Invisible India's Corona

A few questions that I am struggling with….

Yet another normal day in the hospital. All around the COVID19 fears, and home quarantines, closure of offices, social distancing and loud and clear media messages of prevention and mitigation. As I walked around seeing a few those who have come to hospital, I realized for most who came to Outpatient Department it was yet another normal day.

A few quick questions to some of them revealed that, they are there because they need their regular medicines. There is no “Amazon” that delivers their medicines at home! They need to check their sugars, their BP, their prescriptions must be filled.  (I put up the picture of the OPD somewhere and there was a suggestion that only essential services should be open!)  For this community, what is essential is their daily medicines, and they need a service which will provide that – could we close it down, because the urban well off can afford to get in online? And deprive regular treatments?

Yet others are there, because they are worried. A young man came into ask; can I eat chicken. Chicken is going at 30 Rs Kilo! Another elderly man came asking – “Corona tho nahi hei”? They need a place where they can walk in and get dependable information. Should we close regular services and put the shutter on the option of people getting dependable information?

Then there are the many who are coming in with their crisis’s situations – the so-called essential services. They need to be cared for, come what may. They can not wait another day – because life may not wait for them! The answer here is clear, we need to care but, if tomorrow we are overwhelmed by COVID19 critical cases – what would happen to others? What would the impact on the health care professionals be?

Then there is the question of triage – based on travel history and symptoms. Being post Holi – all have come back after travels to various other locations – so if we triage, how many need to be tested and quarantined? If they must be tested, the nearest center is 250 kilometers away. Being transition between winter and spring, a season for viral illness, reactive airways diseases, many are struggling with cough and fevers – are they or are they not Corona? One will ever know.

Yes, we can suggest home quarantine – but home quarantine for rural daily wages worker? Where will his daily earnings come from? Even if he or she is employed in an office or business, which employer or business in rural India has the system for working from home? The rural people’s life is out there in the community. Health care providers life is with people! What does it mean when we say home quarantine for such communities?

Of course, handwashing, distancing and masks are must keep if services need to run. But masks? The urban market has bought off all the re-usables! The rural market is emptied of all masks and sanitizers. Hospital is stitching cloth masks because disposables have been hoarded off in the cities! If health care institutions can not get mask, where will ordinary rural person get his “masks” from?

Yes - the messages are clear and loud, social distancing by all means! But reality of social distancing in rural India rural communities and health care institutions?

ICMR has shared that thus far there is no community spread, which is a welcome relief! Even if systems are sub optimal, we can be assured that we have more time at hand! We can put our heads together and see how we can mitigate this.

But if tomorrow, the community spread happens, will we ever know? Will there be system to prevent this from happening? Where public health care systems are far from optimal, what intervention will prevent the spread?

With no testing centers available for most communities, will we ever know if the virus came and left? Is a rapid spread and herd immunity (like the UK thought initially) better for rural India? But then what happens to the vulnerable – the elderly and people with co-morbidities? Would they die at home with hardly any critical care systems in place?  Many such questions – I do not know who can answer these! 

So, would we live a normal life amid abnormal circumstances? Majority of rural India are living ordinary lives of living one day at a time. How should we live in this season?  Live ordinary lives in extraordinary circumstances?

But I realize, what is ordinary for the visible urban India is extraordinary for the invisible rural India. What is extraordinary for the visible India is ordinary for the invisible India. To live “relevant” and wise” is what we are called for! What is relevant and wise – I hope in the next few days I will learn!