Putting all eggs in the same basket: Crisis of Non Covid Health in Rural India during Covid -19 Pandemic | Atanu Sengupta, and Asish Kumar Pal

by Dr. Atanu Sengupta, and Dr. Asish Kumar Pal

Abstract: 

The rural poor people are suffering from so many problems due to prolonged lockdown for combating the spread of current coronavirus pandemic. Along with economic crisis they are deprived from health services from public sector. The middle income group and richer people also are in trouble for out break of the covid -19. They confess to be in fear in case of emergency patients of the families. In this time the government has moved to emphasize on covid related treatment such as testing, isolating and research and development on covid patients. In our daily lives there are so many non covid related diseases that have taken a backseat. The vulnerable households who are unable to take the scope of private medical treatment due to poor economic condition are in most deplorable condition now. WHO has already warned that this neglect in general health can become fatal. This paper attempts to show all the rural households including several type of patients have faced so many difficulties from this crisis. We have also focused in this paper the comparative situation between rich and poor. This study wants to say the people are afraid of death by not being infected of covid positive but non covid related health problems which are not adequately available in rural India.

Keyword: Covid, non covid, health, family, household, BPL, APL, crisis 

Introduction:

Covid -19 pandemic announced by World Health Organisation (WHO) in March 2020, has created so many crisis in the economy due to unprecedented prolonged lockdown countrywide. The health sector is also affected with all the sectors in India. In the current scenario of novel corona outbreak every person irrespective of age, sex, religion, cultural , geographical location are at risk to be infected and subsequent disorders as per their individual condition.

However Covid is not the only issue of health or of serious concern for the rural people. They face a lot of non covid health related difficulties due to lockdown. To combat the infection of coronavirus there are so many problems such as crisis of doctors, shortage of adequate medicine, lack of clinical laboratory facility and above all absence of cash money. As the lockdown is going on for a long day, most of the people have lost their jobs. This causes absentee of money. The doctors are not agreeing to provide treatment facility in the clinics due to spread of coronavirus. There is also crisis of proper medicine shortage as the workers are not engaged in production. The health workers who give service of laboratory are not present in fear of infection of coronavirus. Again the vaccination program of infants and pregnant mothers are seriously affected. They have been discontinued leading to additional health risks.

This study focuses on rural health crisis in India. The special aim which is emphasised in the paper on the impact of people who are suffering from any other non COVID-19 related diseases which are common cold, normal cough, influenza, diarrhoea and others. There are a lot of households who have pregnant woman, new born baby, child, old person, heart, cancer and high blood pressure related patients are not getting proper check up facilities due to the pressure of covid-19 in the different health institutes run by government. So the people are afraid about certain unforeseen death and health hazard for the scare of inadequate arrangement of non covid related diseases before being attacked by infection of coronavirus. This is high for poor families who are unable to arrange for private care. The comparative misery situation about non covid related health between lower income group and higher income group are discussed in this paper.

Picture of poor health related structure in India before Covid crisis:

It is acknowledged that the poor health infrastructure exists on the developing countries throughout the world. Being an underdeveloped country India is not an exception. While many data reveal this, we will not go on to tread the usual path. Rather we remember some real incidents that paint the dismal picture of poor health structure.

August 25, 2016 - “Dana Manjhi carried his wife’s dead body on shoulders along with his sobbing daughter for more than 10 km distance as he was denied a mortuary van or ambulance due to less money for transport by hospital authorities where his wife died”

August 27, 2016 - “A man from Damon district of Madhya Pradesh was forced off a bus with his five day- old -baby and mother-in-law, after his wife ailing died in vehicle”.

August 30, 2016 - “A man lost his ailing 12-year-old son on his shoulder after the state- run Lala Lajpat Rai Hospital in Kanpur sent him to a children’s hospital, 250 meters away, without providing an ambulance, stretcher or wheelchair”.

September 2, 2016 -“Man belongs to Odisha’s Malkangiri district walked 6 km with his 7 year old daughter’s body as the ambulance transporting them to the hospital left them midway after learning that the girl has died”.

These pathetic scenarios were cited by Sharma (September 5, 2016) as a report “why the poor deprived of proper healthcare in India” in Hindustan times newspaper. Thus the plight of these families underscores human apathy and a basic failure — the breakdown of public healthcare in India.

Some relevant studies regarding non covid related health structure:

According to ‘Mint’ analysis of the latest health ministry data hundreds of thousands of children might already have missed Vita immunisations (April 27, 2020).

