced problems and they moved towards their village in Meerut. Then, there are many people who move to and fro Delhi on a daily basis from Meerut and areas around Baghpat. This is my own observation." Daurala, Mawana, Hastinapur, Machra, too saw movement of people.

He points out the cases in March were low.

People were hiding that they had symptoms, he says, and in April, the awareness increased, and people rushed for treatment. "They were hiding symptoms because of investigation. For treatment, they would quietly rush to the medical store."

The strategy from the local frontline workers to make medical store owners report such cases worked. The store owners would be asked to provide details of the medicines the locals are coming for. It would also give the local FLWs an idea about where residents are coming from for the medicines for Covid-related symptoms.

However, when information on this spread among the residents, they would provide wrong details about themselves. "They would give incorrect details of their name and phone number and get themselves tested and even take the medication."

This would lead to problems in tracing.

The virus was spreading. There was resistance to the work of the visiting FLWs and their teams. "April ke ending mein aur May ke starting mein ek dum se bahut zyada case badh gaye." (There was a sudden spike in cases in April end and May beginning).

An increase in the number of cases led to fear. Fear led to more investigations. "They would come for testing but still would hide some details regarding their symptoms. Even now people are hiding some details, and provide wrong phone numbers and address. Thankfully, the number of such people is low."

3Ts, Increased Testing And Surveillance, Skipping Names

Doctors at CHC came up with a new initiative to reduce the hiding of correct information from residents. "We would not write their names. Sarkar ke taraf se bhi yeh guideline hai kit (of medicines) sabko do (government has also given the guideline to give the kit to all). But who to give the kits to? We can do that only when the residents come forward.”

So, they told the village that their names are not required. “We even gave them extra kits, to distribute among people known and neighbours. This led to change. Ultimately, iske achche results aane lage (the good result started showing up),” he adds.

After 2 May, which was the culmination of the Panchayat election with the counting of votes, the coming 10-12 days would be difficult. The FLWs were aware of the risks involved with the group of people involved in the process. "People in these groups were tested prior to 2 May. A lot got sorted owing to this step. Those remaining from tests got tested after 2 May. Treatment followed. Lockdown followed."

Meanwhile, FLWs were diverted to the urban areas due to the increase in cases there, as cases in the rural areas were comparatively lesser. This did have an effect on the "one-to-one" surveillance. The "one-to-one" surveillance is back owing to better manpower now, a doctor tells Swarajya.

Door to door investigation, tracing, testing, and medicines for containing positive cases with the help of the nigrani samitis (committee for monitoring) was done. In Covid positive cases, people were isolated, the area barricaded and closed.

Bed availability and oxygen availability were challenges initially. However, the 200 (reportedly increased to 250) bed facility and the centre, which is oxygen support-equipped at Dhansingh Kotwal Mandaliya Parikshan helped in a big way, a doctor told Swarajya.

District Magistrate K Balaji's 7 pm Meeting

Each day at 7 pm, senior front line workers at the Machra block prepare for a crucial event after a long day at work. The event is the 7 pm meeting with district magistrate K Balaji. The fight against Covid has been marked by challenges in this block, owing to its geography and proximity to Meerut urban and other factors.

A senior front line health worker in Machra block Swarajya spoke with was recovering after a challenging Covid experience himself. He attributes the work towards bringing down the numbers to the local FLWs at the village level. The 7 pm meeting with DM Balaji, he points, has been crucial in their fight against Covid, the work to bring down the numbers, and most importantly, to improve. The pointed questions from Balaji, he says, prepare them for more focused action and better execution. What's the takeaway on the ground?

"Positivity has gone low. Initially the antigens used to come positive. Ab antigen positive bahut kam aa rahe hain (now very less positive cases are coming). RTPCRs are coming - where initially there were 10-15 cases coming each day, as of now, they are at two to three," he says.

At 7 pm, it's time to give answers, get the DM's feedback and improve. Here are roughly the areas that health workers are answerable for: contact tracing, home isolation contact sampling -- in case it is low, whether or not they have told the villagers about the "danger sign"; on home isolation attending, medication, and more.

