COVID-19 effects on urban health

The Daily Star in association with CARE Bangladesh organised an online discussion titled "COVID-19 effects on urban health" on May 20, 2020. Here we publish a summary of the discussion.

Muhammad Zahidul Islam, Senior Business Correspondent, The Daily Star and the Moderator of the session

In this discussion, we will try to determine where the urban health situation of Bangladesh currently stands in terms of the COVID-19 situation. We will refer to a rapid assessment on urban health situation in Gazipur, conducted by CARE Bangladesh.

Prabodh Devkota, Deputy Country Director – Programme, CARE Bangladesh

COVID-19 has adversely affected our health system as well as our socio-economic development. Given the evolving nature of the pandemic, the humanitarian and developmental organisations, private sectors, and the government must come together for collective action. CARE Bangladesh's health team has conducted a study in Gazipur assess the challenges and issues surrounding urban health systems in the context of the current pandemic. The study sheds light on the critical challenges in the context of urban health with a particular focus on women. It also highlights the immediate and mid-term needs which will be essential for recovery in the long run.

Dr Md Jahirul Alam Azad, Head of Urban Health, CARE Bangladesh

Compared to February, Expanded Programme on Immunisation (EPI) performances have dropped by ten percent in March. If EPI is hampered, there is a possibility for communicable diseases to increase among children, which was revealed in the rapid assessment conducted in Gazipur. There has been an overall reduction in maternal and childcare services which can lead to morbidity and mortality rates rising. We have also observed a 50 percent decrease in the number of patients in upazila health complexes; instead, patient flow has increased in the community clinics, family welfare centres, and union sub-centresin Gazipur.

41 percent of the participants were found to be aware of the key symptoms of COVID-19 and 11 percent were found to be aware of the main modes of transmission. However, due to their housing conditions, low-income groups are facing difficulties to stay at home.

Most daily wage earners have lost their jobs. The reduction in family income has caused a decrease in their daily dietary intake. Women and girls are also facing shortages of sanitary napkins in the markets or are unable to afford them now. 100 percent of the female respondents also mentioned increased mental pressure due to reduced income.

Though our report shows 80 percent of the respondents did not get any relief, this percentage has reduced recently since there are now many individual relief distribution initiatives in different communities besides government initiatives. Home delivery services and distribution close to the affected communities can help reduce the spread of the virus.

Meeting the supply and demand for personal protective gears and ensuring consistent service in the service sector with a shortage of human resources have proven challenging. Healthcare costs may rise soon since those with non-communicable diseases need routine check-ups, but patients are unable to obtain them smoothly.

One positive aspect is that hospitals will be better equipped with ICUs and other crisis management facilities, which will help Bangladesh's healthcare system in the future.

Dr Dipak Kumar Mitra, Chairman, Public Health Department, North South University

Public health is a multi-sectoral area where everyone has a scope to contribute. We have to work in levels here, including individual, family, community, national and global levels.

As long as we do not have a vaccine or proper medicines against the virus, we have to rely on our behavioural changes to protect ourselves. Scientific evidence is available in other countries, but we need to customise it by engaging all the sectors. We need to undertake preventative measures and build up the capacities of our hospitals.

The mindset that only doctors will help us when we fall sick is wrong. Majority of the public health work and preventative measures must be undertaken at individual and community levels. We must normalise taking care of our mental health besides public health to deal with other diseases and crises in a better manner.

Shovon Islam, Managing Director, Crown Wears (Pvt) Ltd.

BGMEA, Better Work Bangladesh, ILO and the health ministry have helped us prepare safety guidelines by implementing which, we have resumed work in our garment factories. We did regular follow-ups on our workers and asked them to stay in home quarantine for at least 10 days, when the factories had reopened.

The working-class people involved here are in a vulnerable situation, harbouring a constant fear of losing their jobs. Consequently, they are unable to grasp the idea of home quarantine fully and require constant reassurance that they will not lose their jobs and obtain their salaries as well. Moreover, some labour unions and journalists constantly instigate them. Therefore, we must all act together and not instigate each other.

Farid Ahmed Shariff, Secretary General, Ward 37, Ward Health Development Committee

The number of doctors and nurses, compared to the huge population in this country, is very low. Moreover, many of these doctors and nurses are being attacked for treating COVID-19 patients. Our mayor, Jahangir Alam, has done a remarkable job of providing adequate PPEs to the doctors and nurses in our hospital in Gazipur.

