May 31, 2021

Understanding the COVID-19 surge in rural Madhya Pradesh

Physical distancing is still a dream and vaccine hesitancy the norm. Here’s what the COVID-19 surge looks like in Narsinghpur district, Madhya Pradesh.

6 min read

During the first wave in 2020, although COVID-19 had primarily wreaked devastation in cities, we noticed that there was fear in the villages about the virus. This, in addition to the strict national lockdown, meant that villagers were hesitant to go into cities, which helped curb the spread to some extent.

This changed in 2021 and the second wave. In Narsinghpur, a district  in central Madhya Pradesh, we saw a huge spike in the number of COVID-19 cases after Holi. Almost 50 percent of the villagers showed mild symptoms such as fever.

With the local district hospital over 100 kilometres away and the nearest primary healthcare clinic (PHC) more than 15 kilometres away, villages like Mehragaon, in Narsinghpur, have largely been left to their own devices to weather the surge in cases.

Physical distancing is still a distant dream

Even today, physical distancing is not the norm. Huge gatherings—mainly marriages, religious functions, and festivals—are one example of where almost all guidelines about physical distancing are flouted openly. In addition to bringing hordes of people together in confined spaces, traditions such as touching the feet of elders have resulted in the virus spreading. Further, patients who are asymptomatic tend to become super spreaders at such community gatherings and celebrations.

Bad infrastructure impedes ready access to medical services

If a patient’s health reaches the critical stage where they require hospitalisation, the roads to the villages are so bad that no ambulance will come to fetch them. Ambulances and drivers have previously refused to come into the villages citing the damage that the roads would do to their vehicles. Private vehicles offering transportation services charge exorbitant rates and are hence out of the reach of most low income families in the district.

Ambulances and drivers have previously refused to come into the villages citing the damage that the roads would do to their vehicles.

If the family does manage to reach the nearest hospital or PHC, it is rare that they also have a literate family member who is able to navigate the logistical challenges involved in getting a patient admitted in the hospital and fulfill any required formalities.

Given this, most families’ options usually include relying on advice circulated within the community, waiting the illness out, spending a significant portion of their savings seeking treatment, unauthorised doctors (also known as local Babas), or relying on local nonprofits and primary healthcare service providers, if available.

Overcrowding and home layouts make isolation increasingly difficult

Home isolation is almost impossible and potentially counterproductive in small, crowded homes where four to five family members share common, cramped spaces. Over the past few years, older, bigger village houses—equipped with courtyards and open spaces—have been replaced with smaller, minimally ventilated four-walled houses built under the Pradhan Mantri Awas Yojana. Additionally, given the high incidence of mosquitoes in the region, and the inability of most families to afford mosquito nets, most families are unwilling to stay inside the house.

It is therefore almost certain that when one family member is infected, the infection is passed on to the other members of the house.

a group of three women, one man, and a child standing_Sukarma Foundation_covid19 surge in rural madhya pradesh
“It is therefore almost certain that when one family member is infected, the infection is passed on to the other members of the house.” | Photo Courtesy: Sukarma Foundation

Stories of death and arrests fuel low testing numbers, and vaccine hesitancy

Stories of confinement in isolation centres, lack of good food there, COVID-19 positive persons being taken away from families, and forceful arrests have instilled fear around testing. In several cases, villagers have refused to go to testing centres to get a RT-PCR test. In this situation, we have found that the best treatment is home isolation, monitoring, administration of medicines and fluids, and timely follow-ups.  

Home isolation is almost impossible and potentially counterproductive in small, crowded homes where four to five family members share common, cramped spaces.

In Mehragaon, a village with a population of approximately 2500 people, only 80 people have been vaccinated as of May 5th, 2021. The tremendous fear around vaccination is so pervasive that I have struggled to convince my own parents to get vaccinated. Stories of illness and death—reports of four family members dying after taking the vaccine have also heightened this fear within the community.

We have seen this vaccine hesitancy play out even among the health workers working at Sukarma Foundation. These frontline workers—for whom the vaccine is mandatory—have refused to take it, retorting that they would prefer working under the risk of contracting the virus, rather than taking the vaccine.  

Local administration is also partly to blame for the low vaccination rates. Execution (namely mobilisation of resources required to conduct vaccination drives), has been riddled with inefficiencies and gaps. In Mehragaon, vaccinators only came once, and that too without a thermometer. Instead of checking the temperature using a thermometer, they relied on asking the villagers to self-report if they felt feverish or sick. When the villagers expressed doubt or said ‘perhaps’, they were turned away without their dose.

