As the second wave of Covid-19 seems to recede from the big cities, the focus is on the rural side. That is where more and more cases are coming up and that is where health infrastructure is especially weak. What needs to be done?

Can gram panchayats act as the first line of defence? To strengthen them and to provide grants to them, the finance ministry on Wednesday released Rs 8,923.8 crore to 25 states, following a recommendation of the ministry of panchayati raj. Also, the health ministry issued SOPs on Covid-19 containment and management for the countryside including awareness campaigns. Among other measures, its guidelines direct states to open 30-bed makeshift Covid care centres in panchayats, depute AYUSH doctors and community health officials and conduct rapid antigen tests.

Homeopathic doctors Sujata Goda and Chandrashekhar Goda, who have been working in the tribal-dominated Vikramgad taluka of Palghar, near Mumbai in Maharashtra, for 30 years, say fear, dogma, low education, lack of awareness, misinformation and geography of the region have been major hurdles in the fight against Covid-19.

Villagers prefer not to report any symptoms they may have due to lack of knowledge and awareness. They fear they’d be sent to quarantine centres far away from their homes. Experiences shared by those who were taken to government hospitals for treatment and the fact that 60-70% people could not come back home too have exacerbated the problem. They are avoiding vaccination because they think of temporary post-vaccination discomfort as illness; misinformation in the form of negative videos circulating on mobile phones have added to vaccine hesitancy.

The doctor couple, working at the Smt Janki Bachchubhai Dubey homeopathic hospital community centre in Bhopoli village that caters to 25 surrounding villages (totalling a population of 40,000), say that the financially better-off people of other backward classes (OBCs) go for vaccination whereas the poor from the scheduled tribes (STs) are afraid and resentful of government and agencies working there and don’t want to get vaccinated. The hospital has several outreach programmes for mothers and children in the villages, which form its main intervention in these villages.

Dr Sujata Goda recalls that when the village health sub-centre had a vaccination drive some days ago, people of the village itself were not aware of it and could not get inoculated while people from outside the village came to take the vaccine. “Locals thought it was some medicine on sale. Incidentally, our village sarpanch was also unaware of a vaccination drive that was to take place this week. When government representatives went door to door for vaccine registration, they ran away as they did not want to get registered. Only about 5-20% population has been vaccinated so far.”

Dr Chandrashekhar Goda says that the common perception among the tribal population is that Covid positive means you are as good as shot dead. “While majority of the patients recover, the situation worsens for 20-30% people who have symptoms but don’t report. They move around and spread the virus and also endanger their own lives. The system of care has not worked for the tribal community,” he says.

Telemedicine, underlined also by prime minister Narendra Modi, can be an effective tool for Covid care, but poor mobile network connectivity in rural and tribal areas make its implementation challenging. With their livelihood coming from jungles traditionally, tribals have depended on indigenous herbal plants, medicines and remedies for healthcare – much of which may not have scientific basis.

How effectively the health ministry’s guidelines are implemented will be seen in the days to come but Dr Chandrashekhar Goda says that healthcare has to be tailored as per the requirements at the grassroots. The government can tweak and tailor its programmes for tribal populations so that information is provided in the language they understand. As an example, he suggests ‘farm quarantine’ for those with mild symptoms and others who do not require institutional quarantine. “As the sowing season is on, they want to work in their farms. ‘Farm quarantine’ will remove their hesitancy to treatment and fear of staying away from homes. Monitoring can be done by our team of 48 mobile multipurpose care workers.”

Historically speaking, such measures make sense, as they were indeed adopted for quarantine and isolation during pandemics in earlier times.  

Dr Sujata Goda, however, adds that monitoring will always be a challenge as homes are spread out over in hamlets which are themselves spread over a vast region. A single monitoring health worker can at the most cover three or four hamlets in a day and that too if the patients are at a single place. Those in need of health monitoring should be in a single centre where food, medical and healthcare facilities are available. As power supply is erratic and irregular in rural areas, a single centre with assured power supply for care and treatment of patients and oxygen concentrators will work best as generators and invertors only have certain available capacity.

Dr Chandrashekhar Goda adds that what tribals want are compassion and empathy, and a suitable awareness campaign that speaks to them will bring them out for vaccination.  

Palghar district collector Manik Gursal says the administration will now quarantine Covid patients in primary schools where they can get homely food. He said that villagers don’t believe Covid is life threatening due to their superstitions, dogmas and local quacks. “We brought many quacks to the police station and fined them. The word has spread. This has brought a fear factor among these ‘private doctors’ in Vikramgad. We have issued an advisory that they should not treat anybody without sending them to testing or they will invite problems. We have activated village committees.”

According to the Godas, after the start of pandemic and community surveys done by their health care workers, three homeopathy medicines were identified as per the symptoms in body. With a liner indication given to community health volunteers/workers for differentiating symptoms and stage of infection, the medicines are accordingly given to patients and have shown good results after one or two doses or a single day’s medicine. With the word spreading about the efficacy of these medicines, out of the 400-500 people who have been given these medicines, 90-95% have shown good results within a day or two. Most patients are milder cases and get better with correct medicine.

Gursal says that extensive RAT tests conducted this month has substantially reduced the numbers. “From 18,000 cases in a single day, the number of cases has fallen to 10,000 today,” he says.