Jaipur: With swine flu cases on the rise, the Rajasthan government on Monday launched a five-day door-to-door screening drive to identify patients with symptoms of an influenza-like illness.
The aim is to test them for swine flu and contain the spread of the disease – but the manner in which the screening is being conducted could have the opposite affect.
First- and second-year students of BSc nursing courses in government and private colleges, along with some health workers, are involved in conducting the screenings. The students were also made a part of the Zika screening that lasted for approximately one month in October last year.
The health department called for a meeting with college heads, after which colleges were assigned to a primary heath centre (PHC) for further allocating them a certain area. Depending upon the number of students committed to be deployed by the college, their teachers were made tutors after a two-day training at the health department, so they could supervise students during the door-to-door campaign.
No safety gear
Swine flu is a highly contagious disease which can spread through human contact, in the form of direct or indirect touch. However, the screening teams are not being adequately protected.
Nursing students The Wire spoke to were wearing masks that had already been used the previous day, and the health workers were wrapping their faces in cotton scarves. Even in photographs sent on the official WhatsApp group of the health department for journalists, teams were seen without masks or safety gear.
Masks contain filters that prevent germs and pollutants from being spread. For hygiene reasons, masks should be worn for a maximum of eight hours and changed regularly to sustain its effect.
Even masks aren’t the foolproof way of protecting oneself against the spread of swine flu. According to the Centers for Disease Control and Prevention’s H1N1 flu advisory, “Face masks help stop droplets from being spread by the person wearing them. They also keep splashes or sprays from reaching the mouth and nose of the person wearing them. They are not designed to protect against breathing in the very small particle aerosols that may contain viruses.”
An unwelcome test
Apart from the risk of infection in the absence of safety gear, there are challenges that the teams have to face on the ground.
Neha* (18) talked about how she is not let into several houses if she mentions the swine flu survey. “Many households we go to believe that we are spreading swine flu and merely talking to us would infect them. So they don’t let us in. Forget listening to what we have to say, they treat us as if we are forcefully selling them something.”
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The nursing students are not incentivised to conduct these surveys, with no certification or stipend from the health department.
“When we conduct surveys during polio campaigns, we are still paid Rs 300 and given certificates, but nothing is given during swine flu or Zika screening. We are at risk on the field, but even something as small as a clean, useable mask is not provided,” said Rajni* (19), a first-year BSc student from a private nursing college in Jaipur.
The students and health workers gather in public parks near the PHC at 9 am every day, from where they are divided into teams and given Tamiflu, an anti-viral medicine dissolved in water in plastic bottles to put into every water tank, sewer line and accumulated water body they see.
The tutors tell them to write the name, age, address and mobile number of every child below five years of age or pregnant women, irrespective of whether they have a cough or cold, for each household they visit.
For people suffering from a cough and cold, they have a separate form in which they mark symptoms against a list. Depending on that, the PHC calls the patients to take a swine flu test.
The tutors say that no training was provided for swine flu screening this time. “There was no training session for us by the health department. All we have is the order to deploy 60 nursing students in three different areas of the city, with three teachers and five auxiliary nurse midwives. The students are listing people suffering from a cough and cold. The health department calls them and asks to test for swine flu,” said Khushi*, a tutor from a private nursing college.
As per the state health department, 6,117 tests were conducted within the first 22 days of January this year, out of which 1,414 samples were tested positive for swine flu. Fifty-four deaths have been reported in the state so far, with the maximum number (20) in Jodhpur.
Speaking to The Wire, Ravi Prakash Mathur, additional director, rural health at the state department of health and family welfare, said, “The students are included as part of the ‘swasthya karyakarta aapke dwar’ campaign, where they are being utilised as health workers. This campaign began last year and nursing students were deployed during the Zika outbreak too. The campaign is just about counselling, and not screening as such.”
On being asked what arrangements were made for the safety of students and health workers on the field, he said, “Surgical masks are being provided to the teams by the PHC.”
*Names have been changed to protect identity.
All images by Shruti Jain.