"It’s not the patient’s fault that they got infected. Attacking them and the doctors and nurses who treat them is like committing a sin. After all, we are all human, and it’s our collective responsibility to offer assistance."
The first two COVID-19 positive cases in Ladakh were reported on 7 March 2020. Both patients had recently returned from their pilgrimage in Iran, a country devastated by the epidemic.
Instead of taking her scheduled night off that day, Tsering Yangzom Skurbuchan (35), a senior nurse at the Sonam Norboo Memorial Hospital in Leh, volunteered to look after the patients alongside trainee nurse Angmo Likir (27), who at the time was on duty.
“Angmo and I decided that we would take care of their needs since their family members couldn’t help. One patient was a 65-year-old man, who has since been discharged, while the other is a 75-year-old man, who is still under close observation at a quarantine facility,” says Yangzom, speaking to The Better India.
Despite this show of courage, their respective families initially expressed their sense of fear and trepidation.
“When I volunteered to care for the patients, my family members weren’t pleased, and asked me why should I be there with these patients carrying a very serious disease. But, we took all the necessary precautions, like wearing personal protective equipment (PPE). It was our duty to look after them and give them the best care possible,” she recalls.
Covering themselves from head to toe to ensure there was no possibility of getting exposed or infecting others, they went inside the isolation ward, gave them food, oxygen, and medication from time to time.
They would also regularly check their blood pressure and keep a close eye on their physical condition. After leaving their isolation ward, they would dispose of all the materials brought from inside the room properly. Only after washing their hands properly would they return to their separate adjoining room.
“We haven’t seen our families since 7 March. I have a five-year-old daughter who I haven’t seen in more than a month. We were with our patients till 30 March, following which we have been kept under quarantine. This will go on for 14 days till 13 April, following which we will resume our duties whether it’s looking after COVID-19 positive patients or general ward duties,” says Yangzom.
“I am a government employee, and it is part of my duty to take care of these patients. But Angmo is just a volunteer. She is a nursing student who has just finished her course. She did not have to be there with me but chose to work nonetheless. Our only purpose was to ensure the containment of the virus and that it does not spread outside,” she adds.
Their courage in stepping up to the plate came from their enhanced knowledge of the virus. They had read about it extensively from relevant sources online.
“Although dangerous, the COVID-19 virus is not airborne, and we knew that if we protected ourselves at all times, nothing would happen to us. Dr Thinles, our physician, would regularly come for his rounds and check on the patients without any fear,” she says.
Yangzom and Angmo are only representative of the remarkable work Ladakh’s medical fraternity has done to manage the epidemic.
From doctors, nurses, medical administrators and even cleaners who have worked long 12-hour shifts to sanitise isolation wards, this has been a collaborative effort.
‘When Being Negative is the Best News’
— All India Radio News (@airnewsalerts) April 4, 2020
There have been other key players as well. For example, Rigzin Samphel, a 2003-batch Indian Administrative Service (IAS) officer, has received a lot of praise for his handling of the epidemic.
Under his leadership, some residents believe that the administration has left no stone unturned in this hour of crisis. What’s been particularly impressive are his regular briefings to the media where he takes all sorts of questions from journalists and in his characteristic calm demeanour, delivering information with real clarity.
Out of 14 patients who had first tested positive for COVID-19, 11 have recovered. In other words, more than 78% of the patients have recovered so far. So far, nearly 600 samples have been collected for testing.
“They are recovering well. After two negative tests, patients have the choice to go back home and rejoin the community or stay a few more days in our facility and help them maintain their nutrition levels. As you may know, one person from Kargil district had recently tested positive. After tracing the said person’s contacts we have sent a further 100 samples today,” says Commissioner Secretary (Health), Ladakh, Rigzin Samphel, speaking to the press, on 7 April.
He went on to add that around 200 pilgrims from Ladakh have come back from Iran and are under quarantine in different parts of the country. For those still stuck in Iran, the Ministry of External Affairs and Ministry of Health are working closely to bring them back to India.
