Overseeing healthcare in a pandemic: Auroville’s COVID response

Auroville Today: Aurosugan, What is your background?

I was born in Auroville and I’m part of the third-generation here. I did all my schooling here and completed my undergraduate degree in microbiology, and went on and did an MBA in healthcare administration in Madurai and a diploma in sociology of health. I then did a fellowship in hospital management at Aravind Eye Hospital, and then worked there for ten years, in administration and quality assurance, handling new projects, and focusing on sustainability initiatives. I have travelled to many places, like Nigeria, Tanzania, Kenya and Nepal, to help them build their eye care systems. I also worked on reducing the hospital’s waste and improving environmental sustainability - these eye care initiatives won me a lot of awards and recognition. I’ve published and presented papers on environmental sustainability at various conferences. It was a proud moment to be selected as International Eye Health Hero and to interact with Queen Elizabeth online for World Sight Day last year. I always wanted to come back to Auroville and to contribute to building this community as Mother’s dream, but due to financial constraints it took time, and she knows when to call. It was a hard decision to leave Aravind, because of the opportunities, recognition and inner joy of doing something beautiful. But I felt the time was right now, and I received the call from her grace. I approached Santé and there was a need to take responsibility of COVID health management. By then, the COVID task force team that had handled the first wave had dissolved, and Santé had been given the task of the healthcare coordination, with communications support from the Working Committee. I was given the responsibility of coordinating COVID management, due to my experience in handling this at Aravind Eye Hospital, where I led the COVID safety protocols during the first wave in a facility that sees over 2,500 patients daily. I was ready to take this responsibility - at that time there were no signs of a second wave. I was also asked to look at strengthening the health system in Auroville as part of the coordination work.

What happened when you came on board with Santé?

I started work officially in February, and at that time there were no Corona cases in Auroville. Then there were two cases and, suddenly, a lot of cases appeared. It was a big coordination work, and being new to Auroville and not knowing people made it difficult to handle. The members of the task force volunteered to help with case investigation. We needed to arrange a lot of testing, case investigations, quarantine facilities, and set up a team to do the vital monitoring. My work was to oversee and coordinate all the activities, to update the Block Medical Officer and plan resources.

How many people were in the team?

First, I was helped by Helena from Santé. When the cases spiked, the old team (Induja, Prashant, Shivangi, Tejaswini) stepped up to help with case investigations. The ambulance team -Alok and Srijita and volunteers - helped in monitoring vitals monitoring, and Naren delivered instruments and medicines. The Santé Team (Helena, Sumeet, Ayesha) all came on board to help with medical management. The physician team (Dr Brian, Dr Gayatri, Dr Uma) took care of health monitoring and consultation. The Working Committee (Chali, Sauro) helped with communications and other coordination matters. The team effort helped us overcome the tough situation. A special mention to all volunteers who supported us in all ways.

Was it like a baptism by fire?

Yes, what with being back to Auroville after a big gap and being the sole contact person for this task. The second wave was totally unexpected, and came very fast, and was highly symptomatic. We didn’t have time to think about what to do, the cases kept multiplying. For one and a half months, it was a very difficult time with new cases being reported every day. We handled around 100 people. In this period, I was overwhelmed with messages, calls and emails. There were days when I couldn’t handle more emails in my inbox, and was praying that people would not need to be shifted out [to hospital] for treatment. It was a lot of work to track everybody, do case investigation, to ask people “Who did you meet?”, but it was great to get support. Even the government had not planned for this wave, but the impact in Auroville was less compared to the outside. We were very lucky, by Mother’s grace, to have survived the second wave with minimal hospitalisation and mortalities.

How many Aurovilians were hospitalised?

We were blessed not to have many hospitalisations, as finding hospital beds with oxygen was a nightmare at the peak time. In total, four people were hospitalised and, unfortunately, three passed away - two of them were aged and one had comorbidities. One person recovered in hospital. At that peak time of hospitalisation, my father-in-law got Covid and also passed away, so I was in the hospital with him while the team took care of situation here.

At the peak, was your team running to catch up?

Yes, it was very hard, but there was great team work and we collaborated closely to do our best. We knew the limitations of our health infrastructure to take care of our residents during the peak. We had a lot of meetings to come up with a protocol of how to handle cases: when to transfer patients, when to treat people in-house. We could get equipment such as oxygen cylinders, but it was difficult to find extra resource persons in Auroville, such as a doctor or nurse, because the outside health system was already burdened. The biggest challenge was when we had a few cases in Mahalakshmi old age home. That was scary for us because there were people staying there together, and four of them were diagnosed with Covid. The team there cooperated with us, so we arranged some outside nursing staff, and the doctor gave some treatment. So, we were able to take care of our aged residents there. The challenge is that we don’t have the human resources to take care of our health system. Building a building is easy – we have a lot of buildings in Auroville. Buying equipment is easy, as we can get the funds. But where do we get the people? We needed a medical doctor trained in Covid protocols, and foreign doctors cannot practice here unless they have been registered. In Auroville, we don’t have cases all the time, so how can we recruit people and pay them a high salary? That was a challenge we really faced.

One Aurovilian couple wrote a letter that was published in News and Notes, saying they felt unsupported when they were sick, and the doctor did not answer the phone, and they called the ambulance in the end. What happened there?