Parvin Akter, Vice President, Kunia Community Support Group

We have been implementing and raising awareness on safety measures such as washing hands properly, even before the coronavirus crisis. We have volunteer teams ready and we also go door-to-door to raise awareness about hygiene among mothers and children, particularly pregnant women. So far, we have not found any coronavirus patient in our group.

Akhi Akter, Member, Ward 12, Community Support Group

We need to work on women's issues. Besides, violence against women has increased recently so, we need to tackle this.

Nusrat Amin, General Secretary, Kunia, Ward 37, Community Support Group

The supply of women's sanitation products has stopped during this coronavirus crisis. Besides, the women health workers, including Family Welfare Assistants (FWAs), field level workers, are also suffering due to a lack of proper distribution of sanitation products, pills, etc. The worsening economic crisis is also giving rise to family tensions, gap in children's EPI, food shortages, etc.

Abbas Uddin Khokon, Councillor, Ward 12, Gazipur City Corporation

We have mobilised our ward volunteer force in every neighbourhood to raise awareness about the pandemic and ensure people are following the health safety guidelines.

As per the instructions of the mayor of Gazipur City Corporation, handwashing stations have been installed throughout the entire ward. Liquid hand soap is refilled at the stations daily.

We have distributed relief to the impoverished dwellers of the ward through the local relief committee. A control room has been established in the ward, which is run by the Gazipur City Corporation volunteer force. Any resident facing food shortages can contact the control room, and volunteers will provide them with sustenance. The volunteers are also spraying disinfectant on the streets of the ward.

Dr Md Khairuzzaman, Civil Surgeon, Gazipur

Around 106 health workers, including doctors, nurses, health assistants (HAs), and family planning representatives, have been affected by the pandemic in Gazipur. We are compensating for this by appointing 25 doctors from the 39th BCS.

We have a control room, and the contact numbers of doctors have been made available to the public. A large number of people are availing these telemedicine services.

The number of COVID-19 positive cases in Gazipur soared after garment factories were reopened. The health sector must be informed if any worker shows COVID-19 symptoms. Many factory owners are asking us to carry out sample collections far away from the factories. These factories must cooperate with the health sector.

Dr Md Muhiuddin Osmani, Joint Chief-Planning, Ministry of Health and Family Welfare

Due to COVID-19 being a new and unfamiliar virus, it was more challenging to protect against infection during the first few months. Hence, the number of positive cases among health workers was quite high. Hopefully, the numbers will decrease as better safety measures are now available.

The government has been taking the right measures to tackle the pandemic, such as raising awareness among people, increasing testing by establishing 40 times the number of labs we previously had, and multiplying the number of PCR labs. Soon, all medical college hospitals at the district level will have suitable PCR labs.

Telemedicine and teleconsultations have become vital now since they are easy to use by both doctors and patients.

Md Abdul Hakim Majumder, Additional Secretary, Ministry of Local Government, Rural Development and Co-operatives (MOGRD&Co) and Project Director, Urban Primary Health Care Project

Public and private clinics have not been meeting the demands of people in providing treatment. Adequate PPEs are now available for the doctors; hence there should be no fear in providing medical services. A monitoring system must be set up to ensure patients are not denied treatment.

The RMG sector should establish isolation centres where COVID-19 infected workers can avail treatment.

Ward committees must be reformed and strengthened. Multi-level volunteer groups can be linked with these committees.

Central points are required, based on wards, where the public can gain primary information about health services related to COVID-19.

A national database of COVID-19 infected people and a database of public and private health clinics in Bangladesh need to be developed.

Advocate Jahangir Alam, Mayor, Gazipur City Corporation

If garment factories had remained closed for 15 to 21 days, the situation would have been better now. All garment factory owners should instruct workers daily about the safety guidelines: how to wear masks properly, how to enter and exit factories, how to maintain social distancing within workplaces, etc.

Public health complexes have proven useful, but their numbers are limited compared to our large population. Doctors and civil surgeons should inform us of what health information to disseminate among the people of all wards.

We must maintain a complete lockdown for 10 to 15 days, enforced by the police and military, and ensure nobody leaves their homes. If anyone exhibits symptoms, they can be tested at their homes. These measures could lead to the eradication of COVID-19 from Gazipur.

Dr Ikhtiar Uddin Khandaker, Director-Health Programme, CARE Bangladesh

Everyone's participation today proves that people are enthusiastic about finding ways to tackle the current situation at a national level. Both the public and private spheres must work together to help us recover from the significant challenges we are facing today due to the pandemic. I thank all participants for their time and productive contributions in the discussion.