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Farmer Narayan Gaikwad and his family faced ostracism after testing positive for COVID-19 in 2020 / Credit: Sanket Jain

Narayan Gaikwad knew something was wrong.

For eight days in August, he received intravenous drops of electrolytes and saline, twice a day. By the time he realized he was being treated by a charlatan, it was too late. Fatigue had gripped him and in no time he collapsed in his home in the village of Jambhali in Maharashtra state in western India.

Her family feared COVID-19 had caused her symptoms. They rushed Gaikwad, 73, to a makeshift public COVID center 10 miles from his home. “There were at least 500 patients, while the establishment had about 100 beds,” recalls his son Bhagat. Then they drove another eight miles 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 COVID patients,” he says. Quickly, they rushed him to a local village doctor, who prescribed him some injections. “I came to my senses, but my cough and cold did not go away,” recalls Gaikwad. All he wanted was a COVID test, which was hard to find as the system was overwhelmed and unprepared. After that, he spent 5,000 (Indian Rupees or $ 70) and had a CT scan. “We then rushed to a doctor, who prescribed drugs and injections for a week. It cost me an additional ₹ 13,000 ($ 180). It was 10 days after starting his trek for proper health care and Gaikwad still could not pass a COVID test. “I was out of breath.” To be tested, his family took him to a private university that had been converted into a COVID center, 20 kilometers away. As expected, he tested positive. “I was put on oxygen and within three days I started to feel better,” he says with a sigh of relief.

Meanwhile, all nine of the Gaikwad family have tested positive for stigma. “People started to circulate that my whole family was 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,” Bhagat explains. Gaikwad never expected that it would cost them the winnings of a season.

After testing negative, Bhagat posted a screenshot of this report on his WhatsApp status, with the caption “Negative”. “It was necessary. Otherwise we would have starved to death because people wouldn’t let us go out,” says Gaikwad. In India, as in many parts of the world, ordinary people rely on groups created in India. ‘WhatsApp messaging application on their smartphones to communicate with a wide range of people, such as their neighbors, colleagues and political allies.

It didn’t take long for the second wave to devastate India. On May 14, India reported 414,182 infections in 24 hours, the world’s highest peak in a single day. Far-right Indian Prime Minister Narendra Modi prematurely declared victory over COVID in January 2021. Leaders of the Bharatiya Janata Party (BJP), of which Modi is a member, began addressing election rallies in four states from eastern and southern India – drawing several thousand people without masks. At one event, Modi proudly said: “I attended such a gathering for the first time.”

On the same day, India reported over 234,000 infections. With an oversaturated health system, India ran out of oxygen, hospital beds, ventilators and essential medicines. Soon people took to social media, making SOS calls for healthcare facilities. Hospitals have started to go to higher courts for the lack of oxygen supply because several people have died. As of May 30, India had reported more than 28 million cases and 329,000 people had succumbed 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 couldn’t find a bed during 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 involved opening it up to international markets, leading to massive privatization of public goods and services. In 1993, the World Bank released its World Development Report, focusing on health care. Ravi Duggal, health researcher and activist, writes: “This report is primarily aimed at third world governments to redirect public health spending towards selective health programs for targeted populations, which clearly implies that curative care, most of health care, private sector. “

The World Bank report said 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. As a result, 85.9% of people in rural India do not have health insurance.

To encourage privatization, the government reduced tariffs on imported medical equipment from 40 percent in the 1980s to 15 percent in the early 2000s. By 2016, it had fallen to 7.5%. From 1986 to 1987, India spent 1.47% of its GDP on health care. Today, it invests just over 1% of its GDP. At the same time, it has 43,487 private hospitals and barely 25,778 public hospitals. Still, a 2019 World Health Organization report said average global health spending was 6.6% 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. They do this by investigating households, finding suspected cases of COVID, and monitoring oxygen levels and body temperature. ASHAs also support COVID patients who are housebound and serve as a liaison with people who can seek treatment outside the village. This is in addition to more than 50 responsibilities that include universal immunization, ensuring proper pre and postnatal care, contraceptive awareness, hygiene and health record keeping.

An Accredited Social Health Worker (ASHA) monitoring the temperature of a community member in Kolhapur district of Maharashtra
An Accredited Social Health Worker (ASHA) monitoring the temperature of a community member in Kolhapur district of Maharashtra / Credit: Sanket Jain

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

By avoiding it, people circumvent the ostracism that follows if they test positive, as in the case of Narayan. “During the previous closure, everyone lost their livelihood, and now they can no longer afford 14 days of isolation,” she says. This contrasts with last year, when ASHAs like Nandavdekar managed to trace contact with COVID patients.

Dr Sangita Gurav, the only public doctor in the 15 villages served by the Bhuye public health center in Kolhapur, commented on the increase in the death rate. “People don’t come to us for a week after testing positive,” she says. “At this point, their symptoms become severe and the oxygen levels start to drop.”

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

On May 24, ASHA workers across India began a one-day strike to demand legal status for permanent workers, adequate health safety equipment, insurance and increased wages. Last year, more than 600,000 ASHA workers demonstrated with similar demands.

For 833 million people, India has only 155,404 health sub-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 1 district hospital for every 1 million people. With such a 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,” 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 healthcare workers. “If there was insurance, why weren’t we told about the business and other details? Jadhav said. “They took our signature on a white paper.”

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

“We die every day,” says Nandavdekar. “The only difference is that it’s not called death.

Sanket jain is a freelance journalist based in Kolhapur district in the Indian state of Maharashtra, western India. He was the 2019 People’s Archives of Rural India Fellow, for which he documented endangered art forms in the Indian countryside. He wrote for Speaker, Progressive Magazine, Counter punch, Signing time, The National, Population, Media cooperative, Indian express and several other publications.

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