As the Greater Chennai Corporation (GCC) scrambles to trace over 220 COVID-19 patients who are missing from the local body’s surveillance, Health Department officials have flagged the stigma around the disease as one of the major reasons behind people hesitating to approach fever camps.
The GCC has set up fever clinics in every ward to detect people with Influenza-like illness (ILI) — cough, cold, fever and breathlessness. These camps are aimed at identifying early cases of COVID-19, monitoring and managing those at the micro-level. Since June 1, over 400 such clinics are operational across the 15 zones under the GCC.
Field officers of the GCC and FOCUS (Friends of Covid Persons Under Surveillance) volunteers play a major role in identifying and ensuring that people living in and around a particular fever clinic are aware of the camp and visit the camp if they have any of the ILI symptoms. The helpers in the camps take down the address and phone number of the visitor as the staff nurse checks for the temperature. The doctor inquires about the person’s contact history in the previous seven days while checking the oxygen saturation in their body. However, municipal authorities say that visitors providing incomplete or inaccurate contact information at the fever clinic makes it difficult for authorities to track them, especially if they test positive for the coronavirus in the future.
“The biggest issue that we, as healthcare officials, face on the ground right now is the stigma. People, especially in low-income residential areas, seem to have this fear of what will happen to their family if they test positive and who will take care of them,” Dr Geetha*, who works at one of the fever clinics, told TNM. This feeling not only pushes people to furnish wrong details, but also prevents them from approaching the fever clinics, despite displaying ILI symptoms.
The fever clinics see a footfall of anywhere between 80 and 150 visitors a day and are open from 8.30 am to 1.30 pm in a ward. Every clinic has a doctor and a staff nurse apart from two or three other staff members to help with infrastructure and publicity.
Dr Gopal*, a health officer in one fever clinic, told TNM that though the clinics aim to close by 1.30 pm every day, if there are many visitors, the timings extend accordingly.
Explaining her experience with fever clinics, Dr Geetha said that while most people who visit the clinic are happy to share their real addresses and phone numbers, the team does get the occasional person who tries to get away with providing a wrong phone number.
“When I feel something is off in the manner a visitor gives the details, I immediately tell the staff to dial the phone number provided by the visitor, just to confirm that it is indeed a real, correct number,” she added.
Dr Gopal pointed out that ground-level workers, including FOCUS volunteers, play a major role in ensuring everybody in a particular area knows about the fever clinic. They help in mobilising patients to be checked by the doctor in the clinic since these workers have granular knowledge about the locality.
“We are doing our best to keep track of people who are visiting the camps, but there are chances of them giving wrong addresses to us. We cannot even blame the people because they are scared. But since our volunteers know these people by their faces, they are able to keep track of them,” he explained.
Dr Geetha pointed out that the GCC has set up a team to provide counselling to address the issues around stigma amid COVID-19 suspects and patients.
“Every division has a health officer who is in charge of monitoring COVID-19 positive patients and those under home isolation. These officers visit their houses every day and record their vitals and monitor them closely. They are also in charge of counselling COVID-19 patients and their families so that they don’t feel neglected or left out while recovering from the disease,” she explained.
In order to provide the psychological support that COVID-19 patients would require and address the stigma that their contacts and families face in society, the GCC has put a psycho-social counselling team in place. The main role of this team would be to talk to COVID-19 patients and their contacts and reassure them about the disease, the treatment and the lifestyle issues around it.
“We have around 50 volunteers at our counselling centre, over 220 at remote locations who are working to provide this support to the people. We have also trained 200 police personnel and 75 health workers who are on the frontline to deal with the families of the patients and their neighbours. The aim is to erase the stigma and the ostracisation that follows the family once someone is diagnosed with COVID-19,” said Dr Florina Xavier, Co-Coordinator of the psycho-social counselling project with the GCC.
Once a person is tested positive for the coronavirus, the psycho-social support centre contacts the person and explains to them about the disease in an attempt to destigmatize the experience. “The centre also helps in contact tracing of the patient and thus they get to talk to them as well about these things,” she added.
Emphasising that the local body and the government need to take proactive measures to get rid of societal fear and stigma around COVID-19, Dr P Kuganantham, a public health expert and a member of the expert medical committee that is advising the state government on COVID-19 management, said that the cause of fear is ignorance.
“We have to take efforts to address ignorance. We have to tell people about the disease, the measures and relief that the government is providing,” he said, adding that the committee has told the government to not put up barricades or metal sheets around a house where COVID-19 cases have emerged.
“These actions promote stigma and fear in the society. The key now, is to create more awareness among the people about the disease,” he explained.