The number of Covid-19 cases is easing off across India but not as rapidly in rural as in urban India. Some numbers themselves are under a cloud, particularly in areas where the quality of reporting is not good. A recent Centre for Science and Environment report said that rural districts had seen almost 52% of Covid-19 deaths and 53% of new cases in May 2021, based on a sample study. It also said that community health centres in rural districts needed 76% more doctors, 56% more radiographers and 35% more lab technologists, which illustrates the nature and extent of the problem.
To understand what India can do to improve hard and soft infrastructure in rural areas, we spoke with two doctors who have been working on some of these challenges.
Rajani Bhat, consultant pulmonologist from Bengaluru, is a postgraduate from the Albert Einstein College of Medicine in New York and an American Board of Medicine-certified doctor in pulmonary diseases and critical care medicine. Pavitra Mohan, based in Udaipur, is co-founder of Basic Healthcare Services, a non-profit that has been working primarily in southern Rajasthan. He has an MBBS and MD from Delhi University and a master’s in public health from the University of North Carolina. He has worked extensively in community-based primary health care and nutrition. Edited excerpts:
Dr Mohan, as you look back over the past two months of the second Covid-19 wave, what can you tell us about the behaviour of the virus and people’s response, particularly in rural India?
PM: One thing is clear that the virus has spread much more rapidly in this wave compared to the past wave and there have been no divides between urban and rural, or rural and deep rural, or deep rural and tribal areas. The infection has spread in the [remotest] areas, which was not the case the last time. So in some ways, it is actually the first wave for the deep rural and tribal areas. Last year, there was no wave for them, it was largely restricted to urban areas. Some spread happened when the migrants started returning. After a month [of nationwide lockdown], when they were allowed to come back, there was a slight surge, but it was not really a wave, it was probably a small ripple. So for [deep rural areas], it is actually the first full-blown wave. The virus has spread much more and much deeper this time and has not followed any boundaries of urban, rural or tribal.
The way people have responded to [the second wave] has been guided by a lot of fear and also a lot of mistrust of public healthcare systems. I think this led to a situation where the combination of fear and mistrust meant that people stayed indoors. They would not go out to access healthcare, and especially not from the public healthcare systems at all. They would seek care from whatever was available closer by, but avoided the public healthcare systems in general. This is the scene in areas that we work in. I’ve heard similar things from other people working in similar rural and tribal areas elsewhere.
[Where did] the mistrust have its origin? I think, in general, there has been a mistrust of the public system for a long time in rural areas, partly guided by the fact that services, especially curative services, have not been responsive. Wherever there are strong public health systems, that is not the case. There is greater trust and that continued.
The [mistrust] was further accentuated by the fact that last year when people, especially the migrants returning from the cities, were isolated and forcibly quarantined, that led to a fear of the government and public health systems in particular, and of the disease. [The fear was that] if you said you had Covid-19 or were found to have the disease, then you’ll be shifted away. This was of course fueled by social media, news and reports of people dying and all kinds of myths and misconceptions also being…