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Tuesday, July 05, 2022

How the second wave of the Covid-19 pandemic has ravaged rural India

In rural India, beyond the lack of oxygen beds and life-saving drugs, doctors and nurses have had to battle fear, misinformation and despair

Written by Ankita Dwivedi Johri |
Updated: June 6, 2021 10:10:10 am
rural doctorsEven as the worst appears to be over in many parts, the devastation of the past months, the fatigue of gruelling shifts for over a year and the fear of a third wave have left many distressed. (Illustration by Bivash Barua)

Around the second week of April, Suraj (name changed), a ward supervisor at a 1,500-bed government hospital in Saifai, Etawah, stepped out for a rare break. The daily caseload in Uttar Pradesh was almost 10,000 a day by then. Soon, he saw a bus approaching with 70 COVID-19 patients, most of them over the age of 60. “I felt my ears get hot. The hospital was already brimming with patients. It had been 45 days since I had got a day off, and wearing the PPE gear for six-seven hours daily was making me feel nauseous and disoriented, but the patients kept streaming in,” says the 24-year-old.

By mid-May, about 1,200 km away, Swapnil (name changed), a senior resident doctor in West Bengal’s Alipurduar district near the Bhutan border, watched five COVID-19 patients die in a matter of hours during his night shift. “The elections had just wound up and I couldn’t help but blame the campaigning and polls for the spate of deaths in the state. Exams, elections, weddings, everything is unnecessary in such times,” says the 30-year-old.

After leaving a trail of death and misery in major metros, as the rampaging second wave of COVID-19 began to tear through India’s poorly-equipped rural areas since April this year, the country’s 3.8 million healthcare workforce (National Sample Survey Office, January 2016) found itself scrambling to treat patients, while dealing with acute shortage of oxygen, life-saving drugs and beds. Even as the worst appears to be over in many parts, the devastation of the past months, the fatigue of gruelling shifts for over a year and the fear of a third wave have left many distressed.

Uttar Pradesh has had over 20,600 deaths since the pandemic struck last year, up until now. With over 99,000 deaths in the same period, Maharashtra reported the highest number of deaths in the country. Karnataka reported over 29,500 deaths and West Bengal had over 15,800 at that time, while Bihar’s death toll stood at over 5,200. Suraj blames misinformation and fear, among other factors, for many COVID deaths.

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Dr Arvind Kumar Singh, who works at the Vardhman Institute of Medical Sciences in Bihar’s Nalanda district, agrees with him. “People don’t want to get tested, they self-medicate and doubt the doctors at every step. I have had patients who have been popping Ivermectin pills (used to treat parasitic infections) without ever seeing a doctor,” says Dr Singh.

In neighbouring Bengal, Swapnil says, what bothered him the most were the crowds in large election rallies, without masks, all through March and April. “We knew we would be overwhelmed with patients after May 2 (the result day). And that’s what happened. With 250 beds, ours is the biggest government hospital in the district and our patients are among the poorest in the region. Seeing them die made us feel helpless,” he says.

Health workers carrying vaccines walk down a hill during a vaccination drive against Covid-19 in Doodkulan village, south of Srinagar, Saturday, June 5, 2021. (AP Photo: Dar Yasin)

The “shortage of everything”, including staff, had also taken a toll. “With the second wave, over 50 per cent of our staff got infected. Doctors had to double up as nurses, technicians and ward boys. Not everyone can operate equipment such as ventilators and eventually we had to train people on shifts. The government was doing everything in its capacity, but the severity of the infection and the volume of patients — ek jaa raha thha aur ek aa raha thha (one left and the other entered) — weighed everyone down,” says Dr Singh.

Meanwhile, in early May, when 23 patients passed away at a COVID-19 facility in Karnataka’s Chamarajanagar district, allegedly because of a shortage of medical oxygen, Yogesh CB was busy checking sugar levels and vitals of infected patients at a COVID-care centre in the district’s Kollegal taluka. The incident sent alarm bells ringing across the centre, admits the 35-year-old nurse. Karnataka’s high death toll and daily caseload — which continues to be over 20,000 a day — have consistently put it among the top five worst-affected states during the pandemic’s second wave.

“There was no such shortage at our facility, but relatives of patients got very aggressive. They were not allowed in the COVID wards and they started asking for hourly updates. In every shift, there are two staff nurses, and we are a 100-bed centre. It was impossible to update families and also do our job. Patients come from nearby villages. They have little knowledge about COVID-19 and want immediate results. It is very difficult to handle such expectations,” says Yogesh.

Dr Singh, too, faces similar situations when “families leave the patient and flee as they are scared of contracting the disease. Or, they quarrel with us after the death and don’t let us pack the bodies in bags and follow COVID-19 protocols. Both ways, it gets difficult for us,” says Dr Singh.

Last week, a video of a doctor on COVID-19 duty in Assam, which showed him being brutally kicked and thrashed by relatives of a patient who had died at the health facility, surfaced on social media. So far, the police has arrested 24 people allegedly involved in the incident.

