WEBVTT

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Hi, my name is Tanvi Prabhakar and I'm a first year MPH student at Columbia University's

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Mailman School of Public Health and I'm in the Epidemiology Department. My certificate is in

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Health Policy and Practice, which led me to take this class that I'm interviewing you for.

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And thank you so much, firstly, for the prestigious opportunity to interview you.

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To begin, could you please introduce yourself, including your professional background and

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just give us a little more insight into your responsibilities as a public health leader.

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Okay, my name is Anil Vankade. I'm a state government officer, Maharashtra's government

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officer. I have about 28 years of service completed in the government, worked in various sector

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infrastructure, health, skills, social sector. So various sectors I could lay my hands on

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and moreover, when I had my opportunity to work with Mumbai Municipal Corporation,

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that is one of the biggest municipal corporation in the local body in India. If not in India,

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it's across Asia, it is one of the biggest because we cater to about

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1 crore 40 lakh population. Wow. Yeah, so it's a very, very big organization and health is a very

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prominent subject in the municipal corporation and particularly during the pandemic, I was

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director and in charge of the COVID hospital, one of the biggest, what do you call,

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is the biggest hospital we created in Bandrakurala complex. It was a temporary setup,

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having capacity of about 2,300 patients, which is a very big number and was the largest facility

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available in Mumbai. Wow. And what were your responsibilities as a director for such a huge

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temporary setup? Yeah. Well, I was in charge of the facility, overall in charge administrative

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head of the facility. There was a doctor, Dean, who was reporting to me and he was primarily handling

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all the health related activities and reporting to me. Okay. That's so and just to get a little

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more insight into this, as a leader navigating the complexities that arise during the COVID-19

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pandemic in Mumbai, could you paint a picture of the ethical landscape that you had faced

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during this as a leader for this? Okay. During pandemic, there was a lot of challenge

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as to how do we do our procurements. That was, I think, one of the biggest challenge.

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In the traditional way, how we do the procurement in the government was impossible. And having said so,

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how do we do that procurement transparently? And how do we document? Because you may be

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aware that the situation was so bad that we were not getting doctors for work. And handling papers,

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handling printing, handling tenders about the procurement was just not possible. So,

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there were a lot of such hurdles. But we decided that whatever we would be the hurdle,

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but we must follow some process, whereby there will be a transparency. And there will be proper

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documents which will be created so that there may not be any objection in later part. So, accordingly,

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accordingly, I myself took initiative to prepare SOPs. Like for a transit hospital,

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there are no SOPs. Like, where do we should put our garbage? Because that's not a planned hospital.

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It was a tent-like structure. And we were supposed to manage within that. And then,

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there was a safe area and there was a contaminated area where the positive patients were there.

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And we have created a separate facility for the doctors. So, all these challenges were there.

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And primarily, how do we do that entire thing in a transparent manner? I think that was a major

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challenge. Right. And could you elaborate a little more about the transparency aspect of it in terms

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of, you know, as an ethical decision-making process? Like, why was it so important to be

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transparent? Well, we were dealing with public money. And whatever may be the situation, because

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in Maharashtra, across India, there are a lot of issues come up every year. There are floods

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coming. There are cyclones coming. There are a lot of such natural calamities come. But during that

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natural calamity as well, there are certain processes followed by government and the government

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agency and government officers. So, there are some said precedents that through what kind of

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process has been followed early in the cyclone. Mumbai flood is very common and people know how

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do people manage during Mumbai flood, how do those transparent things are being done. So,

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some skeleton guidelines were there. Based on that, we internally created a proper process.

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Like, every procurement was done by the committee of doctors. Like, there were three doctors,

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five doctors, odd committees were created. And there were every day morning meetings, every day

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discussion and everything was documented, especially the procurement. We used to ensure that at least

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our advertisement go on the website. Let people see, even if suppose you get a response online.

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So, let that committee of doctors go through and the best suited proposal is accepted and

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likewise. So, that is how I think because we had some processes created, that helped us

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following all the transparent process. But I know that this transparent process

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are having little issues because during that time, through the thorough process was just not

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possible. Because in government, in case we have to go in for procurement, then 10 days

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advertisement, 15 days. So, all that process runs over for 20 to 25 days. And here we had to get

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procurement done within two days, three days. And that too, we don't know the vendor.

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We don't know the tradition of the vendors. But online, those documents we asked, we created and

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within the framework, within the problem, within the difficulties, we tried to

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find a solution just transparent for that. That's wonderful. Thank you so much for giving us more

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insight into that. So, I also wanted to kind of ask about, because we're talking about Mumbai

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as a big metropolitan city, right, in particular, I wanted to ask about how did the dense environment

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and diverse population dynamics shape how you approached the decision making in the pandemic?

