Marathwada: The Social Virus

—Mahatma Gandhi

Through the second wave of the pandemic, as it washed over the Indian landscape, Marathwada was a microcosm of what was happening elsewhere. Like many other swathes of rural India, it saw the same cloudburst of morbid events—death stalking high and low, oxygen running out, scanty health infrastructure, inadequate ­vaccines and the viral inkblot spreading out into far-flung villages. But Osmanabad, in this poverty-ridden ­region of central/southeastern Maharashtra, has added a small note of optimism to that: it has got the first ­establishment in India to produce medical grade oxygen from an ethanol plant. It’s created a flutter of hope even as the district, like so many others in India, continues to reel under the by-now-familiar tsunami of horror.

The second, deadlier, wave of COVID-19 has even reached the ­remote villages, of that there’s no doubt. And though social media ­timelines remain flooded with urgent appeals for beds for urban patients, ­villagers are succumbing to the virus due to the slightly different dynamics that plays out in the hinterland. Stigma is a real factor, and that brings on both vaccine hesitancy and reluctance to test. And both contribute to the risk of mortality in different ways. Add to that the usual list of things: lack of hospital beds, oxygen, and the existing ­logistical nightmares that attend to ­diagnosis and treatment in rural areas. Not to speak of good data being even more conspicuous by its absence than good healthcare.

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ASHA worker Alkatai Magar, from Shingoli village of Osmanabad district, has her job cut out. She’s thankful for being vaccinated as a frontline worker, but constantly deals with chronic ­anxiety about not having sufficient ­protection—sanitisers, masks and gloves—while surveying and meeting Covid-positive patients on a daily basis. ASHA workers like Alkatai are the only link between thousands of ­villagers and the public healthcare ­system. Their experiences of these crucial primary screenings tell a ­disturbing story of people burdened with stigma, misconceptions and social pressures, besides the disease itself and lack of medical treatment.

She not only tries to convince people to come forward and share the ­information if they have symptoms, but tries to help them reach the health centres for testing and treatment. Very often, she’s the only emotional support for a grieving family that has lost its loved ones to Covid, sometimes in ­faraway hospitals—love departs, but stigma spreads like a virus all around you. “So many families have lost their main, elderly, earning members. They are not in a position to talk to anyone. It is very bad. Treatment, cremation, life after losing family members,” she says. Social attitudes to calamity can anyway differ widely between a city and a harsh place like the Marathwada outback. An urban populace is prone to loudly vocalising its demands and protesting when they are not met; in this part of the ‘Suicide Belt’, afflicted as it is by endemically high levels of agrarian distress, a death can be just another silent index point in a ­philosophical register leaning towards fatalism and stoic resignation. Life ­carries on, mutely.

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Alkatai cites four deaths in Shingoli village in the first week of May and talks about a family where mother and daughter both died of Covid due to lack of beds. “Sumitra Adate, a 45-year-old mother, had really struggled to make ends meet as her husband suffered from mental illness and couldn’t work. She worked at a hotel and got her son and daughter married. Now both the mother and daughter are gone.” Another woman of 37 years died on the fourth day of hospitalisation. “Same story: Swati Shinde did not get bed, ­oxygen and ventilator on time…. She was married very early to a relative of hers in the village and has two children. Everytime I call surviving family members, they start crying. They don’t know what to do,” Alkatai says. At a human level, tragedy carries the same ineffable weight universally, but the social elements mark out a village differently. What Osmanabad is witnessing could be the story of any primarily rural district—it’s predominantly agrarian, with 87 per cent of its population residing in rural areas and low human development indices.

“We try to tell them everything about precautions and symptoms, but there’s a general tendency to treat yourself at home when it comes to cold, cough and fever,” Alkatai explains. She adds that people are extremely scared by ­whatever they have heard of corona. Hanumant Pawar, a Congress functionary from Osmanabad, says the reliance on quacks and sadhus for jadi-booti treatment too has worsened the situation. Like elsewhere in rural India, he says, many deaths and infections are simply not recorded. And the stigma att­ached to “being positive” is such that people are trying their best to avoid being tested and found Covid-positive.

Ramchandra Survase, from Kajale ­village, learnt this the hard way. He has a tamtam rickshaw, the ones that carry six to eight passengers, and has pretty much been jobless for over a year. He and his family tested positive and were asked if they could isolate at home. “We agreed because there was so much rush at the hospital. But we didn’t expect to be treated like this by society. Even the milkman refused to deliver milk at our house. It was very hard.” His wife and two children all had Covid and none could step out of the house. Treatment and recovery happened, but he’s more shaken by the ostracism they faced.

Testing facilities and hospitals are typically at least a few kilometres away, and once someone is suspected to be infected, no one agrees to ferry the person. “Covid has ruptured the ­community help or collective action in villages, which was crucial to general functioning because other facilities are so limited,” says an activist. The ­disturbing impact of this complex thread of factors is always on the ­infected individual. So Osmanabad may have a relatively lower caseload, but by the time a patient reaches the hospital, it’s often too late. District ­collector Kaustubh Divegaokar says many Covid deaths occur within 72 hours of admission. The intangible ­social dynamics play as much of a role here as infrastructural issues.

Advocate Nitin Bhosle of the Bar Council of Osmanabad recently wrote a letter to the state health minister, Rajesh Tope, to highlight the precarious situation on other counts too. “We believe the deaths in private hospitals do not get notified. Also many patients are neither testing nor getting treatment. The numbers could be much higher. In the span of a few days, nine lawyers who worked at the district court have died.” Collector Divegaokar concedes there are issues—they more than doubled the capacity of beds at the district hospital (from 120 to 400) during the bit of the breather they got between the first and second waves, but cases more than tripled. “And the beds need power supply for oxygen…if the load increases too much, the ­pressure can drop.” The district lacks ­sufficient medical staff in terms of ­specialised secondary and tertiary care. However, compared to last year, the availability of ICU beds, oxygen beds and the number of ventilators in the district has increased significantly. There are 1,035 oxygen beds, 262 ICU beds and 126 ventilators available in the district now. But remember, that’s for a population of close to 20 lakh—with 32,573 new cases registered since February. And that’s the official tally, which records only an active caseload of 5,439 as of now. Multiply that by an unknown factor—data scientists ­suggest anything from 10 to 20—to guess the real extent of the gap.

What’s more worrying, the unrolling of vaccines has not picked up. Officials deny any “vaccine hesitancy”, but act­ivists talk of a three-fold problem on this front. One, vaccines are simply not available. Two, the rural population is inevitably lagging behind on digital registrations. And three, rumours or reports of side-effects of the vaccines are rife. Also, Covid deaths after ­vaccination are adding to the fear and reluctance. State Surveillance Officer Dr Pradeep Awate, an old hand at pandemic management who had handled the 2009 swine flu in Maharashtra, says the state has crossed 2 crore vaccinations. “We need to release our own data backed by science to deal with hesitancy, especially in rural areas,” he adds. “We have to send a clear message that it’s a disease and can happen to anyone. Patients should not be ostracised.” But for now, Covid is not the only virus stalking these parts.