To discuss a pertinent topic of the time, measures to tackle the spread of the second wave of Covid in rural areas, the Centre for Habitat, Urban and Regional Studies (CHURS), Department of Social Work, Bharathidasan University, Tiruchirapalli, and Impact and Policy Research Institute (IMPRI), New Delhi, organised a panel discussion with eminent panellists on “Rural Realities | Tamil Nadu Practitioners’ Experiences in Tackling the Second Wave” on May 22, 2021.
Prof R Mangaleswaran, Professor and Head, Department of Social Work, Bharathidasan University, Tiruchirapalli, the moderator of the session, initiated the discussion. The coronavirus pandemic has prompted unprecedented death, despair, and affliction among the entire population. Currently, Tamil Nadu contributes about 15% of the positive cases and 6.7% of the Covid-19 deaths in the country.
The 38 districts of the state comprise 15,979 villages within 12,524 village panchayats. The sizable village community in the state of Tamil Nadu faces severe threats and it is essential to bring the rural realities to light so that effective measures can be taken for the welfare.
The IMPRI team gave a brief presentation on the overview of the state of Tamil Nadu by tracing the Covid-19 situation since the first wave. These were presented by setting a backdrop on the state’s performance in the socio and economic indicators.
The first panellist in line, Mr D Kotteswara Rao, Assistant Director, Schizophrenia Research Foundation (India), Member, State mental Health Authority (SMHA), Government of Tamil Nadu, expressed his concerns on struggles of the differently-abled. While plans have been set in place to take care of the needs of the differently-abled and the mentally disabled, the policies lack clarity on accessibility.
For instance, a disability camp has been set up, but since 108 is not allowed to carry mentally disabled individuals. Additionally, there is scarcity of psychiatric medicines in rural areas adding to the woes of the existing crisis.
Prof G Palanithurai, Former Professor, Gandhigram Rural Institute, Dindigul, highlighted the lack of institutional preparedness in the second wave that was, however, better in the first wave. He attributed the unpreparedness to the negligence of political parties.
He stressed “responsible wellbeing” is imperative to prepare the citizens and overcome the pandemic. The current government is exerting serious efforts to build a health movement on the same line. Moreover, the media has the responsibility to communicate the messages around Covid comprehensively and prepare citizens to approach the situation with the right frame of mind.
Mr Subramania Siva, Managing Trustee, Service Initiative for Voluntary Action Trust, Coimbatore, emphasised the role of NGOs. While NGOs have been pulled in at the state level to collaborate, the same needs to be done at the district level, too. He criticised the negative propaganda against vaccination spreading through social media and its influence even on the learned.
He suggested, “Since MGNREGA works are continuing in some rural areas, the government could drive to such locations to do on the spot vaccination.” It is only through innovative methods that maximum inoculation can be attained.
Mr P Arularasu, Practicing Advocate, High Court of Madras, and Trustee, Christian Comfort Ministry, gave a glimpse of rural realities in a slum in South Chennai. The people there were deprived of fundamental amenities and living in pathetic conditions, relying only on natural medicines like kabasura kudineer. He questioned the very existence of such slums that are located close to rich neighbourhoods.
While there are neatly laid roads on posh streets, the poor hardly have a road. The plight of the poor is immense and amidst the pandemic, worsened. Nutrition is the need of these people, even more than the vaccine. He stressed the need for social change and how it is essential in overcome pandemics such as the ongoing one.
Dr K Kolandaswamy, former Director, Public Health, Government of Tamil Nadu, remarked that peripheral institutions need to be strengthened and prepared for the next wave. The incompetency of testing facility is one of the many challenges in rural areas. Upgradation of Taluk and non-Taluk hospitals with oxygen and more testing facility can prepare us for the upcoming third wave.
According to him, the availability of vaccines is another major crisis facing the state. The government of Tamil Nadu has called for a global tender for 5 crore vaccines, implying that 2.5 crore people can be vaccinated. Once vaccines arrive, with the help of NGOs, SHGs and the existing team, the state can very well implement the vaccination drive.
He asserted that the state has the ability and capacity to carry out a massive vaccinate drive, as was evident in the 2017 MR campaign through which 1.5 crore children below 15 were vaccinated against measles and rubella. Optimistically, he noted that the small proportion of people who exhibit vaccination hesitance is not a serious challenge as he believed that when a majority of the population gets vaccinated, the rest will fall in line. So, the focus should be on the availability of the vaccine.
He added that just like the government has expanded its capacity, corporate and private medical hospitals that have immense resources should willingly expand their capacity, too. He believed that while industrialists in the name of CSR are voluntarily helping with vaccines, those in the private health care industry have not extended their help sufficiently, with a few exceptions.
Ms Esther Mariaselvam, Associate Director of Action Aid India, shared her experience in the nation’s Covid response. In rural areas, there exists negligence and a lack of awareness. This populace often postpones medical attention and testing when they develop minor symptoms, thus increasing risk and accelerating spread.
