COVID-19 Makes It Harder For People To Access Basic Health Services

New Delhi: On April 1, 2020, nine months pregnant Hemlata, a resident of Kalyanpuri in Delhi started feeling pain in her lower abdominal region. Hemlata thought it to be the start of the labor pain and considering the COVID-19 pandemic and the lockdown, she decided to visit the nearest hospital – Lal Bahadur Shastri Hospital under emergency. But since Hemlata was seeking medical treatment from Delhi’s Lady Hardinge Hospital, Lal Bahadur Shastri Hospital denied her admission. Recalling her plight, 32-year-old Hemlata said, “Back then India was under a strict lockdown and everyone was afraid of stepping out of the house and meeting anyone. Because of the restrictions and the fear of contracting COVID-19, we didn’t get any means of transport for good three hours. Even the local police station denied help. They just gave us permission to move and said, ‘we have no role to play; call the ambulance.’ The emergency number for the ambulance was continuously busy and after three hours, when we finally managed to book a cab, an ambulance arrived.”

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When Hemlata reached Lady Hardinge Hospital, the administration questioned her for coming to the hospital amid a pandemic especially when there is still some time for her delivery. But Hemlata managed to get admitted and deliver a baby girl the next day. After the birth, a local ASHA (Accredited Social Health Activists) worker assisted Hemlata with the vaccination of her daughter.

Some of the vaccines got delayed but ASHA didi (sister) helped me with information on vaccination schedule and the dispensary open for vaccination. Due to the COVID-19 induced lockdown, most of the dispensaries were closed and they would open only on particular days, said Hemlata, currently working as an artisan at a Delhi based NGO Gulmeher Green.

Like Hemlata, 49-year-old Swapna Tripathi, a former domestic worker from West Bengal has a tumor in her uterus and requires a surgery, but it has been on hold for over a year now. Since Ms Tripathi cannot afford treatment at a private hospital she is completely dependent on government hospitals. And so Ms Tripathi kept hoping for the COVID-19 situation to improve, to get an appointment for the surgery. Though Ms Tripathi has a ‘Swasthya Sathi’ health card provided by the state government with a health cover for secondary and tertiary care of up to Rs. 5 lakh per annum per family, she says, pre-surgery tests are not included in it.

49-year-old Swapna Tripathi, suffering from a tumor in her uterus is waiting for the pandemic to get over so that she can get an appointment for surgery

The healthcare sector of the state has a huge demand and supply gap. The hospital facilities are limited in number and there is also a scarcity of doctors. The COVID-19 has further added to the burden on the healthcare sector and domestic workers have been affected in a big way. With the loss of livelihood, COVID-19 made it cumbersome for people like us to meet health and nutrition needs, said Ms Tripathi, a member of Paschim Banga Griha Paricharika Samiti (PGPS-West Bengal Domestic Workers Society).

NDTV reached out to more people like Hemlata and Swapna Tripathi from different cities, states and circumstances to understand the challenges faced by them in accessing healthcare services due to the COVID-19 pandemic.

Maternal Healthcare In The Times Of COVID-19

Sharing stories of fellow domestic workers, Ms Tripathi said,

Domestic workers were stigmatised as infection spreaders because of which they were prohibited from coming to work and many lost their livelihood. Pregnant women couldn’t access health services as the priority was COVID-19 patients. There were no special arrangements for pregnant women requiring pre-natal and post-natal care. One of the domestic workers of the union couldn’t afford to buy milk for her newborn. People who have chronic diseases like thyroid, hypertension and diabetes and need to take medicines regularly for their well-being, and they struggled with purchasing daily dose.

Also Read: COVID-19 Pandemic Impact On Women And Their Struggle To Feed Their Families

25-year-old Dolly living in Delhi’s Jahangirpuri also faced difficulties during her pregnancy back in August, 2020. Because of a continuous rise in the COVID-19 cases, most of the hospitals and resources were diverted to COVID patients, Dolly was denied admission by two government hospitals when she complained of abdominal pain.

