For an agnostic, blind faith fascinates me. More so when I travel though the rural crevices of India, where forget about divinity, even basic justice seldom reaches. The more I have traveled through rural India the more I have understood the true essence of ‘Ram bharose’.
The customary greeting of “Ram Ram” is often steeped in the belief that it’s all up to him and no one else. Primarily because there is no one else and those in the villages know it best that it’s all Ram bharose. The rural health infrastructure of our country pays the fittest tribute do that old adage of Ram bharose.
Before I get to the pandemic which bridged the rural-urban divide far better than anything else could, I want to talk about the ‘mystery fever’ that has killed at least a hundred across Uttar Pradesh and Bihar.
The fact that at least 50 of those who died were kids is a side note that might temporary shock the urban dwellers but for the rural record books, it’s a routine statistic during flu/viral/encephalitis/mystery fever season.
It was around August 18 that news started to filter in of sickness in the hinterlands of Uttar Pradesh. A wave of mystery fever was sweeping the rural heartland of the state. Small towns and villages around them were mostly in its grip. The epicentre was Firozabad. Hundreds were falling sick, many were dying.
As days went by, the cases rose. What was highly troubling was the fatality rate among children. The import of young kids dying of the fever raised an alarm. What could authorities do? This was after all a mystery fever that had come calling after a deadly pandemic.
Days turned to weeks and the numbers of dead and infected rose to hundreds and thousands respectively. Neighbouring state Bihar was also now in the grips of this fatal fever. Reports of the sick and dead from many areas started to filter in.
The intense fever was sweeping through the two states. In Uttar Pradesh most children who passed away had symptoms of high fever, dehydration sudden drop in platelet count.
Two weeks later, as the fatalities rose yet the Indian health authorities remained confounded as to what this mystery illness was. The national media picked it. The news made it to international publications. It was then the authorities finally solved the mystery of the debilitating illness at-least two weeks after it was reported.
It was not one but two diseases – one caused by a bacterium and the other a virus. What had foxed authorities for weeks was scrub typhus and dengue. Not any mystery illness but two well-versed easily diagnosed diseases. Yet, we have lost at least a hundred people including more than 50 kids with thousands sick.
Kids died like flies because in many cases platelets count was never done. Something that could have easily been avoided but wasn’t because when it comes to the rural heartland it’s all Ram bharose.
It now brings me to how the pandemic silently ravaged through rural India. If urban India was about desperate tweets screaming for help, then rural India’s angst and desperation were eerily displayed by floating bodies in the Ganga. Shallow graves around rivers laid testimony to the shallow promise of equity.
Village after village I saw many hooked onto IVs (intravenous intubation) from trees being injected by quacks. A vivid memory from eastern Uttar Pradesh during the brutal second wave is that of a halwai’s shop on top a hardware basement store in Ghazipur. Both had been turned into a make shift hospitals run by unqualified ‘jholachaps’.
The problem was not as much as the free-run of these quacks but the fact that most villagers preferred seeking treatment from them to even setting foot in a government-run unit. Here, the promise of ‘private’ was found way safer than a government hospital. Nothing can be a more honest testimony to the state of our rural health infrastructure than that someone trusts a phoney with their life over a possible doctor at a government ward.
The disparity between rural and urban India has always been stark. Even though urban India suffers from massive shortcoming in comparison to its rural sibling, it’s in far better stead. While urban India takes the lion share of facilities, rural India is but left Ram bharose.
According to World Bank data, more than 65 per cent of India lives in rural areas. Yet, hospitals in rural areas have just 37 per cent of the beds available in all government hospitals across the country.
According to the World Bank, in 2017 India had only 0.5 beds per 1,000 people, far below the global average of 2.9 beds. No surprises that the rural healthcare infrastructure is in tatters.
According to the Rural Health Statistics (RHS 2019-20), there are 1,55,404 rural Sub-Centres (SC), 24,918 Primary Health Centres (PHCs) and 5,183 Community Health Centres (CHCs).
As per the same data, there is a shortfall of 18 per cent SCs, 22 per cent PHCs and 30 per cent CHCs. What is worse is the inaccessibility to these centres, and how these centres are crumbling, ill-equipped and mostly shut.
The second wave of Covid-19 pandemic underlined all of the above, where all these inadequacies were exposed. Travelling through several districts in Uttar Pradesh, I never saw a PHC which was open or a CHC which was equipped to deal with even a basic illness leave alone a pandemic.
The government hospitals in the smaller cities are a nightmare. The way to understand how bad a nightmare is to walk into emergency or the general ward of one.
India’s public health expenditure has remained between 1.2 per cent and 1.8 per cent of GDP (gross domestic product) between 2008-09 and 2019-21. Let’s compare this with health expenditure done in other countries such as China (3.2 per cent), the US (8.5 per cent) and Germany (9.4 per cent).
Let’s now also look at another figure in the mix. The allocations for the rural component (under the National Rural Health Mission) have been decreased by three per cent since last year.
As of 2018, there was a deficit of 46 per cent of doctors, and 82 per cent of specialists including surgeons, gynaecologists and paediatricians required in the PHCs across India. Primary Health Centres (PHCs) were primarily made by the states to facilitate rural health care.
The World Health Organisation (WHO) recommends 44 health workers per 10,000 people but India has only 22 health workers for every 10,000 persons. Rural areas have lower health worker density than the national average.
India has a doctor-population ratio of 1:1445. The WHO recommends a ratio of 1:1000. The doctor-population ratio in rural India is appalling; a small example – the doctor-population ratio in Bihar is 1:28,391.
The heath infrastructure statistics of rural India are always shocking. Sadly, the collateral it extracts from rural India has always been nothing more than a statistic in itself invoking zero empathy. Accepted as something that happens in the hinterland, afterall, it’s a land where everything including ‘god’ is ‘Ram bharose’.
(Views expressed are personal)
Source – India Today