This is largely due to stigma and discrimination that causes even the positive patients to shroud the news. She opined that all attention is diverted to oxygen and medical supply and thus, other areas like nutrition and livelihood are overlooked. A study by the Azim Premji foundation reveals that between March and Oct 2020, 23 crore families were pushed into poverty. Mental health issues are another ignored area. Therefore, it is necessary to address all the issues equally.
Every disaster is an opportunity to till the power in favour of the powerless. This pandemic is an opportunity where more resources are allocated for health, to ensure quality health for all regardless of location, caste, creed and colour. — Ms Esther Mariaselvam
Dr Sundaresan Chellamuthu, Professor, Madras Medical College, Chengalpattu, cited the cases of misdiagnosis of Covid-19 that occur in rural areas due to the presence of incompetent institutions. The golden opportunity of early identification and treating is lost as a result. Also, some practices alternate non-tested medicines that offer no sure cure or protection. This, he said, can be addressed by having a clear-cut referral protocol system.
Having a clear-cut referral protocol system can be done by taking the help of teachers, nurses and government staff. An early referral system is key to save lives and also eases the stress on the health infrastructure. — Dr Sundaresan Chellamuthu
Concerning the need for vaccination, he claimed that to attain herd immunity, 90-95% of the people needs to be either vaccinated or should have contracted the virus. The vaccine allocation to the state is low and the global tender will take time to be executed. Thus, as we wait for the vaccine, the government needs to devise a detailed plan on how the vaccination drive will be executed.
Dr S Sathiyababu, Managing Trustee and Founder Director, Tamil Nadu Institute of Palliative Medicine of Scope India (TNIPM), shared the insights he gained from Village Health Nurses (VHNs) who had surveyed the symptoms of all families under their division during the first wave. In the second wave, VHNs expressed their discontent with vaccine hesitancy.
Out of the 1,000 houses, 10 houses show symptoms, but they confide the news within the house fearing isolation. Now there is a growing tendency to hide news even from volunteers who reach out for help. They fear, and only in the last stage do they seek help. In the first wave, villagers set barricades in entry points and restricted pass-less entrants. However, now the villagers themselves enter towns to purchase groceries and come back without restriction, despite the lockdown. These are posing a severe challenge to the rural people.
Dr Samuel Thomas, Chief Operating Officer (COO), SEESHA NGO, Chennai, observed that in certain places, both vaccination and Covid testing happen close by. An appointment system needs to be implemented and the sites must be separated to prevent super spreading.
He also recommended that the Rapid antigen test could be used in the first stage in place of RTPCR, the only test recommended in the state, due to delay in announcing results. Moreover, “there should not be any discrimination between the private and public. Allocation of resources should be also done for private hospitals and NGOs who are willing to help,” he said.
There should not be any discrimination between the private and public. — Dr Samuel Thomas
Mr Elango Rajarathinam, Director, Elders for Elders Foundation, opined on the lack of awareness of the people in rural areas to the extent that even PHCs lack awareness in some places. They are ignorant of the effect of clustering and even lack the understanding of where to seek help and how to approach such cases.
The elderly and the destitute are pushed into suffering in the rural areas. He emphasised the need to empower panchayats. Panchayats should have been trained and equipped from the experience of the first wave. They should have allocated funds to train and equip them.
Mr Reni K Jacob, Legal consultant, International Justice Mission (IJM), Chennai, commented on the plight of children who have been orphaned and families who are suffering from an income loss. Child labour, human trafficking and bonded labour have increased during the pandemic. Since it takes a long time to recover to perfect health after Covid-19, vulnerable families need to be supported financially so that they may not be compelled to unwillingly or willingly exploit their children.
In a desperate tone, he further said, “When people die because of lack of medical facility, it is not death, rather it is murder because of the dysfunctional system and lack of strategic planning by decision-makers.” The right to life is guaranteed by the Constitution, but people are being pushed to death in these times. Further, he questioned the reliability of the statistics and how, without proper statistics, strategy, development and the action plan of the state is being negatively impacted.
The Way Forward
Mr Reni K Jacob said that the power of the youth must be channelised properly by encouraging volunteerism. Prof G Palanithurai called for the need to recruit ,ore and more volunteers to assist the burdened medical team. Dr K Kolandaswamy recommended that volunteers who have recovered, are fully immunised or have recovered and do not need serious medical attention should be brought in preparation for the third wave.
Mr D Kotteswara Rao said that a centralised system to reallocate resources to the needy must be set up. Dr S Sathiyababu commented on the need for convergence and collaborative effort in tackling the pandemic. Individual resources can be better allocated when there is a collaboration between departments. Mr Elango Rajarathinam stressed on the empowerment of the panchayat. Mr Subramania Siva suggested avoiding the blame-game and collectively involving all stakeholders to eradicate the virus.