The Doubly Disadvantaged

With already a lot to suffer and surmount, they have got another reason to struggle. No wonder, ‘they’ are the inhabitants of the countryside. Fear dominated the minds of the people last year that if the virus would transgress to areas difficult to monitor and keep a track of, India will not be left in a position to contain the devastating effects of the pandemic. Converting this fear into a reality, the second wave (B.1.617, double mutant strain) has engulfed the vulnerable areas and drawn out the list of their hardship.

Between ‘cause’ and ‘effect’, India chose to prioritize the latter over the former. The power of effect (in terms of overcoming the first wave) had strongly overwhelmed the country last year that the causes were undervalued to such an extent that India itself welcomed the second wave when it could have easily avoided it. Had the dominating reasons like religious ceremonies and public gatherings been taken care of despite noticing a “flattening of the epidemic curve” in September, the current sufferings wouldn’t have been a self-invitation. Had India learned from its past which is last year (a very short period to have repeated the same cause) and avoided gatherings like Kumbh Mela, religious processions, massive election rallies and campaigning, it wouldn’t have let the virus to make roads into the remote areas. Rather, these causes cannot be attributed to this upheaval in isolation. The relaxations that were given to wearing of masks, inter-state as well as intra-state travels without any pre-defined regulations, the usual celebration of the festivities, international visits, among others, very well justify the multiplication of the cases.

India, in this context, is not to be misread as the government of the country. The number of common people choosing to wear mask without the pressure of paying fines and avoid public meetings, weddings, religious ceremonies and unwanted travelling without government restrictions itself answers the contribution from the ‘responsible citizens’ of our country. As the purpose of evaluating a cause is to either correct it or to not repeat the same, this evaluation holds no significance in case of our country where the purpose of finding the cause in relation to the pandemic has been defeated. With alerts from other country’s experience on the possibility of the arrival of second wave, effect was still allowed to supersede the cause. Whether to call this as ignorance or overconfidence is left on the readers.

Prevention is better than cure. With lack of awareness and information on the development of the mutant in existence, how do we expect the rural habitations to prevent themselves from a disease which they term as modern in respect to its import from the developed areas? From the daily wage-earners, how do we expect an arrangement of pre-requisites such as thermometers and oximeters at home? At a place where livelihood is chosen over lives not by choice but by obligation, how do we plan to prevent the spread? In cities where social distancing, maintaining hygiene and sanitation have been a tussle, how do we ensure the same at the countryside? Where water has to be collected from wells or hand pumps and toilets to be availed publicly, is social distancing a reality there? With the first wave not affecting them much, the preparedness of the households as well as rural health services for the deadly repercussions of the second wave is highly doubted.

Frontline workers as part of local communities have been tasked with monitoring and surveillance in rural areas. For instance, ASHA workers in the villages of Uttar Pradesh are required to make door-to-door visits to check if the families undergoing any symptoms are sent to test centres or are under proper isolation conditions. Most of the workers lack medical equipment such as thermal scanners and pulse oximeters to check the temperature and oxygen level. Even if they are provided, they are sometimes taken back by the village headmen. This restrains their ability to aid, advice and convince the families. With just one mask and a pair of gloves assigned, it not only poses risk to their own health but also the houses they visit. The recent decision of the Jharkhand government to undertake “Intensive Public Health Survey” for all households is a welcome initiative but has to be viewed through similar critical lens of Uttar Pradesh. Although around one lakh Sahiyas, Sevikas and Community Health workers will be employed to trace the number of cases as well as the deaths and suitable precautions that a family is following, its effectiveness has to be carefully examined on grounds of targeted delivery. On finding any sign or symptom, a Sahiya will be required to carry a Rapid Antigen Test (RAT) which has a possibility of showing false results. This might demand conducting repeated test without the cause being addressed on time. Also, the ‘stigma’ associated with this virus is widely prevalent in backward regions. The fear of being socially rejected and blamed for spreading the virus disallows infected individuals revealing their problems to the health workers and hence, it majorly contributes in few turning up for the test, hence, keeping the test positivity rate low. Test Positivity Rate (TPR) is a measurement index that determines the approach to be adopted in tackling the virus and a false reflection of the same will cause alterations in the policy formulation process.

When the cities and towns in its phase of surge in cases have battled for a single hospital bed, the fate of rural areas with smaller heath care units and inadequate infrastructural facilities stands dubious. This calls for a provision of well-integrated transport system that can be accessed during emergencies such that the patients do not have to undergo logistical disturbances. Also, vaccine availability has to be strengthened by its accessibility. Technical incompetency as well as poor internet connection in relation to booking a vaccination slot for 18-44 years has deterred this opportunity to many, resulting in inequity. The recent release of “COVID-19 Containment &Management in Peri-Urban, Rural and Tribal areas” by the Ministry of Health and Family welfare seeks to strengthen the primary health system of these disadvantaged areas by focusing on community mobilization. As the virus has already arrived at the doorsteps of many rural and deprived households, its implementation, execution and reformation of the challenges faced in the process might threaten its efficacy. Nevertheless, it should primarily aim to counter the rudimentary problems that arise in local-level screening and management, few of them already seen above. With the virus taking over the lives of the handicapped (in terms of physical, mental, financial and social restraints), the pandemic has descended the disadvantaged to the strata of “doubly disadvantaged”.

– Bishakha Jajodia (Freelancer)

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