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Yes, I think this is a very good question, because Mumbai scenario is a little different.

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About 60 lakh people stay in slums, which are informal, which doesn't have most of the places,

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doesn't have proper accesses, doesn't have proper sanitary facility, doesn't have proper drinking

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facility. And most of the most of the facilities are shared, like, take example of toilets,

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the toilets are public toilets. The toilets are being maybe shared by 100 people, 200 people,

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depending on the size of the, you know, toilet block. So, and there are no proper accesses.

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So, during pandemic, it was a challenge as to how do we approach this slum? And how do we approach

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the conventional buildings, because there are buildings, there are accesses. So, comparatively,

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managing buildings and residents residing in the building was a little easier. But in the

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informal setup, it was a big challenge. But within the framework, we created

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SOPs there also, how do we manage our containment area? If you remember, there was a phrase called

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containment area, in case a certain number of persons are found to be positive, then that area

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was pardoned off and cut off from the rest of the area. And then all the facilities, because they

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are they are cut off from other people. So services was another challenge. How do we provide them

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milk? How do we provide them medicine? How do we ensure their health? So all those. So for everything,

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there was there was some mechanism, word wise, sector wise, area wise. So that mechanism was

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created. And that's how we approached primarily to the informal settlements. Wow. That honestly,

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just just even like listening about it in hindsight, it just sounds like such a huge

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challenge because especially the temporary settlements, the slums, navigating around that

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must have been just so hectic at that point of time. But I would say hats off honestly because

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the way we were able to recover as a city is just commendable. So truly.

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Well, I also wanted to kind of because you mentioned that there were people like ward boys,

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sector boys, and, you know, frontline healthcare workers. So I just wanted to see that, like ask

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you, like, during the, you know, admits the urgency of the crisis, how did you prioritize

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the well being of these frontline workers and all the people that were coming in

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to like help out during this process. And like thing on your role, could you share like maybe a

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specific instance where you found yourself at a crossroads, you know, balancing the imperative

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for public health interventions with the ethical considerations of individual liberties or cultural

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norms here. Okay, so I must tell you one thing which was very, very important for us. So far as

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bandrakoot law complex, COVID hospital is concerned. Luckily, the team of doctors,

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you'll be surprised the age of doctor, average age of the doctor was between 35 to 38, average,

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I'm saying. So I was lucky to get a team who's young, you know, they were on their toes,

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they were ready to take challenges, they were having their own ideas. And that's how I was very

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blessed to have a team like that. And second, so far as doctors are concerned, we were very sure

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that we have to take care of our doctors. Because unless we don't take care of them,

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their health, their well being, their needs, then we will not be able to fight with this,

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you know, situation. So we have, we requisitioned 5 star hotels in the BKC bandrakoot law complex.

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So right from our compounder, the smallest level staff, they were residing in a hotel. So all the

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facilities were made available along with the transport. And BKC primarily is because the

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closeness. So the doctor could easily walk in, walk out from the hospital to their destination.

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So that, I think, the first thing we have done. Second, we were closely monitoring doctors and

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providing all the safety gears, whatever was required. And we were ensuring that stock is there,

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and those are properly being used. And best quality of material is available for them.

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And the most important thing is to create a work environment where these people don't lose their

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confidence. I think during that period, the most important thing was to keep these people energetic

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and high on spirit. So that's how we used to have open discussions within the framework

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by following all norms, talking to most of these doctors. I myself was, you know,

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visiting in the ward along with the doctor, even though I don't, I'm not a qualified doctor and

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not having qualification of that, but to give them moral support. So we used to go in the proper

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ward where all of these patients are there, including ICUs, just moral boost them. And

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continuous dialogue with them in case they want anything, because Lakilya had a young team. So

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they had a lot of suggestions, a lot of objections. So that's how we could create that environment

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and run it properly. That's honestly, that's such a good system. And I absolutely agree that it's

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super important to have like build up team morale. And you mentioned that you yourself went into this,

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went into the hospital and went into the wards, like, you know, give them company and keep the

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morale boosted. How did you grapple with the ethics of prioritizing your well-being versus

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prioritizing your well-being and your family's well-being versus, you know, like putting yourself

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out there and going into the front lines yourself, even though you did not have to,

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like that was the decision that you made yourself. So what was the ethics behind that?

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Well, while I was in charge of this VKC COVID pandemic hospital, I was also in charge of

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Mumbai Airport for quarantining the international passengers, they are there, travel to their

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destination, following all norms at the airport. So I was in charge of the mission at airport.

