COVID-19 Response: Work with the elderly population

HOW COVID – 19 CHANGED THE DAY TO DAY WORK
It was around 17th-18th March that the offices around started closing down and the house- maids, drivers, gardeners and others residing in the slum were asked to stop coming for work in respective households they were providing their help. As the momentum of COVID-19 pandemic was building up in Pune, one of the messages that started spreading across was related to – COVID-19 disease is all about deaths of older people, and the entire project team was faced with a challenge of making the families aware that it is time that we look after each one of us in the family and specifically protect our elderly, and that we can do this with simple practices of social distancing, hand-washing and hygiene,
wearing of face-covers and also keeping ourselves healthy.

OUR EFFORTS IN RESPONSE TO THE PANDEMIC
Between 17th and 24th March we realized that we will need to work out a strategy to reach out to our elderly and their families in the best possible way to address the day to day challenges they will face during this situation. From 25th March, onwards the team started working in the following manner. Since the situation compelled us to think beyond normal measures, we devised a comprehensive, community-based emergency response plan with a focus to protect vulnerable older adults in these
times of lock-down.

This process entailed:

  • Creating first responders/peers of elderly through our community workers that reside in slums
  • Training these peers on meeting the unique needs of vulnerable elders
  • Creating back-up service providers for tele-health (both counselling and consultations)
  • Creating a system for listing and providing basic supplies: raw ration, hygiene products for standard precaution, medicines, multi-vitamins, adult-diapers and other life sustaining items Creating an individual care plan based on ‘Saving Life Checklist’ for elderly with chronic illnesses

Interventions we defined and started implementing for 602 older people in the slums:

ince the lockdown started, the elderly in the slums were facing problems with regard to arranging for their daily needs and food, this almost started affecting their daily survival. Thus, the very first step was supporting them with the basics, especially ration and medicines as they are habituated with
storing minimal requirements at any given time due to the hand to mouth existence they have.

Raw Ration Kits:

We started distributing raw ration kits to each elderly, which comprised of 2 Kg Rice, 3 Kg Wheat Flour, 1 Kg Moong Dal and 1 Kg/liter Surya Soyabean Oil. All the ration was bought from the local shop in the community, as the shop-keepers outside were not willing to deliver due to lack of transportation facilities.

Personal hygiene kits:

Personal hygiene and messaging on the same continues to be the top-most priority. We extended the hygiene kits to all the elderly members which comprised: 2 soaps of 125 gms each; tooth-paste – 2 packs of 50 gms each; and sanitizers – 200 ml bottle for each. Diapers were also provided to certain elderly in need, especially the ones who are bedridden, these were 1620 in number for 27 elderly members for them to use average diapers per 2 per day for a duration of 30 days.

Face-covers:

We purchased cloth to make face- covers, this helped us in providing an opportunity to the women of the community to make the face-covers, wherein they could earn making charges of Rs. 5 per face cover.

We could actually extend 2 face-covers for each elderly in the amount of 1 face cover that we could have purchased from outside. While we work constantly thinking of helping the community with some kind of livelihood opportunity, this work came in as a blessing in disguise where we were able to think through that why should be not help and train our community women in making face covers and pay them for cutting and stitching the masks.
This proved to be a very fulfilling experience of the women who were doing the tasks and it helped us in rolling out this small but meaningful livelihood initiative for the community during this lockdown period.

Essential medicines:

The essential medicines we extended to the elderly comprised of analgesics, anti-hypertensives, anti- glycemic, calcium and multivitamins.

During the pandemic, Hydroxychloroquine was very important to get hands on, but with the suggestions of our tele-health doctors from Yashwant Hospital, Raipur, we did not give it to the elderly as it was not yet tried and tested. Unfortunately, we could not procure Vitamin D due to the
scarcity in the market, because of its immense demand during this time.

Tele-health support:

Tele-health counselling and consultation support comprised medical advice for chronic health conditions, physiotherapy for pain and walking difficulties and counselling for mental wellbeing of elderlies. The tie-up established with Yashwant Hospital, Raipur in the month of April proved to be very fruitful for our community workers and the elderly to understand different aspects of their problems in detail, which they were not informed of before.

