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Coronavirus continues to wreak havoc. After the disastrous second wave, health experts are predicting the third wave in coming days and that may make the situation worse than ever. Now the most concern thing is that the second wave of corona is spreading in rural India. The question became very vital at this point of time that, are the villages ready to deal with this pandemic? Because more than 65 percent country’s population lives in villages or rural India and mostly depend on Government health care services.
A survey shows that in 13 of the 24 Indian states, more Covid cases are reported from the rural area (village and small towns) compare to the urban area. According to the data in Odisha on May 9th, out of the total cases, 76 percent is from rural area and 24 percent is from urban area. Out of the total cases in the neighboring state of Jharkhand, 54 percent are from rural area and 46 percent are from urban area. Likewise, Chhattisgarh has reported 89 percent cases from rural area and 11 percent from urban area.
Government figures show that even today, the average level for secondary level health facilities in the country one has to cover a distance of 40 km.
Case Study
A few days ago, a pregnant woman named Suturi Majhi of Lukapai village of Mandibishi panchayat in Kashipur block of Odisha’s Rayagada district was taken to Bohi Kashipur Community Health Center at a distance of 12 km on a cot because the 108 Ambulance could not reach to her village due to lack of motorable road. After reaching to hospital, the doctor was not available and the only pharmacist who was running the show was unwell; so, finally the health worker helped her and she gave birth to a child. Thank God, both the mother and the child survived. But Margel Lachmi of Tialuma village of Malkangiri district was not as fortunate as Suturi Majhi. Her child could not survive as she could not get timely health service. “During my pregnancy last year at the time of Pandemic, I was in severe pain. We could not contact the ambulance due to poor network in this hilly area. So my husband put me on a bedsheet and then tied its two ends with a bamboo pole. He and his brother carried me like this to the public health center covering five kilometers of the hilly terrains. When we reached there, we found that the only Ayush doctor posted there has gone to the district hospital on corona duty. The nurse attended me but due to medical complications I gave birth to a stillborn,” Margel Lachmi busted with tears. “Had there been any doctor, my baby would have survived,” she broke down.
While asking about how they are handling this pandemic situation, she said, “Or village is surrounded by hills and terrains. Crossing the terrains and reaching to the public health centers, which is five kilometer away, is always as such a night mare for us in normal time. Till now, our village is left neglected, but what will happen if Corona comes here? As doctors are often not available here, what will happen then?”
While the rural health system has not even been able to provide 80 percent guarantee of saving the life of a pregnant woman and her child till date, God knows how the village is ready at all to face the epidemic!
A Frightening Picture of the Health System In Rural India
Primary health centers are considered to be the first point of contact between the medical officer and the village community. But the statistics raise the question whether this contact can be made? Rural Health Statistics-March 31, 2020 report states that as per public health infrastructure standards in community health centers, there is 78.9% shortfall of surgeons, 69.7% of obstetricians and gynecologists, 78.2% of physicians and 78.2% of pediatricians.
According to the National Health Family Survey-2018-19, there is a shortage of 22 percent primary health centers and 30 percent community health centers. Only 13 percent of the CHCs meet the Indian public health infrastructure standard. 30% of children under 5 years of age still die in villages due to respiratory diseases, diarrhoea, and measles. According to the standard, a PHC should have an X ray machine, but leave PHC, more than half the CHC does not even have this machine and hence, villagers have to go to the district hospital itself. Adding to the woes, hardly every district hospital has 2-3 ventilators, but in most of the hospitals the condition is worse.
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Health System Not Ready to Face Pandemic in Villages
Dr Girdhar Gyani, director general of the Association of Healthcare Providers, says, "The biggest irony is that government health services in the country have not been taken care of. If the private health services are more ready than the government health services, it is not a matter of everyone to bear the expenses.”
“In 1946, 92 per cent of the health facilities were in private hands while only 8 per cent of the health services were provided by the government. Sensing the danger, the Bhore Committee, which was constituted for the assessment of health facilities at that time, suggested that the government should take the services out of private hands and take it into its own hands as soon as possible. Today, while the population has increased manifold compared to 1946, nearly 55 per cent of beds available for admitted patients are in private hands. How serious the government is about health services can also be judged from the fact that it spends just 1.2 per cent of GDP on health items,” he added.
He further informed that in India about 18 lakh hospital beds are available (both private and government) which means the ratio is 1.3 per 1000 population, but we need 3.5 bed per 1000 population minimum. Apart from this, we do not have adequate numbers of specialist doctors. This, I would say the outcome of our faulty education system.
Things are Worse in Naxalite Affected Areas
An Asha karmi of Paplur village of Andhra Odisha border said that most of the time the doctors don’t come to the Primary health center due to the Maoist fear .The district headquarter hospital is about 110 kms from here. Being a Naxal affected villages if there will be any health emergency arrives, than you don’t even get vehicle to take the patients to the hospitals. Secondly people do not allow any outsiders to come here.
One of the health officer in Bastar, Chattishgarh informed, “The team of health officers who went to investigate Corona taken hostage, but after leaving, no officer spoke on this due to fear of Naxalites. Has Corona spread in the Naxalite affected areas? The administration is also unable to gather data. There are about 12 gram panchayats, or about 40 villages associated with this CHC. Nobody has stock of how many people died in remote Naxal affected areas.
Lesson Learnt
Corona struck us last year and within ups and down it is still aggressively taking toll more than last year. Do we learnt any lesson out of this to gear up our health infrastructure?
“We did not learn any lesson since last year. When the pandemic hit the country, we should have prepared our infrastructure during lockdown to combat but we did not do it. Let’s take an example of MKCG Medical college of Berhampur which was established 59 years ago but unfortunately we are yet to have oxygen plant in it,” Health expert Dr Kamalakant Panigrahi said.
Echoing the same opinion, health expert Dr Ramkrushna Purohit said, “We know that we have shortage of skilled health personnel, but overnight we cannot change entire health infrastructure but we should at least find the way to utilized our maximum infrastructure to provide the best healthcare facility at the time of need. In the last one year, the Government should have oriented its doctors and other health staff to handle the critical care. But unfortunately, it did not happened. So, how can we say that we have learnt a lesson?”
“Apart from this, there has to be massive awareness among the rural population on this kind of pandemic because the people of rural area are also very casual and they don’t know the consequence of this pandemic,” Dr Purohit added.
Corona has already reached to the rural villages. When the cities are ruined, we don’t even have a proper assessment of the infrastructure in the villages. Dengue and encephalitis kill hundreds of lives every year. Now this is a health emergency scenario. The need for oxygen has increased from about 3800 to 9000 MT at this time. No expert has the answer to how much destruction the pandemic will do in villages.
Dr. Gyani says, "God forbid, if the pandemic spreads unabated in villages, it would be difficult to even count the number of the infected patients and the deaths.”
