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Wednesday, June 03, 2020

Nation’s fight against Covid-19 cannot ignore the chronically sick, vulnerable

Physical distancing is imperative to check the spread of the virus. But the lockdown could have been implemented with more compassion. People’s health is the responsibility of the state.

Written by Shah Alam Khan | Updated: April 30, 2020 9:25:26 am
migrant labourers, migrant labourers Gujarat, Gujarat migrant labourers, Gujarat lockdown, Gujarat coronavirus cases, India news, Indian Express A few days after the lockdown was declared, I witnessed a stream of migrant workers and their families on the expressway — men carrying children, women, children carrying younger children and the elderly.

I live in a suburban, gated (let’s call it corona-secure) colony in Noida at the edge of Delhi. I don’t have to worry about my livelihood, clean water, food, or money to buy hand sanitiser. For work, I take the expressway to Delhi. A few days after the lockdown was declared, I witnessed a stream of migrant workers and their families on the expressway — men carrying children, women, children carrying younger children and the elderly. Poor people, deprived of their livelihoods, were supposedly walking to their villages, some as far as 200 to 400 km.

Sitaram (name changed) sits in front of my corona-secure colony. He sells balloons and had once told me that he earns about Rs 200 a day. Sitaram lives in a shanty across the road and has three mouths to feed. After the lockdown, his only source of income has dried up. But Sitaram is still lucky — he and his family members are apparently healthy. The lockdown could mean death for a large number of the chronically-ill or those under treatment or awaiting hospitalisation.

I have written in this newspaper about cancer patients who come to metropolitan cities for treatment. Once their funds evaporate, they live on the streets near the hospitals where they are undergoing treatment (‘The cancer refugees’, IE, July 23, 2018). Hundreds of such cancer refugees live on the street outside the AIIMS, in Delhi. Within 24 hours of the announcement of the lockdown, the streets and footpaths near the hospital were empty. I’m not sure where this cohort melted away. What is more worrying is that they might discontinue their treatment. It’s unfair to compare tragedies, but I feel that the chronically sick are the worst affected in situations such as the current lockdown.

According to a WHO report (2015), nearly 5.8 million people in India die every year of non-communicable diseases (NCDs). Constant evaluation and surveillance hold the key to treating such diseases — this anyway is a difficult proposition in a country like India. After the lockdown, a large number of these patients could have been severely affected.

In 2018, 2.15 million new tuberculosis (TB) cases were diagnosed in India. Imagine the plight of these patients, a large number of whom would be on treatment at DOTS (directly observed treatment short-course) centres and/or at hospital OPDs, which are now either shut down or inaccessible due to the stringent curfew. The resurgence of TB — multiple drug-resistant TB — as a result of not following treatment protocols is well known. It is important that we track the health of TB patients during the lockdown period.

The devotion of my colleagues, students, nurses, ancillary staff, and other members of the hospital where I work is worth mentioning. It was encouraging that the prime minister asked citizens to clap and clang thalis (utensils) as a mark of appreciation for healthcare workers. People responded to the PM’s call with gusto. Unfortunately, such appreciation was short-lived — junior doctors of the hospital where I work were asked by their landlords to vacate their premises. There were also reports of a female doctor in Telangana being assaulted by the police who had stopped her for violating the curfew — she was reportedly on her way to work. I wish there was less noise and more assurances about providing equipment to medical professionals.

Physical distancing is imperative to check the spread of the virus. But the lockdown could have been implemented with more compassion. People’s health is the responsibility of the state. But at no stage should it resort to methods that hurt the marginalised. The healthcare system of a nation should not be judged by its response to an epidemic but by its commitment to its peoples’ health in the long term. A well-oiled healthcare delivery system would have been useful in times like these. But it’s never too late to learn from bad experiences.

This article first appeared in the print edition on April 30 under the title “Compassion, Above All”. The writer is professor of orthopaedics, AIIMS, New Delhi. Views are personal

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