Banda (Uttar Pradesh): “At least one person in every household here is extremely unwell.”
Shivdevi, who uses only one name, has over a decade’s professional experience as a journalist and has been reporting from rural Bundelkhand in southwestern Uttar Pradesh (UP) for the women-run, grassroots news network Khabar Lahariya (KL).
Her assessment of the pandemic in her native village of Bhawanipur in Banda district, appears, at first, to mirror the situation in urban, middle-class India. Then, the qualification follows: “Not one person here knows or cares or believes in corona.”
Covid-19 might be the great equaliser in a world of haves and have-nots, but in the rural hinterland of India’s most-populous state and second-poorest by per capita income, decades of social and systemic backwardness among its 155 million rural populace has made the second wave particularly deadly.
Years of living without specialised or even accessible primary healthcare has led to a certain inevitability about illness, disease and death, a fact particularly evident during this pandemic.
On 19 May 2021, India’s official death toll exceeded 270,000 but the global, scientific consensus is that this is an underestimate (here and here), with the real toll perhaps a million dead.
“The biggest gap is what’s going on in rural India,” noted epidemiologist Prabhat Jha, director of the Centre for Global Health Research at St. Michael's Hospital and the University of Toronto.
No place is more representative of India’s vast rural interiors than the backcountry of rural UP, which was largely unaffected when the first wave of the pandemic hit India in March 2020. When on 25 March 2020, Prime Minister Narendra Modi announced a lockdown with a four-hour notice, a panic-stricken reverse migration devastated livelihoods in Banda, as it did nationwide for the 400 million informal workers who subsist mainly on daily wages.
At one point in 2020, India was the only country where the number of reported deaths attributed to lockdown measures—by suicide, police brutality, hunger, exhaustion—was greater than the number of deaths attributed to Covid-19. As Aravind Yadav, a migrant labourer in quarantine in Banda told us in April 2020: “Corona ka toh kauno pata nahi, bhookh se zaroor mar jayenge. (“Can’t say about Corona but we’ll surely die of hunger”).
Today, as death and infection spread across UP—ranked at the bottom among 21 large states in Niti Aayog’s June 2019 health index report and referred to as a “novel coronavirus disease hell” in this May 2021 Down to Earth report—chief minister Yogi Adityanath, on 17 May 2021, proclaimed the second wave as being “under control”. It is, as many media, Article 14 reportage (here and here) and our reporters confirm, anything but.
Chief among the reasons for the widening second wave:
Widespread disbelief among the people that there is even a pandemic, resulting in a resistance to vaccination.
Absence of specialised, or even primary, healthcare and a broken healthcare system.
Lack of access to smartphones and, so, the Internet and health information.
The government’s failure to galvanise and deploy frontline health workers, fearful from their experiences of 2020.
‘Nobody Here Believes in Corona’
The Manikpur area of UP’s Bundelkhand region in the district of Chitrakoot, locally known as patha kshetra/pahaadi ilaaka for its rocky terrain and thick forests that lend notorious outlaws hiding places, is home to tribals who survive on selling wood.
Almost overnight, a band of vigilantes sprung up here two days after the Covid-19 vaccination registration portal CoWin opened on 3 May for those above 18 years of age. Their mission? To protect themselves—from the vaccine.
“We’ll smash anyone who enters our villages with orders to vaccinate us,” said a friend of the vigilante group, speaking on condition of anonymity.
Elsewhere, in Jahaddipur village, Ayodhya district, KL senior producer Lalita Devi was visiting family when she heard a dismissive refrain: “This is only seasonal. Why the hue and cry?”
Evidence of rural UP’s widespread disbelief about the effects of the coronavirus was manifest during state-wide panchayat polls, regarded, along with returning migrants, as one of the main reasons for the ongoing wave of infection and death.
Lalita Devi reported how Dinesh Kumar, contesting from the gram panchayat of Vijayanpur Sajahra, sent a vehicle to Jahaddipur on 15 April to ferry the elderly and the sick to the polling booth. The vehicle was a unique sighting in a village where, to get to the primary health centre, one must first walk 4 km to an auto rickshaw stand and then take a 20-km ride.
Covid-19 related protocol, including masks and social distancing were done away with at polling booths and elsewhere. An officer manning a polling booth in Ayodhya told KL: “Chunav ke time corona nahi hota. (There’s no corona when elections are on).”
Lalita Devi also encountered the disbelief about the pandemic, coupled with a life-must-go-on attitude, at weddings, which were in full swing at the time. “When the mahurat (auspicious time) is right, it has to be done,” Lalita’s neighbour told her.
Locals said they had seen “worse” with malaria and typhoid, just before and during the monsoon. “It [the pandemic] is because of a lack of hygiene. Why can’t they have our villages cleaned up instead?” Lalita’s paternal uncle told her on 25 April, while running a high fever.
That is not untrue. Ill-health is common and widespread in these parts.
Dust from stone-crushing machines and hard labour commonly cause chronic cough and tuberculosis. Wearing a mask, sanitising and social distancing are impossible in cramped, ramshackle dwellings.
“Dhool mitti mein kaam kaike aawe toh nahaiye ke khaatir sabun mil jaaye bahut badi baat (After working in the dust all day, if we get soap for a bath when we return, that’s a big deal),” a resident of Jahaddipur village told Lalita Devi.
What is their view on Covid-19 then?
