The Chapai Model: How one Bangladeshi district successfully fought the pandemic
The prevention model adopted by the district brought down Covid transmission rates to around 13% from a high 60%
For three days, middle-aged Baidya Nath Pal had a fever and cough. Initially, he ignored the symptoms and assumed that what he had was just the regular flu. Baidya consulted a local pharmacy assistant in Ranibari Chandpur of Chapainawabganj and took medicine accordingly.
A few more days passed but nothing improved. In fact, Baidya's condition deteriorated and he started to experience slight shortness of breath.
His son Roni Pal then contacted the Covid-19 emergency number of Chapainawabganj. Fazle Rabbi, medical officer of Chapainawabganj General Hospital, instantly sent the local medical team to collect Baidya's swab sample for the Covid-19 test. Then, the doctor prescribed him some medicines and asked Roni to check his oxygen saturation level.
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When Roni checked, he found it to be below 80. Upon hearing that, Rabbi suggested admitting Baidya to the hospital right away without waiting for the test results.
Within a few hours, the hospital's emergency ambulance service picked up Baidya from his home and he was admitted to the hospital. Fast forward a week: Baidya recovered and returned home.
Baidya recovered from a critical situation quickly, only because Chapainawabganj has been actively fighting the pandemic since last year, following a foolproof model which can be called the Chapai Model.
What is the Chapai model?
Some 500 small groups function with this model, from district to union level. Around 2,000 people are involved in it – doctors, health workers, and volunteers – who provide phone medication and home treatment.
In the Chapai model, suspected Covid-19 patients are traced using instant tests in crowded places and are given primary treatment in union and upazila hospitals. Building awareness among the masses is also one of the core goals of the model.
Dr Shamil Uddin Ahmed Shimul, member of parliament from Chapainawabganj-1, said the district hospital has only 78 seats for Covid-19 patients. If patient numbers go above that limit, it will have a disastrous effect on the local health care system.
"So, we have designed a model to bring everyone – from government officials to NGO workers and ordinary people – under one umbrella. Our goal is to prevent Covid-19 infections and keep patients with mild symptoms at the union and upazila level to curb the transmission rate," Shimul added.
Baidya Nath Pal's son Roni also expressed satisfaction with the Chapai model.
He said, "I must say Chapainawabganj General Hospital has a very responsive Covid-19 team. They are providing top-notch services, from ensuring ambulances to oxygen. Here we have received all the services instantly and without going through much trouble."
Born out of necessity
However, the scenario was not always like this. In mid-May this year, almost 60% of people in the district tested positive for the virus. Soon after, the local administration enforced a strict lockdown in the district.
Medical Officer of Chapainawabganj General Hospital, Fazle Rabbi, said their instant sample collecting method helped tremendously to bring the situation under control.
"Our team used rapid antigen tests which show results in 15 minutes, to randomly test people in crowded places. Interestingly, most people dreaded the instant tests and eventually started to stay home during lockdowns and wear masks if they needed to come out for some emergency," Rabbi added.
After enforcing the lockdown, the medical response team focused on providing medication at home so that patients would not have to come out of their residences for treatment. Local health care workers were closely involved in the process.
"Our health workers visited patients at home and shared basic guidelines on isolation, medicines, food, and home treatment. If deemed necessary, patients were referred to union, upazila or district hospitals," said Dr Sayra Khan, upazila health and family planning officer, Shibganj.
Sadikul Islam, government health inspector in Shibganj, said when they started to enforce the Chapai model, he personally expected a lot of resistance but was surprised when most people voluntarily stayed at home.
Under the Chapai model, local bazaars were made larger to allow proper air circulation while police and administration regularly monitored public places.
Following this model, Chapainawabganj has brought down the transmission rate to around 13% from 60%. In some upazilas, the rate has dropped below 10%.
But the nearest districts have not been so successful. Naogaon has a transmission rate of approximately 23% and Kushtia has a daily transmission rate of about 32%. In fact, Kushtia followed the Chapai Model but failed.
Why did Kushtia's approach bite the dust?
Dr SM Mostanzid, principal of Kushtia Medical College Hospital (KuMCH), said, "Since the beginning of the pandemic, we were concerned about this virus and we knew how fatal it could become over time. We understood that we could prevent it if we started working at the union or upazila level."
The plan worked perfectly for a while and by June this year, two of the district's upazilas – Mirpur and Kumarkhali – had less than 10 Covid-19 patients, but the condition soon deteriorated.
Dr Mostanzid said one of the reasons for the plan's blatant failure was the lack of government support.
"Luckily, a few of our people's representatives agreed to work with us, but not everyone. We alone cannot make everyone listen to us and we could not. So, everything is in chaos now."
Zubayer Rahman, relative of a Covid-19 patient, agreed with Mostanzid. Treated for Covid at KuMCH, he said that from union hospital to KuMCH, every seat was filled with patients infected by the virus, and critical and non-critical patients are kept together in close proximity everywhere.
"Lack of oxygen cylinders and nasal cannulas is acute now. New patients are constantly arriving so doctors hardly have time to monitor the patients admitted in cabins. I found my home safer than the hospital," he added.
Mostanzid said they had enough doctors to tackle this second wave but they lacked health workers, administrative, and economic support.
"Look at Chapainawabganj: it has successfully pulled down the transmission rate following this same plan, but we failed, even though we started at the same time," Mustanzid said frustratingly.
Dr Mushtuq Husain, an adviser to the Institute of Epidemiology, Disease Control and Research (IEDCR), tried to explain why this plan did not work in Kushtia.
"It did not work because it lacked leadership. A few doctors or volunteers cannot change the scenario of a whole district. In a quick survey of the Directorate General of Health Services (DGHS), we saw that around 70% of people in Chapainawabganj voluntarily wear masks. The active role played by local administration played a significant role in this," he said.
Last week, the cabinet division issued a protocol of forming small teams to prevent Covid-19 at the grassroots level.
"As our government officials do not listen to the ministry of health, we had to come up with something new," Mushtaq said.
Dr Benazir Ahmed, former director (Disease Control), DGHS, found this plan viable too.
"We kept saying that preventing Covid-19 would be easier than treating thousands of people where we lack both human resources and money. The preventative model worked for Chapainawabganj. The government should follow the model without periodically easing lockdowns. Only then can we avoid another impending disaster," he added.