Average of hundreds of indicators shows a worrying disruption in India’s basic health services in this time as local administrations focused on contacting the spread of covid-19. These include curtailed immunisation schedules restricted impatient, outpatient and emergency treatment for infections and non communicable diseases, reduce laboratory treatment according to recent data released by National Health Mission(NHM, April 27, 2020).

 As per recent survey conducted by National Mental Health 10.6% of India’s 1.3 billion people suffer from medical health disorders. The report notes that 80% of such patients are not under medical treatment by Chottopadhya (April 24, 2020).

Bishat et al. (May 08, 2020), expressed an opinion that in crisis of covid -19 the pregnant women and new born babies are not directly affected by the virus, but factors such as lack of preparedness and administrative apathy are endangering the lives of them.

Rabichandan (May 10, 2020) reported an article regarding “ Missed vaccines because of lockdown: Tribal mothers in Odisha cited in the wire. He described that five month pregnant Jasmita Manjhi (19) visited the health center in Kespai village, Kalahandi , one of the most backward district in Odisha. The doctor has to immediately put Jasmita on intravenous therapy as her hemoglobin had dipped for the missing of vaccination for lockdown

According to TNN news, a report is Updated (April 15, 2020) in India times.com concerning the child vaccines delayed due to lockdown in a case of Ludhiana. The report is “as the situation intensifies, dilemma grips parents regarding the issue of the vaccination in children, as most city hospitals have deferred that process to avoid crowding in the premises. The step has been taken to keep the virus at bay, as it has often been repeated that children are more susceptible to the virus.

Data Collection Method and Strategy:

The survey is conducted among 600 households in the five selected villages of remote rural area, where all activities are standstill, by stratified sampling method. The households having several types of people who are attacked by critical non covid related diseases and some ones are from general disease in daily life. There are some families who have pregnant women, new born babies, children and old persons, and other serious persons who are attacked from critical diseases face disturbance situation in this moment. For discussing the situation We have classified these type of households by identifying the different patients by different diseases. The data is basically collected by interviewed method through several questions regarding the availability of service from the public sector of non covid related health from the different types of family who hold different types of patients. This survey is completed for more than one month (from April 09 — May 15, 2020) in the area where various problems including economic crisis are faced by the various patient parties during the lockdown period. At the time of conducting survey the households are identified into two groups such as BPL who are socio-economically backward and other is under APL comparatively richer section of the society in the study

Data Analysis:

The information stated by persons from both households regarding the inconvenience of health facility that is focused in the tabulated from by discussion method step by step.

An important issue of public health is maternity health. The first information in table 1 is brought in the consideration of pregnant women concerning the proper check up facilities in the nearest health center under ICDS scheme.85% pregnant women of BPL families are suffering from check up facility from the rural health centers and other related services during this period while 15% women do not feel disturbance from lockdown.Most of the BPL families have told that almost all the ambulance services diverted for covid-19 related activities and suspension of transportation facilities they are finding it increasingly difficult to access maternal health services.

In contrast, the concerns of pregnant women from richer socio-economic backgrounds are completely different. Although 85% of them do not get anyvaccinationbut20% from higher income groups have reported to be anxious due to cancellation of weekly check -ups, increased risk of covid -19 infection during hospital visits and delay in life saving procedure like caesarean sections due to shortage of staff and lack of infrastructure like operation theatres.The BPL pregnant women(90%) have opined that they have missed vaccinations which enrich their haemoglobin.

From the data tabulated in table 1, it appears that the pregnant women from both category (BPL and APL)are left facing huge difficulties in accessing government — run health care as the ’Ashaworkers’ (supervise the pregnant women) under ICDS scheme of central government are in duty relating to covid health and consciousness programme in rural areas.

Table 1: Interruption of proper check up and vaccination program for crisis of medical staffof pregnancy woman among the different households

Pregnancy woman households	Feel interruption about treatment and vaccination not taken	Not interruption about treatment and vaccination not taken
BPL	18	02
APL	16	04

 Our next consideration is about the child health. First consider the neonatal issues. The BPL households with newborn baby have reported about the poor health facilities in the nearest health centers in the villages because the Anganwadi workers who supervise the health centers are now busy with covid health instructed by the government. Even such type of families are unable to collect nutritious food and proper medicine. So they face so many problems due to proper missing of check -up facilities due to covid crisis.The newborn babies (95% BPL)have missed out on crucial vaccinations and supplementation. This may cause which is infamous for starvation deaths, infectious diseases, malnutrition and draughts.