“Humein laagat hai Modi kauno virus hawa ma udaay dehe hai. (If you ask us, Modi has created this rumour of a virus that’s now floating about),” another said.
A widespread distrust of government-led initiatives spurs wild rumours, such as the one about the “lambe chaude” (strong and muscular) Sharma brothers (name changed) from Jahaddipur who went to the government dispensary with “a light fever”, were administered “an injection”, and ended up dead.
The facts of the case are shrouded in uncertainty and details change depending on who you ask. But while the fear in the village is evident, the self-evident solution to infection is not.
“Do whatever you want, but please don’t take that vaccine,” Lalita Devi’s father told her, even though most of her extended family are severely unwell and “have all the Covid symptoms”, according to Lalita Devi.
New Normal, Old Normal: Scant Public Healthcare
As we said, getting to the nearest primary health centre from Jahaddipur involves a 4-km walk to the auto stand and then a 20-km ride.
“If you have a high fever, that’s not really a workable option,” said Lalita Devi.
Most families wait for larger numbers to fall ill before booking a private vehicle in order to justify the fare that can be as high as Rs 500. Far easier, more convenient and cheaper, is to knock on the door of the nearest neem-hakeem medical hack, but most have shut shop over the past month.
Patients now manage with quick measures: A pill to bring down the fever, syrup for a cough and so on. When things get really bad, rasping breaths, for instance, or a sense that death is close, there is a desperate, last-minute scramble for help—20 km away.
For those who do make it to the primary health centre, the medical advice is an inevitable chit: “Lucknow referral” or “Kanpur referral”. But in the brutal second wave, even Lucknow and Kanpur are buckling under the stress on their healthcare systems, forced to turn away patients and reeling from testing delays and oxygen shortages.
And so, the new normal is the old normal. “Kya pehle log nahi marte the? (Didn’t people die earlier?)”, is the response that Lalita Devi got when she suggested that people get RT-PCR tests, which the government unofficially discourages, as Article 14 has reported, to keep cases down.
Rural UP, where deaths during routine sterilisation procedures, tuberculosis or medical malpractice are common and where lives are negotiated over “samjhauta”, has seen it all.
“I don’t go to government hospitals for treatment because there is no point,” said Keerti, a 22-year-old mother of a six-month-old child. She had been suffering from pneumonia, another silent killer in the hinterland, a disease that, like TB, is curable.
Mind The Digital Gap
The digital divide in India, like every other divide, has manifested itself in stark ways through the pandemic. Teledensity, or the number of telephones per 100 people, is around 57%, according to the Telecom Regulatory Authority of India.
That means millions in rural India cannot use social-media to seek help in medical emergencies, as urban India has to tide over the lack of government help desks. Such applications require a smartphone, connectivity, electricity and at least a basic understanding of English—a language that, according to this survey, is spoken by only 3% of rural respondents.
As the vaccine-pricing debate (here and here) continues to rage, there is an unfolding vaccine discrimination in rural India. The need for Aadhaar documentation, a contested issue over the years, in order to register on CoWin, coupled with the Centre’s response to the Supreme Court that people without digital access can take the “help of friends”, renders the entire vaccination drive the very opposite of inclusive.
Missing In Action: Frontline Health Workers
“If the ASHAs (Accredited Social Health Activists, the frontline workers of the public rural healthcare system) go door to door telling people about what to do if you’re ill, then perhaps people might get it and understand that the coronavirus pandemic is real,” said Lalita Devi.
ASHA workers, whose job includes creating awareness, appear to be missing on the ground in rural UP. In states such as Odisha, frontline workers and rozgar sahayaks (employment guarantee assistants), identified and tracked potential cases after recent reverse migrations and the Kumbh Mela.
In UP, no such mandates have been issued at the block level, according to KL’s reporters, even as the state’s top politicians, including the chief minister, tested positive for COVID.
After recovery, Adityanath issued directives for oximeters and thermal scanners for staff at gaushalas (cow shelters) and maintained there was no scarcity of supplies in his state, despite reportage to the contrary and protests from his own party colleagues and fellow ministers, many of whom have lost family.
Adityanath also ordered a clampdown against pleas for medical assistance.
In Jahaddipur and surrounding villages, Lalita found that many ASHA workers had switched off their phones. “Perhaps they are ill themselves,” she said. “They are frightened and know only too well that real medical help is at least 20 km away—and that’s in the best-case scenario.”
Many frontline workers remain scarred from last year’s experience when they were ordered to track cases, particularly in homes where family members had returned from towns and cities.
(See Article 14’s earlier series on ASHA workers here, here and here)
“When we go to get the details of anyone who has come from outside of the village, people get aggressive,” Kusum, an ASHA Sangini from Khiriya Latkanju in Lalitpur, said in a video. “Some abuse us and even beat us.”
By not using the ASHAs, who are regarded by most as reliable last-mile health sources, UP has lost out on a crucial link to successful vaccination drives of the past, such as polio.
Awareness drives do exist, such as the vaccine-centric-monologue that has taken the place of our caller tunes (‘Be sure to get vaccinated when it’s your turn’).
But these drives fail to address the misconceptions and ignorance evident in last-mile UP. This is why in infection-ridden villages, we witnessed used personal-protection kits discarded in Banda, bang in the middle of a residential mohalla.
(Based on reporting and field work by Khabar Lahariya, a network of women rural reporters in Uttar Pradesh. Pooja Pande is head of strategy, Chambal Media, the parent company.)