Case study of a CCI self-isolating during the Corona virus pandemic
The whole world is talking about the Corona virus pandemic and the challenges of self-isolating and flattening the curve. While social media is awash with stories of home schooling, communities coming together to support the vulnerable and celebrate key workers, there is very little being said about the response of institutions.
Established in 1992, Snehalaya’s Rehabilitation Center, in Ahmednagar, Maharashtra, is operated with the approval of Ahmednagar District Women and Child Development Department and is home to 208 orphans, semi orphans and the children of sex workers, around half of whom are HIV+. While the children’s accommodation is separate, the 8 acre campus also accommodates a women’s refuge, sheltering around 50 women and their children and our over 18 girls, the organisation’s head office, a hospital specialising in the treatment of HIV+ patients, an English Medium School and residential accommodation for around 50 staff and visitors.
When the spread of Corona virus first started hitting the headlines, Snehalaya took immediate action to protect and educate all of our beneficiaries about the virus and preventing its spread through hand-washing and hygiene measures. We were particularly worried for all of our children whose immune systems are compromised by living in an institution, but especially for those living with HIV who are extremely vulnerable during pandemics such as this.
As we watched the world lock down and self-isolate we were faced by the challenge of how to close our doors and prevent the virus reaching our children’s shelter. There were many logistical barriers to overcome, including the relocation of our head office, including our accounts team just days before the end of the financial year. All non-residential staff were given the option to either move into the Rehab Center for the duration of the lock down or work from home. All leave for essential staff, including our caregivers, was cancelled and residential staff agreed to stay for the duration of the isolation period.
With no-one going out or coming in, we are taking additional precautions but with up to 25 children in each dormitory limiting contact is a challenge. Also, as we don’t want to cause our children, and the caregivers who are responsible for supervising them, extra stress by separating them and limiting their movement. Therefore, we have tried to accommodate our regular routine with smaller groups of children gathering in one place at a time and have also explained about social distancing of 2 meters. You can read some of the measures we have taken below.
Hygiene, health & wellbeing
The importance of washing hands, how to use masks and safe standing distances were explained to the children. Information and practices in good personal and home hygiene were shared and all children have been involved in ensuring they and their surroundings are kept clean and sanitary. There are daily checks to ensure this is happening and we have created a competition for the cleanest dormitory to encourage the children. To further help with this, additional laundry rooms, toilets and bathroom were arranged in the children's residences. The whole campus has been sprayed with government-issued sanitiser to clean surfaces the virus can attach to.
All caregivers have a digital thermometer and are monitoring the temperatures of all children every evening. Any child experiencing a high temperature of symptoms of a cold, fever or cough are immediately examined by a doctor and we have emergency plans in place should Corona virus be suspected. We have taken the added precaution of isolating two children with very low CD4 counts (below 250) in our on-site hospital.
Given the close proximity to our children’s accommodation, we have closed our hospital to new admissions which also allows us to use it for the treatment of minor medical conditions and isolation of our beneficiaries. This is currently being staffed by a residential team of nursing staff with others on call in case of emergency and our usual three doctors working on a shift system have been reduced to one doctor to limit the chance of infection. Any children showing symptoms will be immediately moved to our hospital where our doctor will examine them before referring them to our local Corona virus treatment center if required.
Our HIV+ children receive free ART from our local government hospital, however at the time of the lockdown second line ART was not available at the hospital, therefore we made arrangements to secure six week’s stock of medication for all of our beneficiaries from a private medical supplier.
We are also concerned about our children’s mental health and regularly check in on how they are feeling during these uncertain times.
Unfortunately our counsellors live off site and are unable to physically meet our children but we are working on arranging telephone and video counselling. In the meantime we continue to hold sessions to develop our peer counsellors, older children who can provide support to younger children and also feedback on the issues facing our beneficiaries so we can make changes where possible.
Our staff wellbeing is equally as important and we are arranging regular sessions, including meditation, reiki and recreational activities, where they can relax and share their thoughts and issues in a safe and relaxing space. We have also converted two of our guest houses into temporary staff spaces where caregivers can ‘escape’ for a few hours and enjoy a well-earned break away from the children and work. We are also working on a rota to give them full or half days off to ensure they do not burn out.
Food & nutrition
Our on-site kitchen caters to all of our beneficiaries and staff, around 300 people, three times daily. Our kitchen is staffed by contract caterers who manage all food preparation and a handful of our own employees. We asked the contract caterers to move on site for the duration of the lock down but due to family commitments only the head chef was able to shift onto campus. Therefore our older children have been helping him and our residential staff with the preparation of all meals. This is actually helping alleviate their boredom of being in lockdown and teaching them valuable food preparation and serving skills.
