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Narayan Gaikwad talks about the ostracism his family faced after he tested positive in 2020
Farmer Narayan Gaikwad and his family faced ostracism after he tested positive for COVID-19 in 2020 / credit: Sanket Jain

Narayan Gaikwad knew something was wrong.

For eight days in August, he received intravenous drips of electrolytes and saline, twice a day. By the time he realized he was being treated by a charlatan, it was too late. Fatigue gripped him and before long he collapsed at his home in the village of Jambhali in the western Indian state of Maharashtra.

His family feared that COVID-19 had caused his symptoms. Gaikwad, 73, was taken to a makeshift public COVID center 10 miles from home. “There were at least 500 patients, while the facility had about 100 beds,” recalls his son, Bhagat. They then walked another eight kilometers to a private hospital. “The doctor didn’t admit him because he didn’t have a COVID report,” Bhagat recalls.

“The whole system was saturated because many private doctors refused to treat patients with COVID,” he says. They quickly took him to a local village doctor, who prescribed some injections. “My senses returned, but my cough and cold did not go away,” recalls Gaikwad. All I wanted was a COVID test, which was hard to get because the system was overwhelmed and not ready. After that, he spent ₹5,000 (Indian rupees or US$70) and had a computed tomography (CT) scan. “So we went to a doctor, who prescribed medicine and injections for a week. It cost me another ₹13,000 ($180). This was 10 days after his walk to get proper health care and Gaikwad still couldn’t get tested for COVID . “I was out of breath.” To get tested, his family took him to a private university that had become a COVID-12 center 12 miles away. As predicted, he tested positive. “They put me on oxygen and within three days I started feel better,” he says with relief.

Meanwhile, all nine members of the Gaikwad family have tested positive due to stigma. “People started circulating that my whole family tested positive,” says Narayan, a low-income farmer. None of them were allowed to leave the house for a month. “We had to throw away 2,000 kilograms of harvested tomatoes worth $275,” says Bhagat. Gaikwad never anticipated that this would cost them a season’s earnings.

After testing negative, Bhagat posted a screenshot of this report on his WhatsApp status, captioned “Negative”. “It was necessary. Otherwise, we would have starved because people wouldn’t let us out,” says Gaikwad. In India, as in many parts of the world, ordinary people rely on groups created within the messaging app WhatsApp on their phones. smart enough to communicate with wide swathes of people, such as their neighbors, co-workers and political allies.

It did not take long for the second wave to ravage India. On May 14, India reported 414,182 infections in 24 hours, the highest one-day peak in the world. India’s far-right Prime Minister Narendra Modi has prematurely declared victory against COVID in January 2021. Leaders of the Bharatiya Janata Party (BJP), of which Modi is a member, have begun addressing election rallies in four states of the east and south India, drawing several thousand people without masks. At an event, Modi proudly said, “I witnessed such a rally for the first time.”

On the same day, India reported more than 234,000 infections. With an oversaturated healthcare system, India has run out of oxygen, hospital beds, ventilators and essential medicines. Soon, people took to social media, making SOS calls to health facilities. Hospitals started petitioning high courts for lack of oxygen supply as several people died. As of May 30, India has reported more than 28 million cases with 329,000 people succumbing to the virus. A New York Times The analysis reveals that a more likely scenario could be 539 million cases with 1.6 million estimated deaths.

But Gaikwad could not find a bed in the first wave.

“For poor people like us, the system collapsed a long time ago,” he says.

Three decades of austerity

In 1991, India “liberalized” its economy, which meant opening it up to international markets, leading to massive privatization of public services and goods. In 1993, the World Bank published its World Development Report, which focused on health care. Ravi Duggal, researcher and health activist writes: “This report is basically aimed at third world governments to redirect public health spending to targeted health programs for targeted populations, clearly implying that curative care, the bulk of health care, they must be left in charge. the private sector”.

The World Bank report says that investments in specialized health facilities should be diverted to the private sector by reducing public subsidies. He encouraged “social or private insurance” for clinical services. The result: 85.9 percent of people in rural India have no health insurance.

