A 38-year-old resident of Jaipur was suffering from cough and cold for two days, for which he had taken treatment at a private clinic. A heart disease patient, he complained of chest pain, anxiety and diarrhoea on April 27, 2020. He was rushed to Jaipur’s SMS Hospital but died on the way.
A 65-year-old woman in Kota, with no history of past illnesses, complained of restlessness and difficulty in breathing at 12:30 am on May 23. She was rushed to a hospital but was declared brought dead.
A 17-year-old girl in Ajmer, who had arrived from Bihar to visit the dargah, started having complications on May 6. However, she was taken to a hospital only on May 9, through 108 ambulance service, and was declared brought dead.
In all three cases mentioned above, there was a delay in seeking treatment for Covid-19. So far, of the 402 novel coronavirus deaths in Rajasthan as of Monday, 69 were brought dead to the hospital.
It is to prevent such deaths that the state government had launched ‘Code Safe’, which is an audit of deaths due to the novel coronavirus in the state. The idea being to move from data collection to evidence-based learning. The deaths due to the virus are analysed and changes in the system are made accordingly.
Over a month since its launch, a social audit has been completed of 38 of the 69 deaths of people who were brought dead to the hospitals – there is a three week delay in conducting audit to respect a grieving family’s space. In eight cases, there was delay in deciding to seek treatment, in four, there was delay in getting treatment, five persons died due to suicide, 16 died when there was no delay, while five deaths could not be audited as they belonged to other state, etc. To ensure that health workers are honest about procedural gaps, no health worker are penalised and no punitive action is taken against anyone, health officials say.
Additional Chief Secretary, Health, Rohit Kumar Singh said that a major finding of the audit has been that “people are taking a bit long in deciding to go for treatment. There is no delay in taking them to the hospital, but there is delay in taking them for the treatment.”
Hence, the state government launched a massive awareness drive on June 21. Initially scheduled till June 30, it has now been extended till July 7. Last week, Chief Minister Ashok Gehlot has said, “We are conducting an audit of deaths due to coronavirus so that we can find out the actual cause of deaths, and use this knowledge in preventing coronavirus (deaths).”
As part of the audit, officials identify the level of delay, which may be delay in seeking care: lack of awareness, ignorance, delay in decision making, dependence on beliefs and customs, etc.; delay in reaching health facility: delay in getting transport, delay in mobilising funds, difficult terrain, etc.; or a delay in treatment at health facility.
A crucial part of the audit is community based surveillance and response (CBSR) to identify personal, family or community-based factors which may have contributed to the death. To get the details, a team of three health workers are employed – one to conduct the family’s interview, second for record-keeping while third to coordinate the process.
They conduct what health department officials call a ‘verbal autopsy’ – a comprehensive collection of data surrounding the person’s death. This form, once completed, is handed over to the Block Chief Medical Officer who then eventually submits this form, among others, to the district level officials.
This data is reviewed at district level by District level Committee chaired by Chief Medical and Health Officer and finally, shared with the State Nodal Officer and top state health officials, where the complied data eventually reflects in policy and government campaigns upon perusal.
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