District Collector Vishnu Venugopal says Indian bureaucracy is like a ‘black box’, but can transform lives. Villagers have named a hamlet after him in gratitude for his work.

SONIYA AGRAWAL 19 May, 2021 1:00 pm IST

Tirunelveli: District Collector Vishnu Venugopal seems to have a looming crisis at hand Sunday, when Tirunelveli only has three tonnes of oxygen left — enough to last till 1 am. But that’s when the 35-year-old IAS officer’s past work as a risk analyst with British insurance giant Aon’s Chicago office comes in handy.

Venugopal’s hands-on live oxygen tracking and dashboarding of the Covid situation has made Tirunelveli the district with the lowest per capita oxygen consumption in the state of Tamil Nadu, even though it has a high Covid case load — as on 18 May the number of active cases in the district was pegged at 6,528.

That’s not to say there aren’t problems — Venugopal spends most evenings devising ways to make the oxygen supply last till replenishments arrive the next day.

On this day, with just four hours left for the oxygen stocks to run out, the civil servant gets on a call with anaesthesiologists deployed in the 920 oxygen bed-capacity Tirunelveli Medical College, the largest Covid facility in the district, to chalk out a plan to last the night.

“We are surviving on an hour-to-hour plan, with limited oxygen and increasing Covid cases. Nights are the most challenging; that is the time when most patient distress calls pop up and the oxygen requirement shoots up,” engineer-turned-IAS officer Venugopal tells ThePrint.

Oxygen optimisation 

The mantra for Venugopal’s model of governance amid the second wave of the Covid-19 pandemic is oxygen use optimisation. To reduce oxygen consumption in the district, the DC has, with the help of doctors, devised a three-pronged strategy.

“A month back, when cases started increasing, we assigned 30 nurses to only monitor the oxygen flow in patients. Our oxygen consumption was high the first two days, after which the nurses figured out the right amount of oxygen flow that should be maintained. Our oxygen consumption has dropped to 5.8 kilo litres a day, and we have maintained it,” Venugopal told ThePrint.

Tirunelveli receives 0.3 kilolitres of oxygen from the Indian Space Research Organisation’s (ISRO) Propulsion Complex located in the district, while the Tamil Nadu Medical Services Corporation supplies varying amounts of liquid oxygen according to availability.

The ‘oxygen’ nurses, working in two shifts between 5 pm and 5 am, monitor its consumption by patients. Their job is to check the pulse oximetry of patients and maintain it to the lowest level required. Since oxygen is addictive when given in any amount, these nurses counsel patients and help recovering patients with demasking — the process of weaning them off oxygen masks.

Dr K. Shantaraman, vice-principal of the Tirunelveli Medical College, explained the optimisation of the oxygen and dynamic pooling of oxygen beds by saying: “The treatment is not about giving patients volume of oxygen, but getting the inflammation down. Oxygen wastage is a common problem that hospitals are facing; we give optimal amounts of oxygen only to patients with 85-90 SPO2 levels.”

He added: “We are using non-rebreather masks for moderately ill patients; this has helped reduce oxygen wastage. Not only this, we have kept the oxygen supply available to all beds. This means non-oxygen beds can anytime be converted into oxygen beds as and when required.”

Additionally, postgraduate students of anaesthesia have been roped in to help with managing Covid patients’ care, and some of them are deployed to keep an eye on the oxygen equipment and its flow. They also keep a check on the patients who need to be taken off oxygen if they have stable SPO2 levels.

IAS officer with a hamlet named after him

Vishnu Venugopal comes from humble origins in Kochi, Kerala — his father, a guard with the railways, passed away when he was in Class 8, and mother Sheela became the sole breadwinner of the family.

The young Venugopal went on to graduate from the National Institute of Technology in Tiruchirappalli, and also has a degree certification in port management from Belgium, and was awarded the prestigious Eisenhower Fellowship in 2019.

He worked as a financial risk analyst for Aon in Chicago in 2009-10, helping clients determine the level of risk involved in making a particular business decision.

Venugopal appeared for the civil service exam because he wanted to be actively involved in the nation-building process, and made it to the IAS in the 2011 batch.

He says while the Indian bureaucracy seems like a mysterious ‘black box’ from the outside, it has the power to transform lives, and he wants to use the reach of the system to bring transparency in governance.