For those in the COVID-19 ward, it’s the isolation that is unsettling. “In the wards, people are alone for days. They see videos of piles of bodies being cremated together, bodies being thrown on river banks, and they have no one to confirm or dismiss these reports. The isolation and fear kill them first. The others, who do not have a phone, are seeing patients die next to them. I have seen strangers shudder and cry when patients living with them in the ward pass away,” says Suraj.

Daily wage laborers wearing face masks wait for work in Dharmsala, Saturday, June 5, 2021. (AP Photo: Ashwini Bhatia)

At times, the situation also gets out of hand. “At the peak of the second wave, we saw people trying to flee the wards. One night, I had to put a padlock on the ward from outside. It did make many people anxious but I had no option. Their families would have killed me the next day if they didn’t find them,” says Suraj.

As a ward supervisor, apart from arranging beds and checking on patients regularly, Suraj also has to provide them with regular meals. Each COVID ward at the centre has two ward boys and 35 beds. “We have three fixed meals, apart from snacks like tea, kadha and 100 gm of dried fruits. One week, a message on the benefits of kaju and kishmish in treating COVID-19 started doing the rounds on social media, and patients started demanding them with every meal,” he says.

But it’s the deaths, adds Suraj, especially of young people, that gives him sleepless nights. “Once, a boy my age had borrowed my phone to make a video call to his parents. We spoke for a long time and then I left him around midnight. When I reported to work at 8 am the next day, he was gone. I have seen entire rows of patients, at least 10 of them, collapse at once,” he says.

Inside the wards too, the conversation provides little relief. “It’s only COVID! COVID! COVID! We now have a black-fungus patient in ICU. Like COVID, no one knows anything about it either, par baatein nahi rukti (The conversations don’t stop),” he says.

“I have never feared death”, says Dr Singh, but when he tested positive in late April, he grew concerned for his family. “I didn’t go back home to Patna for days and stayed back at the medical college. I didn’t want to infect my wife and child. I stopped stepping out on campus, too. My symptoms were not too severe and I only took vitamin C and zinc pills. No medicine can cure COVID-19 and I got infected despite vaccination,” says Dr Singh.

Yogesh has also been ensuring social distance from his family for over a year. But despite his efforts, he tested positive just a few days after the Chamrajnagar incident. “I knew there was no shortage of drugs and oxygen at our centre, but I was scared because both my wife and five-year-old daughter also tested positive for the virus. I can go on doing my duty and my family has always supported me, but I couldn’t shrug off the thought that I had infected them. The entire 14-day period of the disease was a test,” says Yogesh, who is among the 45 nurses at the 150-bed COVID facility.

The regular rounds in PPE gear in the oppressive April-May heat added to his physical woes, says Suraj, “I have seen my co-workers faint from dehydration.”

“Even when we hear about colleagues losing their loved ones and see them break down, we can’t go near them. For over a year, I have been stuck in my room after work, following the same routine of sanitisation every night, including using a UV machine to sanitise key chains, wallet, etc.,” says Swapnil.

Ambulance drivers who transport Covid-19 patients halt between their trips in Kochi, Kerala, Friday, June 4, 2021. (AP Photo:R S Iyer)

Most healthcare workers in rural areas admitted to infrastructure challenges in April-May — from lack of beds, ventilators and testing kits to access to oxygen — but have refused to come on record claiming fear of reprisal. At the Saifai facility, Suraj says that an oxygen plant was set up recently to address concerns of shortage. In Alipurduar, Swapnil affirms that “vaccination is helping bring down the caseload”, and, in Kollegal, where the situation “is coming under control”, blaming authorities won’t help, says nurse Yogesh.

But they all admit that the second wave has been a reality check for the country’s rural healthcare systems and has underlined the need to invest more in it. Last week, nearly 3,000 junior doctors went on strike in Madhya Pradesh demanding, among other things, a hike in their stipend and free treatment for them and their families if they contract COVID-19.

The lack of any outlet to break the “cycle of stress and depression” has been making matters worse. “Before the pandemic, travel helped me deal with the stress of my profession, but now it’s not possible,” says Swapnil, whose family stays in Siliguri.

In the meantime, these frontline workers have been finding little moments of respite to stay the course. While Dr Singh has been tuning into his favourite ’90s melodies of Alka Yagnik and Udit Narayan after a busy shift, Swapnil has taken up badminton, “a game that ensures social distancing.” “I want to take up a position in a bigger city soon, maybe Kolkata. It gets very lonely and stressful in these parts. There are only so many walks in forests that one can take,” he says.

Yogesh, however, continues to maintain distance from his daughter, avoiding any direct contact. “It has been the toughest phase of my career,” says Yogesh, who has been a nurse for over 10 years. As for Suraj, who continues to clock in less than four hours of sleep every day, he is grateful for the Rs 25,000 monthly salary in these tough times, says, “Ab toh sapne bhi COVID ke hi aate hain (Even my dreams are only of COVID now).

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