Another challenge was securing a regular supply of food, including fresh vegetables. We rely heavily on in kind donations to replenish our food supplies and while we did receive these in the first few days of closing our doors we knew this supply would soon run dry. We prepared for this and managed to purchase one month’s stock of grains. With the closing of our local fresh produce market we also made contact with local farmers to arrange direct supplies, dropping them at our gate, and ensuring our children continue to receive the fresh vegetables that will strengthen their immune systems. We have also introduced the serving of lemon with each meal which helps boost iron absorption and the serving of warm salted water to help flush out the virus.
As part of the isolation process we also had to make arrangements for our over 18 boys’ shelter and farm projects. Normally our farm delivers food and milk daily to our Rehab Center taking prepared meals back to both projects. To avoid unnecessary contact the deliveries are now dropped at our gate and we provided both projects with enough staples to last one month so they can prepare their own meals.
With the early closure of schools we initially asked our own school teachers to provide a few hours of classes each day in collaboration with our staff. With the enforced isolation this was no longer possible and the task of entertaining the children has been placed on our caregivers shoulders. This includes morning exercise and cleaning routines. We have broken children into age-wise groups and scheduled activities twice a day, including creative, educational and physical activities and life skills, bearing in mind social distancing. Some children are also working on our kitchens while others are producing sanitary pads in our Smiile production unit. We have been presented with an extra challenge with unseasonal afternoon rains disrupting our outdoor activities and have to schedule inside alternatives for the days where this happens.
We are hopeful that our efforts were made in time and are currently entering the two-week period where we will discover whether any of our children or staff contracted the virus before we isolated ourselves. Our management team meets daily to review the health of everyone, discuss the day’s schedule and any issues that have arisen and importantly gives us a chance to check in with everyone. We have also developed and put a crisis plan in place so that everyone immediately knows what to do if one of our staff or beneficiaries does start to show symptoms or is confirmed with Corona virus.
We hope that by sharing our story we can help others and also raise awareness of the challenges facing childcare institutions around the world dealing with the global pandemic. Stay safe!
Our Rehab Center’s project manager holds a meeting with all children to inform them about the corona virus.
Our Children's Parliament meets to better understand and discuss Corona virus and share their suggestions to prevent its spread.
The chief paediatrician at the District Hospital holds a guidance session at our Rehab Center on protection from the virus.
Snehalaya English Medium School and our after school slum centers close. Snehalaya requests all supporters to postpone any scheduled visits to our projects and Rehab Center.
Our founder, Dr Girish Kulkarni, Senior Assistant Director, Anil Gawade, and Trustee, Deepak Papadeja, convene a meeting of all staff guiding them on the steps to be taken to prevent infection from Corona.
Basins, water and soap are placed next to our security cabin at our gate.
Chair of the Child Welfare Committee, Hanif Shaikh advises the children about corona illness and how we can protect ourselves from this illness. Our Childline team are on hand to offer reassurance and distribute face masks to all children.
Ahmednagar’s District Collector orders shut down of all shops.
Maharashtra Chief Minister announces that all workplaces in major cities, including Mumbai, Pune and Nagpur, will remain closed until 31
All staff and children observe the India-wide curfew, staying in their dormitories for the full 14 hours playing indoor games and watching videos.
Prime Minister Narendra Modi announces the world’s largest lockdown on 24 March, asking 1.3 billion Indians to stay home for 21 days to slow the spread of COVID-19.
26 March - date
Snehalaya’s Rehab Center goes into full lock down with no movement in or out of the campus, except in extreme emergency.
Special medical cases
Unfortunately at the time of the lock-down we had two children already admitted in hospitals for other conditions. One child is seriously ill in a local city hospital and another had completed a surgery and was ready for discharge in a Pune hospital (2 hours’ drive away). Before we closed our staff were visiting these children and providing food to them. Once we went into lock-down we were unable to continue this and allocated the responsibility to staff from other projects.
When the child in Pune was discharged we requested permission from the CWC to return her to her family home, with additional support services to ensure she is well provided and cared for offered by Snehalaya. Our ambulance and a Childline team member made the five hour round trip to collect her from Pune during which time we learned her grandmother, who had been by her side in hospital, no longer felt able to take her home. Not only was her house unsuitable for someone released from hospital but her village community were fearful of them bringing Corona virus into their locked down community. We also did not want to run the chance of her bringing the virus to or campus and instead made arrangements for her to be admitted into one of our local hospitals where she would be able to monitored and access any follow up treatments required.