Venugopal was promoted to the post of District Collector only five months back. Before that, he was a sub-collector, and his work was so appreciated that villagers renamed Vakaikulam, a hamlet where 45 families live, to Vishnu Nagar. They said this was their way of showing gratitude for “bringing light to their dark village”, as his initiatives literally brought electricity and water to their homes.

Now, as DC, Venugopal spends his afternoons speaking to doctors in the various blocks of Tirunelveli, having begun his day by inspecting Covid Care Centers and interacting with the public at 8 am. The barrage of calls usually ends at around 2 am, 18 hours later.

Command centre works from home

Unlike other Covid command centres across the country, the one in Tirunelveli stands empty. The person in charge, who did not wish to be named, said: “All our staff is working from home. We have a dashboard using which we communicate and do our tasks.”

Explaining the logic behind the move, the DC said: “These command centres can be potential super spreaders. In order to check that all the work is happening remotely, we have created a robust online system, with the help of which the team functions.”

One side of the dashboard, in Tamil, can be accessed by residents for Covid-related healthcare services. The administration’s side of the dashboard, meanwhile, features details of every Covid patient, downloaded from the ICMR website. The district’s Covid team makes regular calls to patients, and the collector says he listens in to 10 per cent of calls to check quality.

The district also started doing ‘testing swipes’ — camps were set up and a large number of people were tested to unearth Covid cases and prevent further spread. “As soon as we were able to identify the index case (the first documented case, which in this instance was a man working in Thoothukudi) in the month of April, we doubled our testing. Initially, our Covid numbers were very high, but that was because we eliminated Covid cases from the general populace early on with amped up testing,” Venugopal said.

“In order to test more people, we doubled our testing capacity to 2,500 tests a day. Although private testing labs do contribute whatever little they can, the government facility pulls the maximum load. We have created three time slots throughout the day when the RT-PCR machines run at full capacity,” he added.

Safety of Kani tribe

Another challenge facing the IAS officer and his team is the safety of the Kani tribe that lives deep in Tirunelveli’s forests. It is the age-old administrative dilemma — should any kind of intervention be made into an area with no Covid cases, or leave the members of the tribe alone?

“Since they are far removed from civilisation, Covid has not reached them. We want it to remain that way; hence, no physical contact has been made with them,” said Venugopal.

He added that about 15-20 families of the tribe live deep in the forests, and even reaching them requires a 15-kilometre trek deep into unfamiliar parts of the jungles on the coast. Since there have been no cases in the area, he has chosen to not conduct a vaccination drive there.

“If at all they need anything, they reach out for help. All the tribal leaders have my phone number anyway,” Venugopal said.

(Edited by Shreyas Sharma)

Source: How this IAS officer, a former Chicago risk analyst, is making Tirunelveli oxygen-smart (theprint.in)

As India’s fight against COVID-19 continues Harmandeep Singh Boparai, a 34-year-old Indian-American doctor has returned to his motherland and is doing his bit in his home town Amritsar.

As the nation struggles to contain a second wave of the Covid-19 pandemic, this 34-year-old Indian-American Sikh doctor has returned to his roots and is doing his bit in defeating the virus.

Harmandeep Singh Boparai, who was working as frontline worker in New York, Unites States, is currently treating Covid patients in his home town Amritsar.

His next stop will be a 1,000-bed hospital in Mumbai, where he has been roped in by Doctors Without Borders, an international medical humanitarian organisation. He is scheduled to leave for Mumbai on Monday and will serve at the facility for the next couple of weeks.

A specialist in anaesthesiology and critical care, Dr Harman, who did his MBBS in Amritsar Government Medical College before moving to New York in 2011, has also imparted training to many doctors and nurses in the holy city, especially at Dukh Niwaran Hospital, at par with the modalities being used in New York hospitals. He returned to India on April 1 this year.

Harman says he would continue extending his help to all those in need until the situation becomes normal in India. His father, RPS Boparai, is an orthopaedic specialist, while his mother, late Gian Kaur, was a gynaecologist. Harman said his mother, who passed away in 2011, had inculcated the value of sewa (volunteer service) in him during his childhood and young age.

