We need innovative ways to tackle covid in rural India
PremiumExtended time lags and poor health services call for another approach to the pandemic in our villages
It’s got to that point in the pandemic when we all know someone who has died or suffered greatly. Our messaging apps have, at one time or the other, been filled with pleas for help and heart-wrenching stories of grief and frustration. We’ve all, individually and collectively, done our best to get beds, oxygen cylinders and medicines for friends and family, raise funds, or even just maintain lists of verified sources of oxygen, treatment drugs and hospital beds so that we could be of help when that inevitable call comes.
And yet, as bad as things are in the city, they are far worse in rural India. Last week, possibly for the first time since the beginning of the pandemic, 13 states reported that the total number of new cases in rural areas exceeded those in urban areas. Unfortunately, it seems that this time around, covid will not spare our rural hinterland.
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The earliest signs I got that things were not okay in rural India was when a doctor friend of mine told me that district hospitals were getting a larger-than-usual number of patients from surrounding villages—people who had all travelled long distances to the nearest town or city because health centres in the villages where they lived were unable to treat them. This exodus has only increased since then, and, unless something is done about it soon, mortality in rural areas is going to be far worse than in urban zones.
When you discuss the situation with doctors on the ground, it quickly becomes clear that we need to adopt a very different approach to combat covid in rural India, as compared to what is being done in our cities. Urban relief efforts have, for the most part, centred around creating oxygen beds and covid-care facilities to supplement the medical facilities that our government and private hospitals already provide. In the rural hinterland, access to oxygen is just one among a number of complicating factors that need to be addressed on a war footing.
Healthcare in our villages is almost entirely provided for by the government. As a result, health centres are subject to all the procedural impediments that dog government procurement. Given the ferocity of the pandemic, this has resulted in a severe shortage of even the most basic medications required to treat the disease, as the velocity at which drugs are being consumed has far outpaced the rate at which government procurement can replenish them. Most taluk hospitals (and the public health centres under them) are short on supplies of basic medicines. To cope, health officers have to ration whatever they have, trying to ensure that their meagre stocks stretch to cover as many patients as possible, even if it means that everyone gets less medication than they really need.
That said, while it is important to treat symptomatic patients, it is fast becoming apparent that in the rural context, we also need to make sure that we detect the disease early enough to prevent mild cases from becoming moderate—or worse. Only if we do this will we be able to ease the burden on hospitals in larger towns. If we fail, the consequences do not bear mentioning.
This is easier said than done. In its early stages, the disease is indistinguishable from the common flu, and as a result, people in the villages treat themselves with herbal remedies for a few days before even thinking of going to a public health centre for a checkup. This means that when they finally do get tested, and the test results make their way back to them, as many as five days could have elapsed between detection of the first symptoms and the commencement of covid treatment. The time lost could be damaging.
In most cases, it is precisely such delays that have resulted in serious illnesses, forcing patients from rural India to flock to district and city hospitals. By the time they know for sure that they have covid, the disease has already taken such a powerful hold over their bodies that taluk hospitals simply cannot give them the treatment they need.
If we want to improve our ability to manage the disease before it completely overwhelms the country’s distributed health system in the rural hinterland, we need to shorten the time taken to detect covid, so that we can start isolation and treatment much sooner than is currently being done.
The health officers in HD Kote taluk of Southern Karnataka, with the encouragement of their legislative assembly representative, have been trying out an alternate approach over the past few weeks.
Volunteers and ASHA health workers, equipped with thermometers and oximeters, have been going door-to-door, testing every single resident of the village for two key early warning symptoms of the disease: low oxygen saturation and high temperature. By monitoring this information over time, they hope to identify infected people early, sometimes days before RT-PCR test results are available. If successful, this exercise will give them the time they need to appropriately isolate the infected, and, where appropriate, provide them basic treatment for covid.
It is still early days with this approach, and perhaps too soon for definitive conclusions, but last week, three of the persons identified through this method actually tested positive. By the time the test results reached the taluk health office, they had already been isolated and were being treated.
Now that we know covid is rampant across India, we need an innovative approach. If more taluks can adopt that process, we may still be able to blunt the impact of the disease on the country’s rural hinterland.
Rahul Matthan is a partner at Trilegal and also has a podcast by the name Ex Machina. His Twitter handle is @matthan
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