Swarajya spoke to K Balaji over the phone. Why did the 7 pm meeting come up?

He says, "The meeting was organised to begin reviewing the situation. All medical incharges -- community health centres at block head quarters, to help them, block development officers who help the rural health department and panchayat raj department have been deputed, coordination is ensured between them and is looked after by the SDM (Sub Divisional Magistrate)."

Positivity in villages on a daily basis, the work done towards containment, contact tracing of people tested positive, the availability of health teams for all these tasks, distribution of medicine kits, and looking after the monitoring being conducted by the nigrani samiti and their work -- and more areas are reviewed. He adds that from the fourth week of April to second week of May, Sarurpur, Rohta, Machra and Daurala posed a high challenge.

"At one point in time there were 4,600 cases. Today cases have dropped to 1,180 cases. No new village has emerged and the cases are coming down in villages," he says.

Balaji points out that the positive cases were limited to urban-rural pockets and the Meerut Municipal corporation in the first wave. The second wave enabled factors that led to the spread of the infection to rural areas.

He says, "There was a general agreement to one aspect that the virus is spreading fast and could make it to the rural areas. The preparation had to start to fight the spread in rural areas in comparison to urban areas, but they had not faced the spread of such intensity in the past. We had to come up with the a different set of preparations to tackle it."

Balaji points out that there are three agendas before them as of today:

First - vaccination

Second - containment in rural areas

Third - infrastructure development (rural and medical)

Breaking Silos, Linking of Strengths

The timely intervention of the district magistrate towards clipping and linking together human strengths and machinery on the ground has seemingly reaped benefits.

A doctor working at one of the blocks tells Swarajya, "SDMs and BDOs are working neck-to-neck with health department. And they are mobilising people for testing as well as vaccination. Vaccination has improved in the last one week."

With the BDO and SDMs overlooking work, the village residents-level is responding well to the intervention of the FLWs, and to the sanitisation drives being carried out by the safai karamcharis (sanitary workers) and by the village residents themselves.

The sector magistrate at Nyay Panchayat take stock of the situation, and the pradhans are helping their efforts. Mobile teams are working in tandem with the local administration. Helping the pradhans are male village residents over phone calls and groundwork where possible. People are not resisting the entry of FLWs.

Early Detection, Early Treatment

In April and May, door-to-door surveillance was conducted. Once the antigen came positive, it was an indication that the village had an infection. Containment and awareness drive followed.

Nigrani samitis had been activated and provided medicine kits for distribution. If a person developed symptoms, they would contact the nigrani samiti and get medicines. The information would also reach the rapid response teams (RRT). The RRT would then conduct daily consultancy, and they were provided oximeters, and thermometers.

This gave an idea of saturation levels in people, especially in those whose reports were awaited. Hospitals in the rural areas were made L1 plus so that people facing problems relating to oxygen could be shifted there. This helped contain the panic that had emerged for two to three days.

In Daurala's Nagla, Mithepur, Mail, Mawi Meera, where the situation was becoming concerning by April last week and in May first and second week, FLW teams worked proactively, containing and isolating patients barricading mohallas.

Another panchayat representative who also works in the fight against Covid tells Swarajya over the phone: "Several deaths took place in villages in my block. But we worked day and night - on war footing, sanitisation of the villages, isolation of those found positive was carried out." He points out that luckily, mohallas with more population did not see the infection spreading as they remained in their homes. It was comparatively the "better off" people doing more movement at the time when infections increased.

Panchayat and Pradhans - The Powerful Participants

Three days back, new pradhans were sworn in many villages in rural Meerut. This occasion was being looked at with a lot of interest by FLWs at least three levels. Why? For a common goal. The fight against the Chinese virus. Surprising?

The Panchayat poll held in the state during the last week of April was considered one of the factors in the spread of the virus by sections of the media. Though health workers do mention that the event posed a challenge in the fight against the virus and helped it spread, the emergence of new pradhans came as an energetic factor in the fight against the disease and continues to be so, says FLWs at all levels.

Teams are sent for contact sampling. Pradhans inform about cases of fever and areas of suspected cases through word of mouth or videos.