“As soon as I came back to India, though the cases were not so high at the time, I started talking to the doctors here on how we can build capacity in case cases surge, apart from strengthening the infrastructure to handle any kind of crisis. Soon enough, we saw a catastrophic rises in the cases in India. I have been able to build a capacity for intensive care at Dukh Niwaran Hospital, besides imparting training to the nurses and doctors regarding the Covid protocol that I learnt in New York during the first wave,” Harman said.

Dukh Niwaran Hospital, which has now been given on lease, was run by Harman’s father as a charitable hospital.

Sharing his views on India’s Covid situation, he said, “We have not been able to contain the spread of the virus for various reasons here, even though we had time to prepare for the bad waves as were seen across the world earlier. We could have vaccinated many more people so far. But, due to issues in the system, help couldn’t reach many in time.”

He said, “Doctors in the health department, especially in Punjab, have been working so hard in order to save lives. We must continue to support them and give them our best wishes and solidarity, for this is not an easy job.”

He also advocated imposing lockdown to break the chain of transmission.

Source: Indian-American Sikh doctor returns to roots to assist in Covid fight | Hindustan Times

As #indiacovid rages, Dolly Arjun, a physician's assistant in the US, has set up a telehealth service for the lowest Indian caste – the #Dalit (or "untouchables") and others without health access. Now, she treats #COVID19 patients in the US, and helps dozens a day in India. pic.twitter.com/xveyC5c0YD

— Michael Holmes (@holmescnn) May 8, 2021

By Dan Levin

Members of the global Indian diaspora, nearly 17 million, have mobilized from afar to help back home, where the Indian health system is buckling under the weight of a devastating coronavirus wave. Here is one U.S. resident’s story.

The calls come at all hours, sometimes 15 a day, from some of India’s most oppressed and severely ill people, buzzing a cellphone that belongs to Dolly Arjun, an Indian-American physician assistant in Boston.

A few years ago, Ms. Arjun founded a telehealth program to provide free health care to members of India’s Indigenous tribes and to Dalits, who are at the lowest rungs of India’s entrenched caste system and have long faced discrimination. Dalits are typically the last to receive assistance in humanitarian disasters and often live in impoverished rural villages with no hospitals, medical care or schools.

Now, with a devastating wave of coronavirus infections surging across India, Dalits are facing a new peril, Ms. Arjun said. She said she was desperate to help, even though she is emotionally exhausted after a year of working with Covid-19 patients in Massachusetts.

“Tons of people are dying,” Ms. Arjun said. “This is just a human to human need.”

Her focus is not just Hippocratic. She is Dalit herself, a rarity among Indian medical professionals in the United States, most of whom come from upper-caste urban families. “The only reason they might know a Dalit person is because it’s their servant at home,” Ms. Arjun said.

Her telemedicine program has health workers in India who can translate for patients in local languages, but finding medical professionals in the United States to join the effort has not been easy, she said. Still, Ms. Arjun has recruited two physicians.

Patients contact the group through WhatsApp, Facebook and YouTube, and the medical professionals call back on video. Often their first task is to reassure patients who have little understanding of the coronavirus or the appropriate medical treatments, Ms. Arjun said.

“Part of what’s happening now is patients are being told Covid is going to kill you, so they are panicked,” Ms. Arjun said.

She noted that in one Indian state the government has been broadly distributing packets of medications — including 25 days-worth of antibiotics, which cannot treat viruses — to residents, regardless of whether they have tested positive for Covid-19 or show symptoms.

Sometimes, however, the telehealth calls detect life-or-death emergencies. In late April, Ms. Arjun logged onto a WhatsApp video call with a young Dalit man and his 60-year-old father, who was at home with breathing problems in the central Indian state of Madhya Pradesh, where it was around midnight.

“They didn’t know what to do,” she said. “They told us there were no hospitals or oxygen available, and they hadn’t seen a doctor.”

After assessing the man, Ms. Arjun urged the family to check to see whether any hospital beds were available instead of assuming that they were full. “It took a lot of convincing,” she said.

The next day, he was admitted and began to improve, but the hospital was running out of oxygen. Ms. Arjun put out a call on several WhatsApp groups for an oxygen cylinder, though the family did not know the name of the hospital and then fell out of contact.

Days later, she learned that the man had died.

Source: Boston Health Worker Helps India’s Covid Patients Over the Phone – The New York Times (nytimes.com)