To encourage privatization, the government reduced customs duties on imported medical equipment from 40 percent in the 1980s to 15 percent in the early 2000s. As of 2016, it has dropped to 7.5 percent. Between 1986 and 1987, India spent 1.47 percent of its GDP on health. It has now been investing just over 1 percent of its GDP. Meanwhile, it has 43,487 private hospitals and only 25,778 public hospitals. However, a 2019 World Health Organization report noted that global average health spending was 6.6 percent of GDP.

Frontline healthcare workers bear the burden

In March 2020, India’s Ministry of Health tasked Accredited Social Health Activist (ASHA) workers to contain COVID in 600,000 villages. To do this, they survey households, find suspected cases of COVID and monitor oxygen levels and body temperature. ASHAs also support home-bound COVID patients and act as a liaison for people who may receive treatment outside the village. This is in addition to more than 50 responsibilities that include universal immunization, ensuring adequate pre- and postnatal care, spreading awareness about contraception, hygiene and maintaining health records.

An Accredited Social Activist Health Worker (ASHA) monitors the temperature of a community member in Maharashtra's Kolhapur district
An Accredited Social Health Activist (ASHA) worker monitors the temperature of a community member in Maharashtra’s Kolhapur district / Credit: Sanket Jain

For every 1,000 people, one ASHA worker, usually a woman from a village, is appointed under India’s National Rural Health Mission. Swati Nandavdekar, 40, from Mendholi village in Maharashtra’s Kolhapur district, is one of 970,676 ASHAs. “We are tired,” says Nandavdekar, who has been working without leave for 410 days. “People abuse me verbally and don’t answer my survey questions.”

By avoiding it, people are avoiding the ostracism that follows if they test positive, as in Narayan’s case. “In the previous lockdown, everyone lost their livelihood and now they can’t afford 14 days of isolation,” he explains. This is in contrast to last year, when ASHAs like Nandavdekar were able to successfully track patients with COVID-19.

Dr Sangita Gurav, the sole public doctor in 15 villages served by Kolhapur’s Bhuye Public Health Centre, commented on the rising death rate. “People consult us only after a week of testing positive,” she says. “At this point, his symptoms become severe and his oxygen levels begin to drop.”

Sandhya Jadhav, an ASHA supervisor from Kolhapur, who oversees the work of 24 ASHAs, says, “Every day I get calls from ASHAs talking about mental stress and cases of verbal abuse.” ASHAs are given “performance based incentives”. In Maharashtra, they average a meager monthly income of ₹3,000-4,000 ($41-55). But it comes down to $25 for ASHA workers like Nandavdekar, who is from a smaller village. “Most of them have not been given PPE kits, masks, hand sanitizers and gloves for inspection even in the containment zones,” says Jadhav.

On May 24, ASHA workers across India went on a one-day strike demanding legal status for permanent workers, adequate health safety equipment, insurance and an increase in their wages. Last year, more than 600,000 ASHA workers protested with similar demands.

For 833 million people, India has only 155,404 sub-health centers (which are the first point of contact for rural communities of 5,000 people), 5,183 community health centers, 24,918 public health centers and 810 district hospitals. It is one district hospital for every million people. With such poor infrastructure, it is the ASHAs who remain in direct contact with the villages. “We have been working since 2009 and have saved countless lives, which even the government knows about,” says Nandavdekar. “But they won’t even treat us with respect.”

Last year, the Indian government announced a $69,000 (USD) insurance program for frontline health workers. “If there was insurance, why didn’t they tell us about the company and other details?” says Jadhav. “They took our signature on a blank piece of paper.”

As cases continue to rise, the work of ASHA workers is far from over.

“We are dying daily,” says Nandavdekar. “The only difference is it’s not called death.”

Sanket Jain is a freelance journalist based in Kolhapur district in the western Indian state of Maharashtra. He was a 2019 Rural India People’s Archive Fellow, so he documented disappearing art forms in the Indian countryside. He wrote for deflector, Progressive magazine, counter strike, Byline Times, The National, population, Media Cooperative, Indian Express and various other publications.

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