Skip to main content

Rooted in mistrust? Covid-19’s march into rural India is a very different ball game

By Sudhir Katiyar*

As the Covid-19 virus penetrates rural India, the rural communities are responding very differently from their urban counterparts who rushed to the hospitals. The rural communities are avoiding the public health facilities and any mention of the disease. The note argues that this supposedly irrational response is based on a deep-seated mistrust of the state by the rural communities. It can not be resolved with routine Information, Education and Communication (IEC) measures suggested in the Government of India SOP for tackling Covid-19 in rural areas.
It is now acknowledged by all that the second wave of Covid-19 has reached rural India. Acknowledging the ingress of Covid-19 into rural areas, the Central Government issued Standard Operating Procedure (SOP) on Covid-19 Containment & Management in Peri-urban, Rural & Tribal Areas on May 16. The SOP proposes a three-tier structure from Covid Care Centre (CCC) to manage mild or asymptomatic cases, Dedicated Covid Health Centre (DCHC) to manage moderate cases and Dedicated Covid Hospital (DCH) to manage severe cases.
However, management of Covid-19 in rural areas is going to be a very different ball game. As Covid-19 marches headlong into rural India, a strange paradox manifests itself. The urban India saw an acute shortage of oxygen, ICU beds and ventilators as Covid infected patients in serious condition rushed to the hospitals. The pandemic also reasserted the primary role of public health systems in health care as it took the lead in managing the pandemic.
By contrast, the reality in rural India is completely different. While there are already reports of large number of deaths taking place, the rural communities are avoiding the public health facilities like plague. The public health system was never much functional anyway in rural India except for some notable exceptions like Kerala and Tamil Nadu. Rural PHCs remain unstaffed and the infrastructure created falls into ruins.
The number of functional rural PHCs in any district can be counted on finger tips. However, the Covid-19 pandemic has seen rural people enforcing an almost complete boycott of Government facilities. The people fear being tested and if positive, being confined to isolation facilities from which, they fear, chances of coming out alive are slim. In absence of any credible medicine to treat the infection, vaccination has emerged as the only strategy to manage the epidemic. While urban India has embraced vaccines, there is extreme vaccine hesitancy in rural areas.
A rapid assessment by the Centre for Labour Research and Action amongst migrant workers across eight migration streams in Gujarat and Rajasthan revealed that 80 percent respondents did not want to get vaccinated. The rumour mills abound. The disease has been spread by the state to kill off old people, pensioners, organs are being removed, it will not affect rural people, vaccine itself causes disease.
The SOP does have a component called Community mobilization and behavior change. It seeks to use the village level health workers, the panchayat raj and other Government functionaries, and Village Health Sanitation and Nutrition Committees. The last most probably exist only in papers in most places.
However, the behaviour and response of the rural communities is rooted in a deep mistrust of the state that is centuries old. It cannot be done away with the normal IEC type campaigns. Writing in "Autobiography of An Unknown Indian" 75 years ago, Nirad C Chaudhry wrote, "For centuries the political creed of the Indian peasant and the Indian worker has consisted of one single article, never to trust the professions, the motives and doing of their rulers. This distrust of the state and ruling order is virtually ineradicable". 
It is clear that nothing has changed in the last 75 years of independence to change this perception. To quote a Hindi couplet: "Ka nrip hoye, hamen kya haani" (Whoever is the ruler, how does it matter to us?).
Village people burning their own dead without any autopsies is fine as long as they do not start floating the bodies in the river
It is this division, that is sometimes framed as a division between India and Bharat, but it is actually a division between the powerful and the powerless, a division between the Savarnas and the Shudras, a division between the working classes and those who profit from their labour. It is a division that has stood firm for the last two millennia.
The middle classes have made sure that the ingress of modernity – education, health, dignified living, and social security – stop at their door step. To illustrate one only has to look at the state of basic education, the primary means of ushering in modernity. While the ruling elite sends its own children to private schools, it has made sure that the public schooling system becomes dysfunctional.
The Annual Survey of Education Reports (ASERs) that capture state of schooling in India, reveal that educational achievements in Government schools have been falling in the last decade. What needs a behavior change is the attitude of the middle classes not the rural communities.
The response of the rural communities suits the state very well. It is not likely to rock the boat besides issuing SOPs and making some formal noises. It is anyway facing a tough job in hiding deaths in cities with footage of funeral pyres adorning pages of national and international journals. 
Village people burning their own dead without any autopsies is fine as long as they do not start floating the bodies in the river. Then the state will employ its vast security apparatus for ensuring that these do not come to light. Sickness in rural areas remaining away from the limelight is good. As long as the large number of deaths do not get highlighted, it is fine.
Writing in "Indian Express" of May 18 in an article titled 'Virus in the Village', Dr KS Reddy, President of the Public Health Foundation of India, expressed the hope that perhaps the design of a new health system will emerge from the Covid crucible to serve as the platform for universal health coverage. Unless the liberal intelligentsia factors in this deep mistrust, and the ruling classes change their mindset, this hope is likely to remain a hope only.
---
*Centre for Labour Research and Action, Ahmedabad

