அந்த ஏழு நாட்கள்! (Those 7 days!)

Hello all, this blog is a sequence of seven days event during the December 2023 floods, the magnitude of the floods, damages and the unsung heroes are portrayed in this blog. 

17.12.2023

Day started as an usual Sunday except for the constant downpours since around 1 am. Enjoying the rain in the balcony with a cup of coffee and a book was a bliss.

The news feeds in the media warned of red alert to Thoothukudi, Tirunelveli and Kanyakumari districts. My children were little upset with the warning as it fell on Sunday and were anticipating the rainfall to continue next day so that they will have a holiday on Monday! Early in the evening as we received flood alerts along the banks of Thamirabharani, we alerted both our sister in law families to stay safe indoors and not to go out unnecessarily! In one of the Tirunelveli whatsapp group we received a video of water flooding into high ground hospital! At around 7 pm I happened to talk with Thoothukudi RMO, when i asked about water stagnation in Thoothukudi Medical College Hospital, he said he is inside the campus and as of now no much water stagnation except in front of blood bank! Also there was water in the corridors of ENT ward situated in first floor of the old building due to the constant rain! Later in night my husband received a call from his ward staff that water is coming into the plastic surgery ward situated in the ground floor of old building! Not so alarmed as we have seen similar situation in previous rainy season as water level usually recedes and drains as rain stops! My husband asked the staff nurse to shift the patients to ENT ward or any other ward where bed is available.

In Tirunelveli also rain was constantly down pouring. we got various weather alerts in Whatsapp and social media which were alarming us. Then I got a call from one of the supervisor that water level is constantly rising and is about knee level in the corridors. He also shared the photographs and videos of the situation there. He also said that the patients are being shifted to safe zones. Expecting water to drain after rain stops, I fell asleep!

18.12.2023

Waking up the next morning to get ready to go to work was shocked to see the rain still pouring ! Turning on the news Iooking forward for school leave for the kids, as expected leave announced for the kids and red alert was given to Thoothukudi and Tirunelveli districts. As I was getting ready to go to work, my husband was busy scrolling through the whatsapp news feeds and showing water gushing across roads. He said it's not possible for us to go to work today as the roads are damaged and cut off in more than two places. I told him that it must be a rumor and we can't believe these videos, it must be old videos taken elsewhere forwarded with intention to make it viral and asked him to get ready to work. Not satisfied with my reply he called some of his friends and confirmed that roads to Thoothukudi and Tiruchendur from Tirunelveli are damaged in many places and public transport has also been stopped. So no other go for us and we called our superiors to apply for leave. The situation there was very bad. Rmo Sir said DME was there and previous day duty doctors are continuing duty. Dean sir reached hospital in a JCB vehicle as no other vehicle could go through the heavy floods! RMO sir has walked(?swam) through chest level water from his home. On the way he got fumbled into water and the bystanders have rescued him.

He also posted some photos showing knee level water within hospital campus. 

He said patients are safely shifted to 500 building and dialysis machines are shifted onto cots

But water has entered Cardiology and blood bank.. also no power supply there. 

Asking him to take care I hung up the phone. At around 11.00 am I got a call from the kitchen staff that the resident doctors mess is not functional as it is flooded and nearly 150 of them have not had their breakfast. They have served the left over food to them. But still 70 were in need..so we asked them to prepare upma and give.. knowing that food is served there, patients attenders also flooded the kitchen.. upma was made in several batches with the available resources and served to all possible there. At one stage we ran out of stock of provisions and closed the kitchen. As whole city was flooded no shops to buy food or provisions. Meanwhile got call from emergency department staff that the NMLC bodies of patients who died in hospital couldn't be taken home and we retained them in our hospital mortuary. Also there was no power supply in the whole city. In our hospital patients were pooled to 500 building and CEMONC building and power supplied with the help of generators. And it was still raining and water levels were constantly rising and water entered our modern kitchen and mortuary crippling their functionality!