They were the initial cases when I had just taken on the job. I was liaising with them but the coordination did not happen well. They wrote a letter, and the Santé team apologised for the incident. Then, we did a lot of changes: we created the protocol for doctors’ availability, delivery of medicines and when to call the ambulance team. So, we had more clarity. But then, people with fever started ringing the ambulance team for every simple thing, so the team was running here and there just to check vitals, and they were also burdened. This all came up because the team was in transition when the second wave started. The second wave was not like the first wave; people had heavy symptoms in the second wave.

You mentioned there was a total of around 100 cases in Auroville – do you think this was the true number, or were there many more who didn’t report themselves to your team?

There could have been a few more [unreported] cases, because some people did not want to deal with the questions and maybe had mild symptoms. But I don’t think the numbers would be much higher: this is a small community, so if some people are not well, the information reaches us. In the first wave, there were only government labs doing testing and Aurovilians were transported there, so all the results were available to the team. In the second wave, a lot of private hospitals and labs started testing, and private home collection of samples started. Some people in Auroville called those testers directly, and didn’t directly inform us of the result. But I’m sure it’s a small percent of people.

We put the names of people in quarantine on a semi-public list. We had a lot of discussion about that, as it’s not general medical ethics to make the health status of a person public. But this being a pandemic, we decided it’s legally right to make the names known to the community. The reason is because sometimes a person didn’t know the next neighbour was in quarantine. And lots of people weren’t taking quarantine seriously. Some felt they shouldn’t be in quarantine. We also respected the request of a few people that their names not be put on the list, so we informed key people who might have any contact with them. However, there were a lot of arguments. People who didn’t want to believe the test result quoted a lot of articles to us. I had a tough time. We cannot impose anything, health is people’s own business. If we advised something, we would have ten positive emails and ten negative emails. But the majority cooperated and didn’t mind having their name on the list. Once we talked with them, they understood how important it is to cut the chain of transmission. We asked them to inform people, and to get tested.

Did people mostly observe quarantine?

Not fully, and this was a worry for our team, as we put in a lot of effort to cut the chain of spread, but some people did not take this seriously. I got a lot of complaints and calls, such as, “We saw a person who is supposed to be in quarantine moving without any safety precautions.” Or, “What are you people doing? There are COVID-positive people walking around, and you’re not taking care.” The Working Committee and friends were asked to advise such people to do the quarantine. That’s another reason why this common quarantine list was semipublic. We can’t police things in Auroville, so we contacted their friends to advise them to stay at home, for the benefit of others. I felt disturbed: “We’re doing all this hard work to prevent the spread, and then people with COVID are just moving around without masks.”

Did you feel caught between different ideologies at times?

The first thing that I was told during the initial handover was that getting along with people would be the difficult task and that everyone is different here. That is the beauty of Auroville– so I was already prepared. A good example is the vaccination. There were a lot of people against vaccinations, saying that Sri Aurobindo said that vaccinations were poison. But another group was saying, “We should bring vaccines here as it is difficult to get vaccinations outside.” The Santé team was clear that vaccinations could not be administered in Auroville due to infrastructure reasons. We felt that people should make their own choice for their health. I had to agree with that, because none of the Auroville facilities at that time met the government requirements to deliver vaccines. But we could have had a vaccination camp here for those who were interested and who could not travel. As it is, we don’t know how many Aurovilians got vaccinated, and we don’t have good data on health or a common health database in Auroville. It would be useful for the future.

Another thing: when we would release an email about new cases in the community, we’d get ten emails from people saying, “This virus is not serious, you’re trying to create fear.” So, we decided to go by the local government regulations and to focus on how to best give health care, whether the email was negative or positive. Everyone is right in their own way. We forwarded the negative emails to the Mother’s grace – ‘I’m sorry Mother, I don’t have time to take care of this! You take care of this! I’ll take care of what we can do best!’

Were there any cultural tendencies in attitudes towards the pandemic?

Like in all fields, there were cultural differences. Westerners tend to ask more questions and look up literature and share it. There was also a difference in opinion about vaccines, because even different governments had different approaches, and it was not clear whether other countries would recognise this vaccine when people travelled abroad. In Indian culture, we are used to listening to what healthcare professionals say; we don’t ask many questions. But people received a lot of misinformation on WhatsApp and social media, and these messages spread fast. There was big hype that people had bad reactions to vaccinations. [One Tamil movie star died after vaccination, attributed to heart attack, eds]. That really affected [attitudes]. My parents didn’t want to take the vaccine after that. It’s new, in trial and people don’t know what to do. Now it’s said that children will be affected in the third wave. So, I hear more people are getting vaccinated now, because they are concerned for their children.

Did Auroville do OK overall, compared to other places in India?

It was Mother’s grace that saved us, because we were not well-equipped to handle such a pandemic. Maybe our environment with good oxygen and health monitoring saved us. We were fortunate to escape with minimal damage considering what was happening outside. The medical team did well with our limited resources. We had some good tracking systems and gave out monitoring equipment to all cases and kept tracking them continuously through their quarantine.

Do you think there will be a third wave? What is your plan?

I see there’s a possibility of the third wave, but I don’t know what impact it will have. Some of our volunteer team members have stepped down after the second wave, they have other work to focus on. I had a meeting at Santé about what will we do if there’s a third wave. We now have Standard Operating Procedures, and more understanding about when to shift patients to a hospital. There will be always support when the need arises - I am confident about that. L