 Here, the APL families of newborn baby (85%) face the same problem regarding inadequate vaccination because local health centers run by ‘ICDS’ scheme of central government are busy with covid -19 consciousness programme. They however can depend on child specialists who give service in private Chambers, medical shops or nursing homes with high cost. So the babies of some APL families are not in such a deplorable conditions as the APL families in getting proper healthcare like adequate nutritious food, proper medicine and so on.But vaccination is a moot problem even for them.

Table 2: Answerfromnot getting vaccination program and check up amongthe newborn babies of the various families

New born baby households	Not gettingof check up and vaccination programme not hold in health centers	Getting of check up and vaccination in health centers
BPL	19	01
APL	17	03

The picture is almost repeated for the children above the neo-natal range also (Table 3). Again almost 90% of the BPL children and 80% of the APL children faces the problem of non-availability of vaccination programme.

Table 3: facing the absence of vaccination programme which increase growth and weight for crisis of doctors

Child holding family	availability of Vaccination or other facilities available like check up,	Not availability of vaccination or other facilities
BPL	02	18
APL	04	16

Our next matter is about the initiation of vaccination in this period. We put some questions regarding the initiation of vaccination programme which is not held during the situation. The people of both families expresses the village health centers have not started vaccination programme for subsequent lockdown. 95% pregnant women,85% new born baby and also 90% children of BPL families have not got any vaccination that has not been started at all. Similarly 80% pregnant woman, 80% newborn baby and 70% child of APL Family have not been able to start these emergency vaccinations. Only a few percent have been started substitute vaccination or medicine and proper check up in private nursing home.

Table 4(a)Distribution of not initiating vaccination among the different group of patients and children of BPL family

Pregnant woman	19	01
Newborn baby	17	03
Other Childern	18	02

Table 4(b): Distribution of not initiating vaccination among the different group of patients and children of APL family

Pregnancy woman	16	04
Newborn baby	16	04
Child	14	06

Access to healthcare, among other things, remains the primary challenge for the senior citizen community. Due to the lack of facilities in hospitals and priority accorded to treatment of Covid -19. The covid -19 has more likely risk in elderly age group with pre-existimg conditions. This is more to do with individuals who are immuno-compromosed. The old age persons of BPL families (95%) are deprived from check up facility from the nearest block level or sub — divisional hospitals where the services from several qualified doctors are available free of cost. Because the most of the big hospitals has been turned to covid related treatment hospitals in the rural India. Though the government has initiated to continue the non covid health related services, the old age persons of lower economic background are not able to go for treatment there by expensive mode of transport. The scenarios of APL families are comparatively far better as they (80%) can go to qualified medical practitioners for holding medical services. Only 20% old-age people has faced the problems not for economical but for being infected of coronavirus. So the maximum old age persons have remained under untreated condition.

Table 5: Problems faced by the aged persons due to crisis of proper treatment among the various sections

Old person existing family	Problems faced from lack of treatment	Not faced from lack of treatment
BPL	19	01
APL	04	16

It is seen from table 5, proper lab facilities under ‘ Swaathya sathi’ scheme are not available during this situation. Many BPL persons(80%) who have different types of patients feel lack of proper lab facilities for testing and examining the non covid related health symptoms. Even persons (70%)from APL also suffer from this because most of the laboratories have remained closed because the lab authorities have expressed opinion that they are passing through a very tough time. Many of workers who are engaged with these testing facilities want to avoid the risk of getting infected by commuting or during work. So both the families feel interruption from adequate lab facilities.

Table 6: Lack of lab facility during the lockdown for examining to identify the symptoms of non covid related diseases among the patient parties of various families

Lab facility available	Available for testingto identify general diseases	Not available for testing to identify general diseases
BPL	04	16
APL	06	14

Next consideration is about the complications of critical diseases like heart, cancer, thalassemia, kidney dialysis and blood pressure and sugar etc. The problem is acute for even those with serious non-covid-related or non -respiratory illness.

Table 7: considers the heart patients of both section of family. The heart patients usually are checked up minimum one time a month. They have remained in without treatment condition. The maximum heart patients of BPL family have opined the deprivation of proper treatment from government undertaking hospitals.

Table 7(a): Response from trouble of heart patients among various families about proper treatment in government hospital due to crisis of doctors, shortage medicine and others

Heart patients family	Trouble felt from proper treatment	Not trouble felt from proper treatment
BPL	17	03
APL	14	06

In the table 7(b): cancer patient (90%) of BPL families are worried about troubles of adequate treatment due to covid crisis. In general these patients have to take camotherapy without regular interval and check up facility in proper time by the specialist doctors.They have not taken any camotherapy at any cost during the lockdown period. So they are deprived from these necessary requirements to survive their lives. Only a few percent such type of patients have taken camotherapy only one time for whole lockdown time.But it is in better position in case of APL cancer patients (25%). Again75% cancer patients of APL households feel disturbance about their cancer patients. They have not been able to take camotherapy at least one time throughout the whole period. Because they have responded the big private hospitals where they can take treatment facility are taken for covid patients who are admitted for cure of disease being infected by coronavirus.