It was my first pregnancy and I didn’t want to take any risk therefore, I visited the hospital as and when I felt strong cramps in the abdomen. But the two hospitals didn’t even admit me for an examination. Ultimately, I had to visit a private hospital where they did a basic check-up and asked me to come only when I have severe pain, said Dolly.

Dolly delivered a baby boy in a private hospital that charged her Rs. 60,000. Now Dolly takes her eight months old son to nearby Anganwadi center for vaccination and sessions where his weight is measured and she, as the mother, is educated about best feeding practices.

ASHA And Anganwadi Workers Provide Support Even During COVID-19

In the initial days of the pandemic and lockdown, Almora district, in Uttarakhand was marked safe from the wrath of COVID-19. By May 10, Almora had reported only one case of COVID-19 of the total 68 reported in the state. Even today, Almora district accounts for 3.01 per cent of the total COVID-19 cases in Uttarakhand. As a result of this, other healthcare services were not affected much. Talking about the same, Nirmala Tiwari, ASHA worker from Gurna village said,

A public health centre (PHC) is 2 KMs away from our village and is well equipped to carry out deliveries. We had told women to step out of the house only when required. During the lockdown, we went door-to-door delivering hand sanitisers, face masks and medicines like Paracetamol to children for seasonal flu.

Also Read: The Unsung Heroes Of India’s Primary Healthcare The Anganwadi Workers And ASHAs

Lata Kumari from Anganwadi Centre number 91 in Purnia district of Bihar said that to support pregnant women, lactating mothers and children, Anganwadi workers went door-to-door and registered all pregnant women.

We provided a stock of iron folic acid tablets to pregnant women and counseled them on initiating breastfeeding within one hour of birth, practising exclusive breastfeeding till six months of the birth and then complementing it with semisolid homogenous gruel, pulses and cereal mix. We also sensitised women on taking extra precautions like washing hands regularly, wearing a face mask when in a public place, among others, so as to protect oneself and the newborn from getting COVID-19, said Ms Kumari.

Ms Kumari also informed that due to COVID-19 an unfortunate situation arose; all hospitals in her village were closed and a woman had to deliver a baby at home only. However, both mother and child are healthy now.

When the struggle is to get two square meals, healthcare takes a backseat and that is when the role of people like Ishrat Bano, an Anganwadi worker in Idgah Kachchi Basti, a slum area in Jaipur, Rajasthan assume importance. Talking about her role during COVID-19, Ms Bano said,

People here live hand-to-mouth and most of them lost livelihood due to the COVID-19. Whenever a child here catches flu, I give basic medicines and guide them to the nearest PHC (Primary Health Centre) but during the lockdown, since everyone was confined to their homes, they were dependent on me. I always keep a stock of medicines with me for an emergency.

Also Read: A Victim Of Poverty Herself, Ishrat Bano, An Anganwadi Worker In Jaipur Is Committed Towards Welfare Of Children In Her Area

28-year-old Mubeena, a resident of Idgah Kachchi Basti is thankful to Ms Bano for her relentless support during her hard times. Mubeena, a mother of three girls said that two of her daughters go to the Anganwadi center where they eat, play and learn. She added,

With the change in weather, children do fall sick and Ishrat Baaji (elder sister) gives medicines. Neither do I have any government issued medical card to take my children to a hospital nor do we earn enough. In fact, my husband who works as a labour was out of work for eight months.

NGOs Serve As Backup India’s Healthcare System

While India’s healthcare system has been grappling with the second wave of the COVID-19 pandemic, various NGOs have taken up the task of assisting state governments in providing primary healthcare at the doorstep and sensitising people about COVID precautionary measures. One such case was reported in Chennai, Tamil Nadu where a 16-year-old Jasmine was able to get medical assistance for her grandfather through Smile Foundation. Sharing her story with NDTV, Jasmine said,

After my father’s death last year, my mother became the sole breadwinner for a family of four. Since my mother is employed in a government office, she was working even during the lockdown. One fine day, my 68-year-old grandfather was having difficulty in breathing. My sister and I didn’t know how to help him. Fortunately, on the same day, Smile Foundation had organised a medical camp in our region and a neighbor suggested seeking help from the NGO.