Though we could continue the emergency services in the hospital, we were in need of safe drinking water and food for the patients. Also we need space for preserving the bodies in mortuary. The hospital mortuary with the capacity of 12 bodies was flooded with water and there was no power supply. The bodies in the lower freezes were shifted to the upper available freezers. Though there was no power supply the temperature inside the freezer boxes were cool and the rest of the bodies were packed and kept in the Mortuary slabs. The bodies then received were packed and kept in the Black room near our Emergency Medicine department.

Meanwhile here in Tirunelveli also it was still raining!

Both my sister in laws' house were flooded with water. They both have shifted to first floor of their houses. When we tried contacting them in the afternoon, their mobiles were switched off ! Later we had a call from one of my husband's niece, she smartly said as the power in her mobile is low she and her sister have switched off the mobile to conserve the power. She said that they will switch on as and when needed and update us. When the photos shared by the sister in law residing in Sindhupoondurai near junction, water drowning a tempo van parked near the house, showed the grave situation there. We had the task of rescueing them safely. They said there were e boat shuttling across rescuing people. We asked them to come out of the houses using one of the boats. Initially they refused but as time went on and it grew dark and they had difficulty in using the rest rooms as the drainage was clogged, they got into one of the boats and came. We went by our car to pick them near Sulochana Mudhaliar Bridge. River has swollen to the height of the bridge!

They said the water level in junction is alarming to the level that when they came by boat, their heads got hit against the name boards of the shops in junction! 

Feeling a sigh of relief as we rescued them, further calls from Thoothukudi GH was alarming as water has not drained and the whole ground floor of hospital, the whole college campus and the hostels were flooded except for the

Emergency Medicine department and CEMONC as they are at little higher level. But then on we couldn't contact many as their mobiles were switched off and whole Thoothukudi is in dark without power supply.

19.12.2023

December Nineteenth was a nightmare, felt guilty and helpless as we stayed safe here in Tirunelveli unaware of situation there in Thoothukudi. Don't know what happened to our house there in Pushpa Nagar in Thoothukudi! When me and my husband were getting some milk powder packets in a shop I had a call from a landline number in Chennai. It was from DME office, Don't know how they contacted my number! ADME sir said as he couldn't contact dean or RMO or MS or Kumaran sir or even DME sir staying there in Thoothukudi, he need their whereabouts and updates. He said he even tried calling the family members of RMO. Then I explain him about the situation here as most of the network connectivity was lost and the mobiles were switch off due to power shutdown. Only one mobile number of Dean sir was reachable and that too only when he was near the radiology classroom! The radiology class room was the war room and the kitchen was shifted to first floor OP block corridor. The staff nurses and the hospital workers prepared the food with available provisions. 

Meanwhile many resident doctors have left to their hometowns and the doctors were on duty continuously for three days as many doctors couldn't come out of their homes as the water levels were upto their necks! However the Medical Superintendent sir managed to come to hospital by swimming 3kms through the roads! Generator were hired to restore electricity in the hospital campus and fuel for generators were outsourced. Meanwhile Madurai RMO Mam called and said that they have send bread packs and water bottles.

I recieved call from ED HOD mam stating that the people in quarters in college campus couldn't come out. And many there were left with no food and water.

The other essential services that were affected were the blood bank service and the dialysis unit. And also the cardiac cath lab and the Radiotherapy unit.

Shifting the patients to other hospital was a huge task as the transportation was succumbed to floods all over Thoothukudi, the only means of transport between Thoothukudi and Tirunelveli was enroute Kovilpatti. But that too the road status was not known. high risk ANC mother's were shifted to TVMCH and Kovilpatti GH.

Some of the 108 ambulance and free hearse ambulance had difficulty in transporting due to floods everywhere.

Mean time we started getting cases who got drowned in the flooded water. Nearly 15 drowning cases were received as brought dead.

 And that night me and my husband decided to go to Thoothukudi via Kovilpatti. Before going to bed I called a police personnel to know about the road status. He said temporary roads are being laid using sand bags near Anthoniar puram and also bigger vehicles like tempo can go through waters beyond third Mile Bridge.. we then packed some extra clothes and food like rusks biscuits some grocery to friends there, paper plates and disposable cups into our bags.

20.12.2023

 Today all the doctors from Tirunelveli pooled into teams and outsourced a tempo traveller and started our journey to Thoothukudi.