Table 7(b): Absence of taking camotherapy with proper interval among the cancer patients of the different type of families

Cancer patients parties	Worried about taking camotherapy	Not worried about camotherapy
BPL	18	02
APL	15	05

Next another problem of critical disease is thalassemia patients of the families. These patients take blood at regular intervals. So 90% patients attacked by thalassemia from BPL families have not been able to take blood during this period. They are suffering from blood crisis as the blood donation camp is not running in the covid situation. But 35% such type of patients of APL families does not suffer because they can collect the necessary and sufficient blood from blood bank by money. Although The majority ( 65%) thalassemia patients of APL families are suffering in same problem. So the picture is almost same of both section of the society. actually in the covid crisis there is a crisis of blood in the blood banks run by government. So data in table 7 (C) reveals the patients identified by thalassemia are in serious condition in this situation.

Table 7(c): Thalassemia patients who are suffering from taking blood among the different types of households regarding taking blood

Thalassemia patient holders	Face disruptions to take blood	Not disruptions to take blood
BPL	18	02
APL	13	07

From the table7(d):85%patients of BPL has reported that they are suffering from kidney dialysis in this time. Almost similar picture is seen in case of APL patients (70%). Most of these patients are deprived from frequent kidney dialysis. They have not been able to get any dialysis throughout this period as the maximum government hospitals have turned to covid hospitals and the shortage of doctors and nursing staff who have been engaged to covid treatment. But 30% of richer section is not in worst condition because of availability of adequate treatment by private hospitals. These patients have to take the facility related to dialysis of kidney properly that helps to pull through in better condition. They are fear of absence of dialysis which may lead to die I’m this time.

Table 7(d): Response of the families about the deprivation from kidney dialysis

Various family types from kidney dialysis	Deprived from dialysis	Not deprived from dialysis
BPL	17	03
APL	14	06

Table 8: shows the blood pressure related diseases and other related problems faced by patients holders from both section have revealed that 65% patients can not hold these facilities which are necessary for staying well and fit. Not only that in this time they are suffering from not availability of doctors and suitable prescribed medicine. While depending on private doctors 70% such patients of APL families are able to take all the facilities in exchange of money.

Table 8: The patients who are suffering from high or low blood pressure of the various types of family

Family types	Did not receive any treatment for sugar and blood pressure	Receive any treatment for sugar and blood pressure
BPL	13	07
APL	06	14

Table9: discusses the diseases by sugar and uric acid related patients among the families both from APL and BPL. From the table the realisation is that 60%persons of BPL families confess the inconvenience by such type of diseases by the lack of treatment. Although 40% of these of BPL families have answered there is no problem about these diseases because they depend on quack doctors or rural medical practitioners in this time. 50% patients of APL families have not faced any problem as they can visit to private qualified medical practitioners. But 50% confess some difficulties to travel to nearest private medical stores where private medical practitioners are available.

Table 9:No of patients who face sugar and uric acid related diseases among the families

Households	Did not receive any treatment for sugar and uric acid	Receive any treatment for Sugar and uric acid
BPL	12	08
APL	10	10

Now our next turn is to understand the impact on mentally disabled patients. It is observed in table: 10 that90% 0f BPL patients suffers from much problems as they are not under medical treatment. This enriches the disorders of mental illness. The patient parties have opined that the hospitals are open but without access to public transport, traveling to hospitals is nearly impossible, especially for those who live in villages. Only 10 % poor mental patients have been arranged by their own families to take care their patients.But in case of APL mental patients ( 65%) can be able to take care by the households by private treatment. Such maximum patient parties arrange to travel by private car to go to nursing homes by private owners. Although 35% BPL patients are under treatment because the family members feel hazard during covid crisis. The families are fear to go outside from the houses at the time of the outbreaking pandemic. So throughout this period the dismal scenario is appeared by mentally disbalanced persons according to their family members due to shortage of adequate medicine and crisis of doctors.

Table 10: inconvenient feelings of mental patients in absence of proper treatment due to shortage of medicine and crisis of doctors among the different sections

Mental patients	Feelings absence of proper treatment	Not feelings absence of proper treatment
BPL	18	02
APL	13	07

We now come to the point of normal diseases like influenza, cold, caugh, stomach ache and head ache or acidity and diarrhoea etc.