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So virtually I had to visit VKC hospital in the first half, second half whatever,

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and another second half in Mumbai Airport. And normally flights were coming late in the

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ninth, 12 o'clock, 1 o'clock, all these distress passengers were coming. And as per the regulation,

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we really had to put them in the hotel, put them in public transport. So it was a big challenge.

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So having said that, being a government employee, having 28 years of service, so we had gone through

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similar situations like this, may not be as big as this, but still we have been through these

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processes. And if you see that the doctors, the nurses, they were not going back to their house

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for 15 days, 20 days, even a month, they were staying in a hotel. So looking at them,

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automatically you feel like, yes, you have to be there to support them and to be there with

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them shoulder to shoulder. Wow. No, that is just incredible. And I think even that,

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I think this is something that was so special to maybe Indian government, Indian government's

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decision or Maharashtra government's decision. But it's the fact that when people came in

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internationally, they were situated in hotels. There was a system for this. And I think that is

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so commendable. Coming up with that must have been such a long process and kind of acquiring

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these hotels. And that's amazing. Well, thank you. And I just wanted to ask more about that in

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terms of how did you foster this collaboration and trust among all the stakeholders from

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grassroots organizations to government agencies to all the people? How was that process?

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Yes, there was a lot of trust deficit in the beginning because there were death rates

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increasing and many places may not be at our place, but many places across Maharashtra,

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across India, people were losing their faith in the system, whether we'll get oxygen,

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whether we'll get beds, those lot of things, a lot of speculation were done there. So finally,

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people were thinking, in case I'm turned out to be positive, if I'm turned out to be

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affected by the virus, so how do I am going to get my medical facility? So those challenges

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were there. So we used to have a continue dialogue. We used to have communication

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over electronic, this thing, website, how do people should take care of them? There are hospitals,

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all these information were available on the website. So on the WhatsApp, whatever possible,

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whatever social media, whatever platform was available. So we used to kind of make

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brainstorming and providing all that necessary information, otherwise it is un-requires.

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That's amazing. And kind of going off of that, as you reflect on your ethical journey of navigating

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the pandemic in Mumbai, what enduring lessons do you believe should shape the future of public

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health preparedness and response effects? Yes. I think this is another very good question,

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because after the pandemic was over, or maybe in the last phase of the pandemic,

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there were a lot of discussion as to how do we fight in case such as in the area of re-occurs.

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Because to be honest, no one was ready to the magnitude of health facility,

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which was required to fight this pandemic. Most of the facilities were created at the last leg,

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because no one was aware as to what kind of facility this element requires, what kind of doctors,

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what kind of beds, whether because if you see in the first phase, people were saying that many

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people require oxygen. And second phase, a lot of oxygen was made available. There were other

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comorbid issues. So once the person is found to be positive and admitted in the hospital,

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so how do he manage his dialysis in case he's a dialysis patient? How do he manage his heart

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ailment? Because many people were admitted having comorbidity. So that was the biggest

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challenge, how do we manage their other parameters? How do we see, ensure that their other parameter

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doesn't deteriorate while they fight with the pandemic, like this COVID virus. So I think that

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was the biggest challenge. But slowly, one by one, we were learning from the experiences.

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But my point is like, we should be taking lessons from this big pandemic and create

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better health facility, create facility where you can convert those facilities quickly into such

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kind of hospital. Like we constructed a big pendulum like structure in BKC, we were not knowing.

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I remember when I was made as a in-charge, first time when I visited, and there was another doctor

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who was appointed as a dean, his state of SES said to me that this is no way the hospital and we

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cannot run a hospital in the pendulum like structure, people will die. So we started from that.

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So there was a lot of reluctance from the doctor, like how do we manage? This was a new situation,

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this was never had happened. Because when you see as a hospital, it is a full-fledged hospital

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with facilities, everything. So the point is like, we should be ready for such kind of occurrences in

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the future, create big health facilities and in case possible, create a regional facility.

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Because if you see this area, especially Mumbai Metropolitan region, where there are about five

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districts including Mumbai, so except Mumbai Municipal Corporation, there are no much equipped

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government hospitals. Now, lot of people, they depend on government hospitals. In case we can

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in case we can create a regional facility, let all these people contribute together and let

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there be a big facility where all these people throughout the year can get treatment and create

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additional such facility like big convention center or whatever, so that that particular place

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can be quickly converted into the hospital. So these discussions happened,

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this was one of the point of course, but how do we manage our procurement, how do we

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take early decisions to stop the further damages. So I think there are many things which we have to

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concentrate on in case any such kind of incidents happen to fight with that.