We could see the remnants of flood damages all along and once we crossed the third mile Bridge we felt as if sailing in ship. On the way we saw many of our colleagues swimming through water with spare dress in a bag over their shoulders.

Health secretary Mr Gagandeep Singh visited the hospital and laid down the plan of actions.

MCH Tuticorin

Plan of Action....20-12-2023

1.To arrange Power Supply for 1st and 2nd floor of the Medical College Campus ....to cover Operation Theaters( Ortho and other ), CemOnC wards, Blood banks ...so that the doctors will be able to take up cases for surgery ....

If power restored, other HoDs such as Surgery, Ortho, New Born and CemOnC will be able to get water supply too...

PWD AEE to complete it and update the feedback

2.Blood Bank

Dean Tirunelveli to divert one REMI refrigerator and transfer 25 Units of blood....and Blood Bank Medical Officer Tuticorin

may send vehicle if required

Dean Tirunelveli

3.Cath Lab and other High End Equipment

To discuss with MD TNMSC later

4.Food and Water supply in cans / bubble top to 160 PGs and 150 CRRIs to be ensured by RMO and DO Food Safety...

RMO & DO

5.Dialysis Units..

Dean Tuticorin to coordinate with Dean Tirunelveli and shift dialysis patients...as Kovilpatti denied due to non availability of free Units

6.33 dead bodies to be shifted to Tirunelveli MCH with Free Hearse Van's

RMO and ARMO / District Manager EMRI...

We also started preparing the estimate of damages department wise.

All the bodies in mortuary were shifted to Tirunelveli medical college mortuary. Kudos to our Male MPWs who shifted the body from flooded mortuary to Free Hearse ambulance parked near ED. The water levels were high for ambulance to go near Mortuary. Both ARMOs played the key role in meticulous packing and labeling of the bodies as it was very important to maintain the identity as decomposition was set most of the bodies. The smell was so horrible as most of them were drowning cases. That smell was in our olfactory bulbs for another two days.

  And our Forensic medicine team was deputed to Tirunelveli to do postmortem at Tirunelveli medical college as the postmortem room in Thoothukudi Medical College was still flooded.. On the way home we went to Tirunelveli mortuary to follow up and get the postmortem details.

The food safety officer also made arrangements for food and water in addition to the food that got ready in our temporary kitchen. Honestly the food prepared in kitchen was tastier than th hotel food. In addition many doctors brought food from their homes!

21.12.2023

Nature had mercy on us, the rains stopped and stagnated water was pumped out of hospital campus.

Minister of Social Welfare and Women Empowerment , Minister for Municipal Administration,  Minister of Public Works Department and Minister of Youth welfare and Sports Development visited the hospital and helped in creating a path to GH through park for pedestrians. They paved way for pumping out the water in the hospital campus.

Other OP services, laboratory and imaging services were restored.

Final Estimate of Damages Prepared.

The multi purpose workers from Virudhunagar and Madurai helped our OHSS team in maintaining the sanitation of the hospital.

22.12.2023

The whole campus cleaned and disinfected.

Health Minister visited the campus and thanked all for restoration of routine services.

23.12.2023

Restoration of almost all services except Cath lab, Linear Accelerator and lift services!!

This writing is incomplete for a Management graduate, without summarizing the Disaster Management Cycle in Thoothukudi Medical College Hospital! 

Disasters are not new to Thoothukudi Medical College Hospital!
It has stand through many floods even Tsunami but this time it was an unprecedent internal and external disaster (affecting both the hospital and the city as a whole) disrupting the transportation in an outside the hospital. During the procession riots in 2018 it was a man-made external disaster effectively managed in our hospital. 

Though we were prepared to face the monsoon, the magnitude of December 2023 floods were very high and it went beyond our preparation! But Emergency Response Plan helped us to stand through and raise back from the crisis. The well prepared internal disaster management plan with adequate stocks of linens, consumables and drugs helped us to sustain in the seven days off the routine functioning of the hospital.