“When it comes to essential commodities, our biggest stress is on vegetables. Through Zoji-la, we are also in a moderate way bringing in cooking oil, LPG gas and petrol. In the local market, we have been told there is a shortage of milk and butter. We have raised this with the necessary authorities, and I am confident these shortages will be addressed very soon,” said Samphel, in another recent address.
Managing the Epidemic
For weeks, the roads in Gongma village of Leh district have worn a deserted look. Alongside the neighbouring hamlet of Yokma in the Chuchot area of Leh district, it is the epicentre of COVID-19 positive cases in Ladakh. Gongma, which is 18 km away from Leh, was put under containment on 8 March, the day after Ladakh reported its first two COVID-19 positive cases.
On 17 March, the neighbouring hamlet of Yokma was also put under containment. Of the 11 cases from Leh district, 10 were from the hamlets of Gongma and Yokma.
Soon after the first case was detected in Ladakh, the administration took proactive measures to contain it and prepare for the outbreak. These measures gave them enough time to put other actions in order, from spreading awareness to mobilising communities and pushing the capabilities of local healthcare facilities.
“After 17 March, Ladakh only saw one positive case in the Kargil district and were well prepared for it. For example, we started screening passengers from the airport from 31 January onwards. Thus far, we have screened more than 30,000 passengers. We have a database, based on which we could work on tracking potential contacts of those with travel history and who had tested positive. Everyone with a history of foreign travel was being tracked from that day onwards, and all positive cases were shifted to the main SNM Hospital here. In the field, our team of health workers, including Anganwadi and ASHA workers, were conducting house-to-house surveys armed with the database of how many people had travelled outside Ladakh and outside the country, and so far have done an efficient job,” says Dr Motup Dorjay, the Chief Medical Officer of Leh District.
As mentioned earlier, patients who tested positive for COVID-19 in Ladakh, predominantly came from one village with a travel history extending to Iran.
“We got them immediately admitted, traced their family and contacts, quarantined them, and that’s how we managed to catch positive cases early. As soon as positive cases were detected in Chuchot Gongma village, it was put under complete lockdown. That’s how the infection was controlled. If you take the ratio of the number of samples taken and population, we must be among the highest in the country,” says Dr Dorjay.
What has also helped authorities is the region’s low population density and geography, along with real cooperation from the people.
Initially, there was some difficulty in helping residents understand why their village was under lockdown and why social distancing must be practised, but they soon realised that these steps were being taken for their safety.
“Nobody is leaving the containment area. Those who went outside are not allowed to return until the epidemic fully subsides. They are living with their relatives outside,” says Abdul Qader, the headman of Yokma hamlet.
NGO’s like the Ladakh Heart Foundation and Mahabodhi Karuna Charitable Foundation have also stepped up to donate their medical facilities. The administration has taken over both these hospitals using their facilities to quarantine suspected patients.
“Our doctors and nurses have adequate PPEs not just in SNM Hospital, but also connected arms of the administration. For the time being, we have enough, but we have ordered thousands more that should reach us anytime soon,” says Dr Dorjay.
However, it’s impossible to discount the role the police have played in keeping people restricted to their homes to prevent the spread of the epidemic, particularly in Gongma and Yokma. They have also played an important role in screening and gathering information of passengers coming into Ladakh. Some personnel have even volunteered their efforts to feed the hungry.
Delivering Essentials & Aiding Migrant Workers
Following the nationwide lockdown, the local administration set up helplines where residents can call for the delivery of essentials, including medicines so that they don’t unnecessarily step out of their homes. To ensure the hospitals aren’t further overburdened, only those with emergency conditions were brought to hospitals.
The Chemists Association of Leh, for example, has extended its services for home delivery of medicines. From delivering a single strip of medicine to flying in urgent medication from Delhi—they have done it all.
For residents living far away from Leh, the district administration steps in to deliver them but is also working to strengthen this system for people with chronic conditions that require regular medication.
Attempts are also being made to set up a systematic delivery of LPG cylinders. Until 29 March, the administration delivered over 150 cylinders to far-flung places in the district.
