Rural India and coronavirus: non-COVID patients suffer as healthcare services disrupted

Jo Corona se nahi mara wo to aise hi mar gaya, jisko bachaya ja sakta tha wo bhi mar gaya kyunki illaj hi nahi mil raha hai.” (More people have died because of the lockdown, even those who could have been saved have died as no medical support was available.)

For 35-year-old Om Prakash, a migrant labourer who walked back 1200 kilometres from Morbi in Gujarat to Attara tehsil in Banda district of Uttar Pradesh, life has changed dramatically in a fortnight – for the worse.

He lost his 60-year-old diabetic mother to renal complications on May 14. Two weeks later,  his 33-year-old wife, suffering from tuberculosis, breathed her last.

Both curable illnesses, but lives lost as no medical help was available because of the lockdown.

Om Prakash says after returning to his village Kuchipurva in Banda late  April, he visited the primary health centre and neighbouring private clinics many times, first with his mother and then with his wife. “Every time we went to the primary health centre no doctor was available. We were told OPD (out patient department) was closed and all doctors and staff were on COVID duty.”

“I only wish this doesn’t happen to anyone. I have no money left now. When no other doctor was available, in desperation I even visited a local doctor that many say is a ‘jhola chaap doctor’. Even his medicines didn’t work for my wife.”

Preventable Deaths

Om Prakash’s mother suffered from a renal complication and her body was swollen with fluid retention due to increased blood sugar levels. This can turn fatal if immediate medical care is not given, and that’s what happened. No health centre or doctor was available in the Attara block and the primary health centre has been closed for all treatment other than deliveries.

His wife, a tuberculosis patient for last five years was on regular medication and treatment at the TB centre in Banda district hospital.

“In her last few days, she had stopped eating properly, was severely anaemic and used to get breathless very often. We used to force feed her milk and roti but she would eat very little. She had become very weak,” Om Prakash says.

Travelling to the district hospital, which is 30 kilometres away, was not possible as no transport was available during the lockdown. Om Prakash says the fear of police action on the roads further dissuaded them to travel with sick people. “Maar to sirf gareebon ko padti hai. Police baat nahi karti. Humne dekha hai gaon ke kuch logon ko, jo gaadi bhada kar ke gaye the. Maar bhi pada aur gaadi ka 1200-1500 ka challan bhi kat diya. Bimar ko le kar kahan kahan jayenge.” (It’s only the poor who gets beaten. You can’t reason with the cops. We saw the fate of our village friends who tried travelling in hired vehicles. They were beaten up and even had to pay 1200-1500 rupees fine. Where all will we run with sick people.)

7 kilometres away in Khamhaura village in the Attara tehsil, an eerie silence has gripped the Kuchbandhiya Dera village in Banda district of Uttar Pradesh. Two members of the community, both suffering from tuberculosis, passed away in a matter of a few hours on June 1.

Raj Kumar, a 35-year-old migrant worker, was taking treatment from a private TB clinic in Allahabad and intermittently used to visit the government hospital in Attara. Raj Kumar missed his TB medication for two months as travelling to the private centre in Allahabad was not possible during the lockdown. Two visits to health centre in Attara town also did not help as doctors would see him from a distance and write pills that didn’t work.

His brother Raju Sunni told CNBC-TV18 over the phone that Raj Kumar’s health was stable and disease had been under control before the lockdown. “It has been 2 months that medicines were not available. All our work has stopped and hence no money to buy from private hospital.”

Severe under-nutrition during the last 2 months of the lockdown has led to significant deterioration in the health of these TB patients. “There is no money to buy vegetables or daal. We are eating boiled rice or salt and roti with the ration we get on our card,” Raju Sunni said.

55-year-old Manohar, another TB patient in the same Kuchbandhiya community faced a similar fate. Malnourishment and lack of medication led to his condition worsening quickly and in a matter of a few days the disease engulfed Manohar’s body.

People in the community say there are 11 more TB patients whose conditions are also deteriorating and the families are now fearful for their lives.

Absent health services 

All primary health centres across Banda district, like the rest of the country, stopped OPD services since the lockdown started three months ago in March 2020. Only emergency services, primarily deliveries, are available, and those too have been erratic. The Community Health Centre in Naraini that covers Attara tehsil has been converted into a dedicated COVID-19 centre. Only the district hospital in Banda town has been handling all non-COVID cases.