Response phase

As an emergency response our main aim was saving lives, therefore we shifted the patients in the ground floor wards to first floor wards and mainly the patients from ILF, Eye ward and Psychiatry were shifted to 500 block. Also the concern ward staffs were smart enough to shift the possible higher end equipments to possible heights, for example the dialysis machine were shifted to patient cots and huge loss was prevented. 

As blood bank was flooded, blood and blood components were shifted from Tirunelveli Medical College Hospital. Also the patients who are at high risk like AN mothers and dialysis patients were sent to nearby hospitals like kovilpatti and Tirunelveli Medical College Hospital. 

In spite of all crisis, the Emergency Medical services were continuing in the Emergency Medicine ward, Intensive care units and CEMONC building for the needy patients. The flooded waters couldn't be pumped out as the motors in the pump room also got drowned and damaged in these unprecedented floods. As the whole city was flooded, water couldn't be pumped elsewhere and also if pumped water flew into GH from near by areas.  As the kitchen was also flooded the kitchen was shifted to the first floor of the 500 building temporarily and the food and water provision was sustained. But we had difficulty in connecting the 500 building with those in CEMONC and psychiatry ward as there was no connecting corridor connecting these buildings. The water level within the campus was to high to walk through to Araeach those wards. The patients were shifted in tractors and rescue boats. Additional generaters were hired for providing uninterrupted power supply. Diesel was also procured to meet out the continuous power supply. 

The sanitation of the hospital was maintained by the OHSS workers who stayed within the hospital campus through out the floods.

As the Mortuary and postmortem rooms were flooded, as a total 43 bodies were shifted to Tirunelveli Medical College Hospital and our forensic medicine team was deployed there and postmortem was conducted.

OUT OF 43, 37 CASES PM DONE, FLOOD RELATED 28 ( DROWNING 25, ELECTROCUTION 3), OTHER MLC LIKE MURDER RTA 9, NMLC HANDED OVER TO RELATIVES 6.

Recovery phase

As part of recovery phase, damages incurred by all departments were estimated and a detailed report was prepared. Meanwhile the multipurpose workers from OHSS deployed from other medical colleges helped us a lot in cleaning and disinfecting the whole Hospital campus.

Some of the articles and things we were able to recover from the floods and reuse after drying. A detailed estimate of damages were prepared department wise and then the damages were categorised into medical equipments, non medical equipments, refrigerators and other electrical items, furnitures, records and documents, civil work damages and electrical damages. A detailed estimate with approximate cost was prepared. Then the priority list was finalized and sent to District Collector and Directorate of Medical Education and Research for fund allocation.

Tamil Nadu Medical services corporation helped us in the restoration of cath lab and LINAC services. Blood bank services were also restored. Some of the corporates like HCL Infosys Sathya agencies were kind enough to help us in the purchase of cots, couches ,stretchers, wheel chairs, furniture and computers as part of their CSR activities. 

Mitigation and Preparation Phase

With a very good experience with the December 2023 floods, the following are being done to face such floods if any in future, 

1. Effective rain water drain system for entire hospital campus ( Herculean Task because of the geographical location of the hospital)

2. Motor Pumps in Pump rooms are raised well above the level of 2023 floods

3. Procurement of additional generators from NTPL and TMB and raising the transformer yard and generator beds to above 1 metre high for uninterrupted power supply. Provision for purchase of Diesel to meet out additional needs.

4. The floors of Blood bank, Medical stores and Surgical stores are raised.

5. Higher and equipments in Central lab are shifted to first floor.

6. This also proposed to have a connecting corridor between the 500 building and the OG block through the Gynaecology ward building and also between the psychiatry block and the admin block extension.

7. Proposals are also sent for new buildings with raised floor level in place of existing old condemned buildings.

Can you hear the mind voice of Thoothukudi Medical College Hospital?

நான் வீழ்வேனென்று நினைத்தாயோ?

Apart from the damages enlisted here, each and every one in Thoothukudi have incurred huge loss and damages. Our doctors, staff nurses and other healthcare workers are no exemption to this. Many have lost many of their household items and almost everyone's vehicles got damaged. One of our hospital worker has even lost her father, who got drowned in the floods.

And personally for us, my two wheeler parked in GH got damaged and our home in Thoothukudi needed a renovation to restore its charm and functionality!!