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Jasmine’s 68-year-old grandfather got medical assistance from Smile Foundation after he faced breathing issues amid COVID-19 lockdown

Following this, a nurse from Smile Foundation examined Jasmine’s grandfather’s vitals, which showed a low pulse level. He was immediately admitted to a hospital for a week. Though now Jasmine’s grandfather is back at home, he is on medication and his health is regularly monitored by a doctor from Smile Foundation.

Smile Foundation runs Smile on Wheels, a medical van to provide free healthcare to the poor at their doorstep. The medical van makes a trip to Jasmine’s locality every week from where the family gets free medicines.

65-year-old Kartar Singh from Gurugram (Gurgaon) who is suffering from a chronic respiratory disease for quite some time has also benefitted from Smile Foundation’s Smile on Wheels initiative. Because of COVID-19, Mr Singh and his family were afraid of going to the hospital for any kind of treatment. As a result of which, Mr Singh who was undergoing medical treatment at Civil Hospital and had to put his health checkup on hold until Smile on Wheels made its way to his locality.

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The hospital is 5 KMs away from our house; because of strict restrictions and the fear of contracting the disease, no one was stepping out. If this medical van had not come to our doorstep, we would have been in big trouble. Luckily, my father is responding well to the medicines he receives from the mobile medical van. Now, everyone in my family consults the doctor on board for viral infections and other lifestyle ailments, said 41-year-old Ajay Kumar, son of Mr Singh.

65-year-old Kartar Singh has a chronic respiratory disease and is seeking treatment from Smile Foundation

COVID-19 has affected one and all and more so for people with comorbidities like HIV as they are at an increased risk of contracting COVID-19. To control HIV infection, a treatment called antiretroviral therapy (ART) that involves taking a combination of HIV medicines is recommended. To ensure ART continues for HIV patients, 45-year-old Surender Kaur, HIV survivor from Haryana’s Rohtak, who is working with over 150 pregnant HIV positive women ensured medicines reach everyone.

Ms Kaur is currently working with NGO SATHII (Solidarity and Action Against the HIV Infection in India) on eliminating mother-to-child transmission (EMTCT) of HIV, a project run by the National AIDS Control Organization (NACO).

I had come to Rajasthan to meet my parents when the lockdown was announced and I had to stay back but that didn’t affect my ART in anyway. I continued with my treatment at a regional center. I had to call the people I was living with in Rohtak and ask for a copy of my documents and the data of other HIV patients undergoing ART in Rohtak. We called everyone and informed them that you can access ART from your local centre and for those who were not allowed to step out of the house, we provided home treatment. However, when I would call pregnant women and children to come for follow-up and tests, some would not show up due to the fear of COVID-19, said Ms Kaur.

Watch: Smile On Wheels: A Mobile Hospital Providing Primary Healthcare To The Poor

Conclusion

India is currently grappling with the second wave of the COVID-19 and the pandemic has disrupted lives and livelihoods once again. People have been left running from pillar to post, looking for hospital beds, oxygen cylinders and other essentials. Now, the pandemic is slowly moving to the rural areas of India which are not as well-equipped as urban India. At a time when people from urban slums and rural areas, daily wage earners and those living hand-to-mouth are still struggling to make ends meet, ensuring well-being is a far-fetched dream.

As per a recent Bloomberg report, in Basi, about 1.5 hours from New Delhi, about three-quarters of the village’s 5,400 people are sick and more than 30 have died in the past three weeks. It has no healthcare facilities, doctors and oxygen canisters.

As the pandemic moves to rural parts of the country, the Indian government has issued Standard Operating Procedure with focus on community-based services, primary health infrastructure and the role of ASHAs.

In every village, active surveillance should be done for influenza-like illness/severe acute respiratory infections (ILI/SARI) periodically by ASHA with the help of Village Health Sanitation and Nutrition Committee (VHSNC), the guidelines say.

Also Read: COVID-19 Rapidly Spreading In Rural Areas: PM Narendra Modi

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.