Dr Santosh Kumar, Chief Medical Officer of Banda district told CNBC TV18 over the phone that in the last 15 days regular services at TB centre have been resumed. “Diagnosis services and treatment has been started,” he said in a brief phone call without giving details. Repeated attempts to connect with him again failed.

Dr B.S. Rajput, Doctor at the CHC Naraini agreed that most PHC doctors and staff had been deployed for COVID duties.

While the government claims emergency health services have been functional during the lockdown, villagers contest that. With no doctor or nurse, healthcare services have been as good as defunct. Reaching the district hospital, 35 kilometres away, has not been possible for all due to unavailability of transport and strict police vigil during the lockdown.

On May 14, Chief Minister of Uttar Pradesh Yogi Adityanath had asked private hospitals and nursing homes to start non-COVID services. However, there has been no indication by the state government or the central Ministry of Health on resuming non-COVID services in government’s primary and secondary health centres that cater to large parts of rural India and those who cannot afford private healthcare.

“I have spent a lot of money on my wife’s TB treatment in private clinics earlier and hence a few months ago had shifted to government TB clinic in the district hospital. Even that did not help,” said a teary-eyed Om Prakash.

India is now in the 11th week of the world’s strictest lockdown that has crippled health services for non-COVID ailments, across the country. As even bigger cities like Mumbai and Delhi, with relatively good heath infrastructure, have seen non-COVID services disrupted, rural areas with limited resources have been impacted significantly. Among other issues, the 2018-19 Economic Survey had highlighted that 5 percent PHCs in India had no doctors and 60 percent had one doctor. In Uttar Pradesh 70 percent PHCs had just 1 doctor.

Health experts have been pointing to the negative impact of lockdown and government’s narrow approach to divert all health resources on controlling COVID-19 on other diseases and illnesses, such as TB, AIDS, Malaria. TB in particular requires regular medication, constant follow-ups and diagnosis.

A recent World Health Organisation survey of 155 countries including India, showed that reduced mobility, reallocation of health staff for COVID-19 control has partially or completely disrupted services for non-communicable diseases. Study showed almost 49 percent for treatment for diabetes and diabetes-related complications, 42 percent for cancer treatment, and 31 percent for cardiovascular emergencies were disrupted.

A study commissioned by the Stop TB Partnership, a global initiative working towards eliminating TB, showed that with a three-month lockdown and a prolonged period to get restore all services, almost 5-8 years of all gains in the fight against TB will be lost. The global incidence could see an additional 6.3 million cases between 2020 and 2025 and an additional 1.4 million TB deaths.

Incidentally, all these diseases and medical conditions are serious co-morbidities that have been linked to higher COVID-19 fatalities.

Dr Madhukar Pai, Director of Global Health, and Director of the McGill International Tuberculosis Centre said, “New TB case numbers have dropped precipitously in India, and large numbers of TB patients on treatment are at risk of discontinuing their TB treatment due to challenges in getting medicines and other support services.”

Dr M C Pal, the District TB officer in Banda while saying that the field officers and ASHA workers have been delivering required medication to patients with the government TB centres, he agreed some patients do get left out. “Those who are seeking private care, like Raj Kumar in Khamhaura village, get left out because they are not registered with us. We do not follow-up with them.” Large number of these TB patients have slipped through the cracks, with absolutely no fallback.

Villagers, however, have also told CNBC TV18 that even the supply of government’s TB medication has not been regular. A doctor, if available, refrains from touching the patient and diagnoses from a distance.

Nowhere to go

Sitting in his veranda Om Prakash looks at his four-year-old son playing in the mud and sighs. He has two children, one 8 and the younger 4 years old.

“I don’t know what to do now. I have to raise my two children, and look after my old father.”

Travelling back from Morbi was like a nightmare he had survived. Om Prakash worked as tile cutting machine operator in the ceramic town of Morbi in Gujarat and got paid Rs300 for a 12-hour shift. As the country moved into a complete lockdown, Om Prakash like lakhs of other migrant labourers headed back home. With just Rs 170 in his pocket, Om Prakash walked nearly 1200 kilometres, with occasional lift in trucks or tempos for some distance and mercy of locals distributing food on the way. It took Om Prakash 8-9 days to reach his village in Banda as the month of April closed.

He already has a debt of Rs4500 that he borrowed from family and friends since he came back.

“Now I can’t even go back to the cities for work. It is difficult to manage even for single individuals and now I have my father and children. I can’t take them along. Will try to find work here on the farm of some wealthy farmer after the lockdown lifts,” he said – CNBCTV18