On the day that rumours of a Cabinet reshuffle swirled about in Delhi’s hot, dry air last week, I went off to Uttar Pradesh. It has been a while since I have been able to do any reporting and I was eager to see if the pictures of shiny, spotless health facilities that appear in Yogi Adityanath’s advertising blitzkrieg are real. I headed in the direction of Agra, only to discover that since I last came this way so many new roads have been built that they form a concrete blanket over the villages and dirt tracks that once made up the landscape. So, I had to drive for a longish while before finding real villages.
It was time well spent. My driver, Rakesh, was from Uttar Pradesh and full of stories of loss and suffering. “My mother died of Covid,” he said, “or perhaps I should say she died because there was no oxygen in the district hospital where we took her. Not only was there no oxygen in the hospital, there were no medicines and there were so many sick people and so few doctors that she died within half an hour… No, they didn’t record it as a Covid death.” He himself got Covid, he said, but was forced to get back to work as soon as he could because all his savings have gone on medical expenses. It is a story that has sadly become all too familiar.
The first village I visited was called Dankaur. I drove straight to the Primary Health Centre where, under a poster of Yogi Adityanath, women sat in rows on the floor of a tin shed and listened to a lecture on Covid symptoms. When I wandered about the rest of the centre, I noticed that it was relatively clean. Outside the ‘Covid room’ I talked to a group of young men who seemed all to have had Covid. There were sick people in every other house in April and May, they said, but most people treated themselves at home. Those who went to the hospital never came back. Twelve young men had died in the village at the height of the second wave, but they did not know if these were recorded as Covid deaths. It was the same story in other villages. Vaccinations have started happening, but people said that the health centres in which they were being given were dirty, overcrowded and unequipped with basic things like fans.
What I gleaned from this short expedition to Uttar Pradesh is that no lessons have been learnt from the pandemic. The Chief Minister is using denial as his shield so he refuses to accept that many more people have died of Covid than he has counted. He is good at denial so he continued saying through the worst days of the second wave that in his state there was no shortage of oxygen, hospital beds or medicines. When long lines of shallow graves appeared on the sandy banks of the Ganga, he said that this was not unusual because there were certain Hindu communities who traditionally buried their dead. Other chief ministers have also used denial to conceal reality, so it would be true to say that most rural health centres and hospitals remain as useless as they were before Covid.
This is the reason why Modi’s new Health Minister is the most important man in his Cabinet. I had never heard of Mansukh Mandaviya and so did some research and discovered that he comes from Gujarat and used to be a BJP student leader. He is not a man who has worked in public healthcare so may I humbly suggest that he begin by inspecting Primary Health Centres in our northern states to see for himself the enormity of the task he faces. Health is a state subject in ordinary times, but these are not ordinary times. This is the worst health crisis we have ever faced, and we do not have the infrastructure to cope with it in the villages of our northern states.
Before the ‘bhakt’ brigade starts screeching, let me say clearly that the abysmal state of public healthcare has not happened in the past seven years. It is the result of decades of neglect by bureaucrats and political leaders who knew that they never needed to use the hospitals they built for ‘the people’. What is worrying is that in the past 18 months almost nothing has been done to make the improvements so urgently needed. They will not happen now either unless the Prime Minister ensures that his new Health Minister has his full support to do what needs to be done to rebuild rural health facilities.
Rebuild may not be the right word, since in many cases health facilities will need to be built from scratch for the vaccination programme to succeed. Our new Health Minister must begin by first doing what his predecessor never did, which is to acknowledge the enormity of the problem. Then he must take stern action against chief ministers who continue to use denial as a shield. Denial is not an option because we need hundreds of thousands of vaccination centres to be built from scratch or we will not succeed in vaccinating all adult Indians by the end of this year.
So congratulations, Health Minister, on your new job. It is the most important job in India today.