For food, rations, and other eating essentials, the administration has designated a few shops for home delivery services in each area.
Residents can send their requirements via WhatsApp, although the availability of certain products is limited because of shortages in essentials. They take orders from 10 am to 4 pm and deliver products later in the evening. So far, they have conducted more than 400 deliveries in and around Leh.
Local vegetables like potato, radish, available with residents are being delivered. As the roads to Ladakh are still closed due to the winter season, they’ve managed to not only fly in essentials regularly but also strengthen the network of local farmers to supply to the people.
“During this time of the year, there are shortages of essential commodities since the roads haven’t been opened yet. Last year, the shortage was even worse because roads had opened only by the end of April. The difference this time is more people are indoors, and therefore consumption is higher. In contrast, earlier they would be travelling or working elsewhere,” says a district official, on conditions of anonymity.
It’s the same situation in Kargil. Although locals are working closely to help each other, in most far-flung areas, people are facing acute shortage of essentials.
“The market is almost empty here. In most villages of Kargil district, they have closed their roads for outsiders and are not allowing people to visit. The government is trying to help, but it’s been four months since the roads closed, and the market is running low on supplies. They need to open the road via the Zoji-La pass, allow trucks to carry essential commodities and they should ensure availability of essential items in Kargil, Leh and far-flung areas,” says Sajjad Kargili, a local social and political activist.
Despite the shortages, people of different religious communities have come together in this challenging time. As Althaf Lankoree, a Kargil resident, says, “Despite the ideological differences, people of different faiths are helping and serving others. Together, we will definitely win this battle against COVID-19.”
Meanwhile, for the thousands of migrant workers in the region, particularly from Bihar and Nepal, the district administration is delivering rations on a war footing.
Before delivering rations, however, the administration directed the village patwari (land records officer), ration storekeeper and the designated cooperative department official to conduct a comprehensive survey to gauge the number of migrant workers in the region.
“Most migrant labourers in our district do have accommodation either on rent or living quarters given by their employers. We had issued a prior warning to landlords and house owners not to evict them and take rent. Without work, they didn’t have enough money to buy food or rations. Under Additional District Development Commissioner Moses Kunzang, we established response teams to ensure basic rations reach them,” Jigmet Namgyal, the nodal officer overseeing labour issues and essential services in Leh district during the epidemic.
“However, many of these labourers were not registered with the district administration, so we went ahead and completed the exercise to have a clearer idea of those we can help in the future. After proper verification, they are registered by the administration. Once the labour department registers them, we give them their rations. We have also had the local village headman overseeing affairs and followed this process all over Ladakh. With assistance from the medical community, we also told them to wash their hands regularly, issued guidelines on practising social distancing and taking all necessary precautions, and offered counselling as well,” says Jigmet.
Thus far, they have extended rations—2.5 kg rice, 1.5-litre cooking oil, 2.5 kg dal, salt and atta—to over 11,000 migrant workers.
Meanwhile, residents who want to volunteer their efforts can fill up this Google Spreadsheet issued towards the end of March. Thus far, the administration has received responses from more than 100 people and organisations, while they coordinate efforts on the ground.
Compassion over everything
Despite all these positive developments, what remains a concern is the hostility some residents are exhibiting to patients and doctors during this pandemic.
While this is not unique to Ladakh, the two nurses and first responders in Ladakh’s battle against COVID-19 have a message that all of us should pay heed to.
“People should never maintain such negative attitudes against doctors and patients. It’s not the patient’s fault that they got infected. Attacking them and the doctors and nurses who treat them is like committing a sin. After all, we are all human, and it’s our collective responsibility to offer assistance. When we cared for our first two patients, at no point did we let them feel any stigma for their condition. Instead, what we did was minimise their anxieties, engage in regular small talk, offer words of comfort and keep them in good spirits. Even today, they regularly call us. This is how we should treat people,” says Nurse Yangzom.
(Edited by Gayatri Mishra)