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

'Modi govt's assault on dissent': Foreign funds of top finance NGO blocked

By Rajiv Shah  In a surprise move, the Ministry of Home Affairs, Government of India, has cancelled the foreign funding license of the well-known advocacy group, Centre for Financial Accountability (CFA), known for critically examining India's finance and banking sectors from human rights and environmental angle.

Misleading ads 'manipulate, seduce, lure' to market unhealthy harmful food

By Our Representative  The Nutrition Advocacy in Public Interest (NAPI) in its new report “50 Shades of Food Advertising” has sought to expose how seductive, luring, manipulative or deceptive these advertisements can be. Consequences of such advertising are increased intake of unhealthy food products that is associated with obesity and diabetes, it says. 

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. 

Swami Vivekananda's views on caste and sexuality were 'painfully' regressive

By Bhaskar Sur* Swami Vivekananda now belongs more to the modern Hindu mythology than reality. It makes a daunting job to discover the real human being who knew unemployment, humiliation of losing a teaching job for 'incompetence', longed in vain for the bliss of a happy conjugal life only to suffer the consequent frustration.

Why's Govt of India reluctant to consider battery storage system for renewal energy?

By Shankar Sharma*  If having so many small size battery energy storage system (BESS) at different locations of the grid, as in the report from Australia (a portfolio of 27 small battery storage projects across three Australian states that will total arounds 270 MWh), is considered to be techno-economically attractive in a commercially driven market such as Australia, the question that becomes a lot more relevance to Indian scenario is: why are our planners not in favour of installing such small size BESS at most of the distribution sub-stations not only to accelerate the addition of RE power capacities, but also to minimise the need for large size solar/ wind power parks, dedicated transmission lines and pumped storage plants; which will also minimise the associated technical losses.

'Failure of governance': India, China account for 54% pollution-related deaths globally

By Vikas Parsaram Meshram*   A recent report jointly prepared by UNICEF and the independent research organization Health Effects Institute has been released, and the statistics within it are alarming. It states that in 2021, air pollution caused the deaths of 2.1 million Indians, including 169,000 children who hadn't yet fully experienced life. These figures are indeed distressing and raise questions about why there hasn't been more serious effort in this direction, putting policymakers to shame. 

New MVA-INDIA MPs asked to raise Maharashtra milk farmers' demand

By Our Representative  All-India Kisan Sabha (AIKS) national president Dr Ashok Dhawale and AIKS Maharashtra general secretary Dr Ajit Nawale have asked three newly-elected MPs of the Maha Vikas Aghadi (MVA-INDIA) from the milk belt of Maharashtra Dr Amol Kolhe (NCP),  Bhausaheb Wakchaure (SS), and Nilesh Lanke (NCP), to take up the cause of milk farmers of Maharashtra in Parliament.  After congratulating them on their resounding victory over their BJP-NDA rivals, the AIKS leaders apprised them of the milk farmers struggle which is intensifying in the state under the leadership of the AIKS and the Milk Farmers Joint Struggle Committee, and requested them to support it. All three MPs agreed not only to support, but also to take the initiative in this struggle, an official AIKS communique claimed. Farmers in Maharashtra are currently getting as low as Rs 24-27 per litre for cow milk, which is being sold in the market for Rs 56-60 per litre, the AIKS leaders noted. The low price to farmer