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That's amazing. Thank you. So essentially, I think my next question was kind of

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just based off of that, how do we integrate these insights into a more ethically resilient

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framework for addressing global health crises. But before going into that, I just wanted to ask

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again, how would you approach a similar situation in the future with while also taking into consideration

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the ethics of the people who live in slums and the population that might not have as much of a

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structure as residential communities or building cooperative houses and stuff. So how would you

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look like what kind of insights have you gained from this experience in terms of that?

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Okay. So my experience of this pandemic is I think we are not able to document the entire

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this health issue properly. That's my personal view because during the pandemic many people

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have written their books. Now those books cannot consider as a document because there has to be

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a document from the day one as to how did you fight a particular incidence. Now those particular

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incidents we fought and created some SOPs and left it there only. So it has to be from the day one

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from the one occurrence to the last occurrence, we have to kind of create a document. What has

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happened? How do we have dealt with? What was the difficulty and more particularly for following

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the transparent process because in general people will say how do we follow this transparent process

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like there is a pandemic but nevertheless because you have already fought this big pandemic, there

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are first experiences you have gone through to learn you found solution and moved a bit.

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So that those documents was not properly done. That's my personal thing and observation.

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That is my technique as far as ethical practice is concerned. Again, I am of the opinion that you

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can follow ethical practice. It doesn't matter what the situation is. Within that framework,

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you can always create a proper transparent process whereby you can do your procurement,

00:26:13.840 --> 00:26:21.600
you can do your proper day to day work, you can create a system for payments

00:26:21.600 --> 00:26:24.240
so that there are no questions asked later.

00:26:24.240 --> 00:26:37.920
That's that's thank you. Honestly, this was all such a so insightful as a public health student

00:26:37.920 --> 00:26:47.600
and also a resident of Mumbai. I feel like there was so much not made. Obviously, a lot of these

00:26:47.600 --> 00:26:53.840
processes happen internally and we like the public never gets to hear about this because

00:26:53.840 --> 00:27:01.840
honestly, nobody asks. But this is this is like so insightful and I'm sure that

00:27:02.480 --> 00:27:07.280
like God forbid, but if another incident like this were to happen, I'm sure that the

00:27:07.280 --> 00:27:16.320
team could learn a lot from all the decision making that you were in charge of. So thank you so much.

00:27:16.320 --> 00:27:24.960
But again, I would like to supplement here. I was in charge of the airport. So when I was in

00:27:24.960 --> 00:27:31.440
charge of the airport, we could put some document on record. I asked you how to because that it was

00:27:32.320 --> 00:27:38.240
a very different situation. Like how do we quarantine people who are coming in a single

00:27:38.240 --> 00:27:45.760
aircraft? Then how do you segregate? How do you send them to the hotels? Who should pay the hotel

00:27:45.760 --> 00:27:51.360
charges after completing the quarantine? How do you release them from the quarantine like hotel

00:27:51.360 --> 00:27:59.120
place? And in case he is a resident of Pune or Nakhpur or wherever. So how do he travel

00:27:59.120 --> 00:28:05.440
during that pandemic and lockdown especially? So these were a lot of issues unless you document them.

00:28:05.440 --> 00:28:11.520
So maybe 50 years later, you will not be able to know what was followed during those pandemic years.

00:28:11.520 --> 00:28:24.880
Right, of course. And but so you're saying that because the airport situation came in a little

00:28:24.880 --> 00:28:32.960
later, you were able to like document that thing. Yes, we did we did prepare some document but again

00:28:32.960 --> 00:28:38.960
I'm not satisfied the way it was done because it has to be a collective effort from all sides.

00:28:38.960 --> 00:28:45.840
Of course, one document cannot conclude the entire episode. Of course, that makes so much sense.

00:28:45.840 --> 00:28:51.600
Yes. Oh, thank you so much. Thank you. Would you have any closing thoughts?

00:28:54.640 --> 00:29:01.200
As far as ethical practice is concerned because these days this ethical word is very, very prominent

00:29:01.200 --> 00:29:07.680
and important for everyone because especially in the government and of course in the private sector,

00:29:07.680 --> 00:29:14.160
unless you follow that ethical practice and unless you follow the transparent process,

00:29:14.160 --> 00:29:20.560
be it be a private sector or government, so the trust building will not be there.

00:29:22.240 --> 00:29:28.880
And to ensure that trust building, your transfer process will come for the organization.

00:29:28.880 --> 00:29:36.880
Thank you so much. That is a great sentiment, honestly. And thank you for your time, Mr. Ankade.

00:29:36.880 --> 00:29:44.320
And hope you have a great rest of your day. Thank you. Thank you. Thank you. All the best.