Early detection, isolation and monitoring, and access to basic treatment: Our 3-pronged strategy against COVID-19

The first few days after contracting the virus are crucial. With the right medication and monitoring, isolation, and patient support, the severity of the infection and recovery time can be significantly reduced. Therefore, in addition to preventative measures, early detection and treatment are equally important.

In Mehragaon, a village with a population of approximately 2500 people, only 80 people have been vaccinated as of May 5th, 2021.

In Mehragaon, Sukarma Foundation has extended its consultation timings and added 10 more beds at the healthcare centre. Further, the consultation fee of INR 60 per patient, has been waived and medication is distributed for free among low-income families. Removing this financial barrier has ensured that at the first instance of fatigue or fever, the person comes into the clinic for treatment. This has helped us detect and treat cases early on, significantly reducing the instances of rapid deterioration and the need for hospitalisation.

Where I work, most villagers are primarily engaged in agricultural activity. It is not uncommon to see patients with a fever continuing to work in the fields instead of hydrating and resting at home. By providing drip and steamer facilities at the local healthcare centre, we are treating and monitoring these patients at the centre itself.

We have also deployed our local health workers and volunteers to reinforce information and protocol about COVID-19 appropriate behaviour, raise awareness about isolation and treatment, and ensure proper surveillance and follow-ups.

The big need however in rural India is access to medical consultation, doctors, and medical supplies. By partnering with volunteer doctors abroad via the telemedicine services we’ve set up, and leveraging the time difference between countries, we have been able to provide round-the-clock accessible care to remote villages.

Awareness and financial support are crucial to tackle this second wave

Almost all of the focus has exclusively been on hospital-based and intensive care as opposed to investing in home-based care and developing infrastructure for proper isolation. From what we have observed in the field, most of the deaths can be avoided if the patients are treated within the first three days with the right medicines, monitoring and isolation, and ensuring that the patient feels cared for and comfortable.

Most people we work with who have visited city hospitals have complained of long lines and barely any face time with the doctor on-call. They’ve also noticed that the same diagnosis and medication are prescribed to patient after patient, reinforcing the notion of lack of care, and in some cases, medical negligence.

At the grassroots, the need of the hour is investment in awareness campaigns—to drill into the communities the need for physical distancing, train the community to identify early signs of COVID-19, encourage widespread testing, and be diligent about taking medications, rest, and home isolating in the event of testing positive. This needs to be supplemented with financial support to low-income families.

Most people we work with who have visited city hospitals have complained of long lines and barely any facetime with the doctor on-call.

When patients visit city hospitals, they usually return with a long list of prescribed medications, injections, and drugs, much of which they cannot afford. They then ration how many medicines they purchase given the money they have. For example, if a family only has INR 500 to cover medical costs, they will ask the shopkeepers to go through the prescription to give them only INR 500 worth of medicines. Providing financial support to these families will encourage them to buy all the drugs and medications needed to make a full recovery.

The only sustainable solution against COVID-19 and any of its subsequent waves is vaccination. Any attempts to overhaul, support, and meaningfully improve the existing public healthcare infrastructure in rural India will take time. In the short term, without concrete steps to address fear and misinformation about the COVID-19 vaccine and vaccine hesitancy, any solution will only serve as a band-aid.

This piece has been edited from a panel discussion hosted by IMPRI and Tarun Bharat Sangh, where Maya Vishwakarma spoke about the ground realities of COVID-19’s second wave in Mehragaon, Madhya Pradesh.

Know more

  • Take a look at how frontline workers are having to bear the brunt of the misinformation and fear surrounding the vaccine in Madhya Pradesh.
  • Read about what nonprofits can do to tackle the COVID-19 surge in central India.
  • Read about the unique challenges of responding to COVID-19 in rural India and suggestions for a path forward.
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ABOUT THE AUTHORS
Maya Vishwakarma profile
Maya Vishwakarma

Maya Vishwakarma is the founder and chairperson of Sukarma Foundation. She hails from Mehragaon, Narsinghpur, Madhya Pradesh where she led the initiative to set up a mini-factory that employs local women to manufacture low-cost sanitary napkins for tribal and rural girls. She has also made a documentary film and authored a book titled Swaraj Mumkin Hai (Independence is Possible) advocating for sustainable villages.

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