Some of the examples of our elderly who received this help are:

Bhikanbai Rajendra Jawale, aged 65, residing in Kasturba Vasahat has high Blood Pressure, Diabeties and Hypothyroidism, before the pandemic she was working as a housemaid and she had to stop going for work due to the pandemic. A support in the form of raw-ration, hygiene products and tele-health specifically made her life easy and she could sail through this difficult time successfully.

OUTCOME OF OUR INITIATIVES
We have been able to reach out to a total number of 602 elderlies which reside in both the slums. (a list of beneficiaries is attached).

The successful outcome of this support comprised:

  • Basic support through the supply of raw-ration and hygiene products
  • Ease and mental well-being of the elderly with the help of tele-health counselling and consultation services
  • Physical well-being through essential medicines, multi-vitamins and diapers.

Testimonials –

1.”We heard of help that will come from the government and we kept on waiting, you gave us all the supplies at the right time.” – Gorakh Dada Giakwad, aged 63.

2.”It is God’s grace that you all are working with us and look after us.” – Shamsuddin Kasim Shaikh, aged 72.

3.”This is the greatest service you have done, both ration and medicines at a time when we did not have a single paisa in our pocket.” – Kanta Joma Waghmare, aged 70.

Response in 40 slums in partnership with Pune Municipal Corporation and WHO

SCHOOL’s work and efforts regarding provision of comprehensive support to the elderly in 2 slums through its ‘Healthy Ageing’ initiative was presented to the Municipal Commissioner, Pune Municipal Corporation (PMC) and the health team of PMC on 20 th April. The PMC appreciated the efforts, endorsed and invited SCHOOL to expand and extend the same efforts in all the slums of Pune city. PMC also request WHO to support SCHOOL in undertaking micro-planning for reaching out to more slums.

Accordingly, from 1 st of May, SCHOOL in collaboration with PMC and WHO has initiated this work in 40 slums of Pune city and is reaching overall 2 lakh population and 20000 elderly people with chronic illnesses

Activities undertaken so far:

  1. Review the existing data to understand the possibility of using the same for micro-planning and prioritizing the clusters for implementation.
  2. Identifying of 5 field NGOs and signing of MOUs with them for each slum cluster
  3. Inaugural meeting and orientation of all staff and the field NGOs regarding the work to be undertaken in 40 slums  A structured orientation meeting was held on 3rd June to orient all the stakeholders involved in the project including the senior management members of 5 field organizations that have been identified and engaged for providing community level support in 40 slums. overview, information and guidance was provided by Dr. Kalpana Baliwant (on behalf of Dr. Hankare) Dr. Atreyi Ganguli from WHO
    Country Office, Dr. Rahul Shimpi from WHO-Central region office and Dr. Chetan Khade from WHO- Maharashtra office. 
  4. Revisiting the micro-plan based on the inputs from the field staff
    A micro-plan with number of slums to be covered in each slum cluster, from the identified 8 slums clusters, the number of households and projected number of elderly people has been developed, this is
    now being revisited by the community staff to ensure the exact numbers, so that when we go into the field, we will have a clear pathway and will also have a clear guidance from Dr. Chetan from WHO on the micro-plan. 
  5. Initiating on-line training of the field staff that will work at the community level A training plan with the guidance of Dr. Baliwant and Dr. Atryei Ganguli comprising 5 different training modules for the field staff has been devised. Accordingly, all 5 modules have been extended to the community staff through an online training platform between 15 th and 23 rd June on alternate days.
  6. Putting together a plan for field work starting from 1st July after the completion of all 5 modules, a field work plan has been developed with the field staff members, with clarity on including or avoiding specific slums based on the designated COVID-19 zones they are right now into. A field movement plan starting from 1st July has been finalized.
  7. A plan for surveying and identifying elderly with co-morbid conditions is being initiated in all the wards of PMC, this will be jointly done by project community staff and the frontline staff of PMC.
  8. Out of 40 slums, the field work has begun in 10 slums, with an initial reach to a population of 50000 in the first quarter.