In Rajpura's Ralsana, people themselves, in association with the pradhan, ensured sanitisation of the village. Currently, vaccination is being done at a government school in the village, a resident says.

The rural health department looped in the pradhans in their network and machinery. The pradhans helped and are helping in campaigns for the awareness drive, the vaccination drive in areas with a more significant number of cases. Pradhans are helping in breaking the hesitation for the vaccines and even sharing their own experiences with the vax shot to encourage others.

Pradhan Vir Bahadur is becoming popular owing to his work in Salarpur, a village in rural Meerut. A panchayat representative tells Swarajya over the phone, "Due to his efforts, the village has seen sanitisation with the help of 10-12 workers on a weekly basis around four to five times now. He is an active pradhan when it comes to ensuring the safety of nigrani samitis."

The advantage of working with the pradhans, FLWs at different levels tell Swarajya is when the emotion and influence of the pradhan comes into play.

On the presence of pradhans in the fight against Covid on the ground, FLWs say: “Pradhan's presence does have an impact, people feel ashamed if they are not going for vaccination, not wearing masks or crowding.”

With sector magistrates looking after work at the village level, the pradhans participate in meetings and present solutions and suggestions.

Opening Of Vaccination Slot For 18 years And Above - The Turning Factor

The 3Ts are the basic tools to control Covid. However, a spark of positive change came with the beginning of vaccination slots for young adults.

Two doctors Swarajya spoke to pointed, "When the positive cases were found in the urban areas, owing to to and fro movement of people, infection increased in the rural areas. We increased testing. Those infected were traced and treated, but vaccination for 18 years plus would bring a positive impact in perception of those who belong to the 45 years and above group."

Another doctor explains, "People from this lot move about a lot. The awareness on the risk of getting infected had now increased. When the vaccination for the 18 plus progressed, people in the age group 45 years and above noticed the fervour for getting vaccinated. This turned them towards vaccination."

Nigrani Samitis, The Eyes, Ears, Hands

This author has earlier written on how the nigrani samitis bears the exceptional exercise of 3Ts - tracing, testing and treating on their shoulders.

In village Alampur Buzurg, the nigrani samitis have played a massive role in nipping the virus in the bud stage to a vast extent using the 3T.

A panchayat representative in Rali Chauhan in Rajpura block says, "From survey to report to medicines and communication to more. With medical kit they go to houses - this after repeated surveys and investigations of entire villages," he says. In Gyanpura village, the vaccination drive is made smooth by the local FLWs.

Munadi and Announcements

There is another tool that is being used by the village level administration to increase awareness and raise caution.

Munadi - the verbal tool vital in villages.

Residents who were active during the polls are now helping make announcements in the village, and as a result, he says, there is a good response from 45 years and older people to get vaccinated per day.

The munadi and announcements also help in trashing misinformation and rumours. What misinformation? "Medicines are not ok, they are still on trials etc.".

Concerns Linger

A resident from Janjokhar village said over the phone that the situation has improved after deteriorating around 11 May. However, he pointed out that Aganwadi and ASHA didis should be directed to coordinate more often and in more detail with the pradhan.

A resident pointed that pradhans can also coordinate the number of people to be sent from the village to the block CHC during vaccine availability. "There should be two to four camps in nyaya panchayat if not village to avoid crowds. People are being lazy and afraid of fever after vaccination. Word of mouth will help."

A resident tells Swarajya that Daurala is one block that can do much better in terms of vaccination. The process and availability should become better. "People don't have the means for tackling registrations, the drive can be better organised, and people should have better access to vaccines. If we are informed before hand that the vaccines are to arrive in the village, we can get a munadi done, organise people in groups and batches, and vaccination can get done successfully."

A common suggestion coming from residents and FLWs Swarajya spoke to was to increase the expansion of the vaccination drive in villages with due precautions and arrangements required instead of the block level drives. DM Balaji was informed about the same by Swarajya, and he has said that work is on to enable expansion of the vaccination drive in villages.

Preparations for the third wave has started. CHC and PHCs for Covid patient admission are being worked upon. Each day is marked by the unseen FLW’s continuing fight to defeat the spread of the Chinese virus in rural Meerut.