Informations (table: 11) regarding problem of normal diseases it is expressed that 80% poor patients of the poor family face hard and critical situation to overcome the barriers. They are failure toget service of such type of diseases. This is far better of the people of richer households because they are able to get services from the doctors who are on practice in the private Chambers. Only 15% of them who are uninterested to go to the private medical stores or chambers for getting infected of covid positive face problem. This is the worst season when the people may be attacked by normal diseases which exist in daily life due to shortage of medicine, doctors and health staffs during this period.This illness may cause death without appropriate treatment and medicine.

Table 11: Information about absence of treatment regarding normal diseases of daily life

Varieties of family	Suffer from absence of treatment and medicine	Not suffer from absence of treatment and medicine
BPL	16	04
APL	03	17

Some important informations (table:12) are gathered from the rural BPL and also APL families about the sudden accident or suicide cases during the lockdown period. From the people of poor families (85%)respondents have responded that they are afraid if any sudden case like accident and suicide or other health related happen during this period they will not be able to reach in nearest hospital due to transport crisis. They are also fear that in this crisis period the doctors and staffs may not be available adequately as the government has emphasised to covid treatment. More or less same picture is risen to the APL households because maximum family members of them (80%) about sudden health related incidents.

Table 12: Data collected from the members of households who have opined some issues regarding sudden accident and suicide cases.

Household members	Confess anxious	Not confess anxious
BPL	18	05
APL	16	04

We asked some questions about the health infrastructure which causes disruptions in this period. The maximum persons of families of both APL and BPL have opined positively that Covid -19 causes disruptions to non covid related health treatment. They are anxious about disruptions in healthcare sector during covid crisis. Only a few percent people of both family has expressed positive attitude and established trust on public health infrastructure regarding non-covid-related health treatment throughout the whole lockdown system across the country.

Table 13: opinion about the disruptions of health infrastructure from the household members who have not any patients during this period

Household members opinion about disruptions of health infrastructure	Inconvenience of disruptions	Not inconvenience of disruptions
BPL	17	03
APL	16	04

Discussing the features about the trouble of rural households we can say the maximum non covid related health patients including households are suffering from covid-19 crisis in India. They are less under treatment and adequate health facilities, proper transportation system, suitable prescribed medicine, crisis of doctors and health workers and after all fear of infection of coronavirus.

Conclusion:

The people both from poor and rich suffers from different difficulties from covid crisis regarding non covid related health trouble. Our analysis shows that the patients of BPL families are more suffering from this crisis than APL families. Despite the assistance by government the patients from BPL families are worried about their different kind of diseases. They are not getting government facilities which are given in free of cost. They are not able to travel to private health centers with huge cost. We have also seen some persons from APL families are in trouble due to the different causes as lockdown is going on. The families who are in richer section they are fear to be attacked by infection of covid positive. So the rural people are in healthcare crisis of non-covid related. At last we can say the Indian healthcare system may have the ability to cope with the pandemic but lives may be lost as all non-covid-related healthcare has taken a backseat. The poor people may to be pushed to death and destitution not because of coronavirus but of lack of proper treatment facilities in India. This is a tragic side effects of the pressure of pandemic on our health system.

Reference:

Ramila Bisht, Jyotishmita Sarma and Rajashree Saharia (May 10, 2020), “Covid-19 Lockdown: Guidelines are not enough to ensure pregnant women receive care” in The Wire. https://thewire.in/women/covid-19-lockdown-pregnant-women-childbirth

Rukmini S (April 27, 2020), “HowCovid-19 response disrupted health services in rural India” in The Livemint. https://www.livemint.com/news/india/how-covid-19-response-disrupted-health-services-in-rural-india-11587713155817.html

National Health Ministry data updated

National Mental Health survey report Updated

Sharma Sanchita (September 5, 2016), “why the poor deprived of proper healthcare in India”, Hindustan Times. https://www.hindustantimes.com/india-news/why-are-the-poor-deprived-of-proper-healthcare-in-india/story-i8VZjCC6HXgqYuYRMACTHM.html

www.aljazira.com

www.indiatimes.com

WHO report (March,2020)

Authors:

Dr. Atanu Sengupta, Professor, Economics Department, Burdwan University, Burdwan, WestBengal, India Email: Sengupta_atanu[at]yahoo.com

And

Dr. Asish Kumar Pal , Assistant Professor, Economics Department, Tarakeswar Degree College,Tarakeswar, Hooghly, WestBengal, India  Email: asish.kr.pal[at]gmail.com