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To discuss the pertinent topic of the time, measures to tackle the spread of the second wave in rural areas, the Centre for Habitat, Urban and Regional Studies (CHURS), Department of Social Work, Bharathidasan University, Tiruchirapalli, and the Impact and Policy Research Institute (IMPRI), New Delhi, organized a panel discussion with eminent panelists on Rural Realities: Tamil Nadu Practitioners’ Experiences in Tackling the Second Wave.
Prof R Mangaleswaran, Professor and Head, Department of Social Work, Bharathidasan University, Tiruchirapalli, the moderator of the session, initiated the discussion. The Covid pandemic has prompted unprecedented death, despair, and affliction among the entire population. During the second wave, Tamil Nadu contributed 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 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 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-economic indicators.
D Kotteswara Rao, Assistant Director, Schizophrenia Research Foundation (India), and 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 the mentally disabled. Additionally, there is a dire scarcity of psychiatric medicines in the 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, which however was better in the first wave. The unpreparedness is attributed to the negligence of political parties.
He stressed “responsible wellbeing” is imperative to prepare the citizens and to overcome the pandemic. The current government is exerting serious effort to build a health movement on the same line. Moreover, the media has the responsibility to communicate messages comprehensively and prepare the citizens to approach the situation with the right frame of mind.
Subramania Siva, Managing Trustee, Service Initiative for Voluntary Action Trust, Coimbatore, emphasized the role of NGO. While the NGOs have been pulled in at the state level to collaborate, the same needs to be done at the district level too. He criticized the negative propaganda spreading through social media against vaccination and its influence 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.
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. They were deprived of fundamental amenities and lived in pathetic conditions and relied on natural medicines like Kabasura kKdineer. He questioned the very existence of such slums located close to rich neighborhoods.
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 even 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 overcoming pandemics such as these.
Dr K Kolandaswamy, former Director, Public Health, Government of Tamil Nadu remarked that the peripheral institutions need to be strengthened and be prepared for the next wave. The incompetent testing facility is one of the many challenges in rural areas. Upgradation of Taluk and non-taluk hospital with oxygen and more testing facility can prepare us for the third wave.
According to him, the availability of vaccines is another major crisis facing the state, but he be. 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 very small proportion of people who exhibit vaccination hesitance is not a serious challenge as he believed that when a majority gets vaccinated, they would fall in line. So, the focus should be on availability.
He added that, like the government has expanded its capacity, corporate and private medical hospitals which have immense resources should willingly expand their capacity too. He believed that while industrialists in the name of CSR are voluntarily helping, those in the private health care industry have not extended their help sufficiently, with a few exceptions.
Esther Mariaselvam, Associate Director, Action Aid India, shared her experience in Covid response. In the rural area, 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 which 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. The 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 favor of the powerless. This pandemic is an opportunity where more resources are allocated for health, ensure quality health for all regardless of location, caste, creed, and color", Esther Mariaselvam said.
Dr Sundaresan Chellamuthu, Professor, Madras Medical College, Chengalpattu, cited the cases of misdiagnosis of Covid that occurs 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 practice alternate non-tested medicines which offer no sure cure or protection. This he said can be addressed through 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 Chellamuthu said.
Concerning the need for vaccination, he claimed that to attain herd immunity 90-95% of the people need 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 & Founder Director, Tamil Nadu Institute of Palliative Medicine of Scope India (TNIPM). He shared the insights he gained from VHNs who had surveyed the symptoms of all families under their division in the first wave. In the second wave, Village Health Nurse (VHN) expresses their discontent at the vaccine hesitancy.
Out of 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, but 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 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 happens close by. An appointment system needs to be implemented and the sites must be separated to prevent the situation of super spreading.
He recommended that the rapid antigen test could be used in the first stage in the 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", he said.
Elango Rajarathinam, Director, Elders for Elders Foundation, opined on the lack of awareness of the people in the rural areas, to the extent that even PHCs lack awareness in some places. They are ignorant of the effect of clustering and even lack understanding of where to seek help and how to approach it.
The elderly and the destitute are pushed too much suffering in the rural areas. He emphasized 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.
Reni K Jacob, legal consultant, International Justice Mission (IJM), Chennai, commented on the plight of the children who have been orphaned and those whose families suffer income loss. Child labor, human trafficking, and bonded labor have increased. Since it takes a long time to come to perfect health after Covid-19, the 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 pushed to death in these times. Further, he questioned the reliability of the statistics and how without proper statistics, it affects strategy, development and action plans.
Way forward
Reni K Jacob said that the power of the youth must be channelized properly by encouraging volunteerism. Prof G Palanithurai called for the need to recruit More and more volunteers to assist the burdened medical team. Dr K Kolandaswamy recommended that volunteers who have recovered, are fully immunized, or who recovered and did not need serious medical attention should be brought in preparation for the third wave.D Kotteswara Rao said that a centralized 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. Elango Rajarathinam stressed the empowerment of the panchayat. Subramania Siva suggested avoiding the blame game and collectively involving all stakeholders to eradicate the virus.
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