Comments

In order to keep Covid-19 overtures engulfing the world humanity under prevention and control, it is imperative to take long term measures across the world as listed below:
1. Regeneration and restoration of forests both in density and diversity.
2. Linkage of waterbodies to facilitate distribution of water across the
world.
3. Effective recycling of organic and inorganic wastes and their conversion to
useful products for reuse thereby reducing land, water and air pollution.
4. Production of biological oxygen in human habitations thereby reducing the
need for artificial oxygen production, by planting trees identified for
the generation of vast amounts of biological oxygen.
5. Establishment of institutions for alternate medicines in addition to
allopathic medicine.

TRENDING

New Odia CM's tribal heritage 'sets him apart' from Hindutva Brahminical norms

By Bhabani Shankar Nayak*  Mohan Charan Majhi took the oath as the new Chief Minister of Odisha following the electoral defeat of the BJD led by Naveen Patnaik, who served as Chief Minister for twenty-four years. The new Chief Minister is the son of a security guard and a four-time MLA who hails from the remote village of Raikala in the Keonjhar district. He belongs to the Santali tribe and comes from a working-class family. Such achievements and political mobilities are possible only in a democratic society. Majhi’s leadership even in the form of symbolic representation in a democracy deserves celebration.

AMR: A gathering storm that threatens a century of progress in medicine

By Bobby Ramakant*  A strategic roundtable on “Charting a new path forward for global action against Antimicrobial Resistance (AMR)” was organised at the 77th World Health Assembly or WHA (WHA is the apex decision-making body of the World Health Organization – WHO, which is attended by all countries that are part of the WHO – a United Nations health agency). AMR is among the top-10 global health threats “Antimicrobial Resistance (AMR) is a growing and urgent crisis which is already a leading cause of untimely deaths globally. More than 2 people die of AMR every single minute,” said Dr Tedros Adhanom Ghebreyesus, Director General of the WHO. “AMR threatens to unwind centuries of progress in human health, animal health, and other sectors.”

What stops Kavach? Why no time to focus on common trains meant for common people?

By Atanu Roy  A goods train rammed into Kanchenjunga Express on 17th June morning in North Bengal. This could have been averted if the time tested anti-collision system (Kavach) was in place. 

A Hindu alternative to Valentine's Day? 'Shiv-Parvati was first love marriage in Universe'

By Rajiv Shah*   The other day, I was searching on Google a quote on Maha Shivratri which I wanted to send to someone, a confirmed Shiv Bhakt, quite close to me -- with an underlying message to act positively instead of being negative. On top of the search, I chanced upon an article in, imagine!, a Nashik Corporation site which offered me something very unusual. 

Buddhist shrines were 'massively destroyed' by Brahmanical rulers: Historian DN Jha

Nalanda mahavihara By Our Representative Prominent historian DN Jha, an expert in India's ancient and medieval past, in his new book , "Against the Grain: Notes on Identity, Intolerance and History", in a sharp critique of "Hindutva ideologues", who look at the ancient period of Indian history as "a golden age marked by social harmony, devoid of any religious violence", has said, "Demolition and desecration of rival religious establishments, and the appropriation of their idols, was not uncommon in India before the advent of Islam".

Top Punjab Maoist who failed to analyse caste question, promoted economism

By Harsh Thakor*  On June 15th we commemorated the 15th death anniversary of Harbhajan Singh Sohi or HBS, a well known Communist leader in Punjab. He expired of a heart attack in Bathinda in 2009.

Saving farmers and consumers from GM crops and food: Philippines court shows the way

By Bharat Dogra*  At a time when there is increasing concern that powerful GM crop lobbyists backed by enormous resources of giant multinational companies may be able to bulldoze food safety and environmental concerns while pushing GM crops, a new hope has appeared in the form of a court decision from the Philippines.