For post-pandemic media, public health needs to be the biggest story

India’s healthcare system has not folded because of the pandemic, it was already broken.

WrittenBy:Kalpana Sharma
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From burning pyres and patients gasping for breath to bodies floating down the Ganga, India has been through another torrid fortnight. The whole world is now aware of the extent of the tragedy unfolding. Yet, our government continues to focus on fixing what it considers to be a "negative" narrative.

A fortnight back, when the focus of international and national media coverage was the desperate situation in New Delhi, where hospitals, private and public, were running out of oxygen and patients were dying not from the disease but from the absence of oxygen supply, we knew already that if we turned our gaze away from the cities, a much more tragic state-of-affairs was unfolding.

That is exactly what has happened. The second wave of the pandemic has inevitably, and predictably, spread to rural India and the devastation here is incalculable. This is so because there is little to no reporting, people are not being tested, not being treated when they finally reach a health facility, and dying not knowing that the "cough and fever" that afflicted them is the novel coronavirus that has already felled lakhs of other Indians.

The reports appearing in the media, mostly print and digital, remind us repeatedly that the Indian health system has not folded because of the pandemic; it was already broken. Although the sheer volume of cases has overwhelmed it even in better-served cities, in much of rural India and in small towns, the existing and abysmal health infrastructure that exists might as well not be there.

What journalists report gives us only a glimmer of the grim reality. Such as this report in the Indian Express by Amil Bhatnagar from Meerut in Uttar Pradesh. What he describes is not the situation in a remote hamlet but at the district headquarters: "A folding cot that a family claims to have got itself, fans that don’t work, a roof that is leaking at several places, and a ward overpowered by the stench of a toilet. As Meerut district climbs to the top of Covid charts in Uttar Pradesh, with 1,368 new cases taking its total active number to 13,941, its largest government coronavirus facility, Lala Lajpat Rai Memorial Medical College, is struggling to keep up."

The situation in UP has become the focus of much of the media attention. Understandably so, as despite chief minister Adityanath's threat to jail those who criticise the work of the state government, the reality cannot be hidden any more. Even members of his party are now publicly complaining about the dismal reality on the ground.

In Varanasi district, one of the four high-burden districts in the state, Jyoti Yadav from the Print reports that people are dying from "cough and fever" without realising it could be Covid because there is no testing. Her reports from Lucknow and Jaunpur tell a similar story. Every day new reports are chronicling the absence of health infrastructure and the price ordinary people are paying.

Most heartbreaking amongst these are the reports of over 700 schoolteachers who died because they had to do poll duty during the recently concluded panchayat elections in the state. This one in PARI, which gives us the full list of 540 men and 173 women teachers who died, is probably the most moving. It illustrates the utter callousness of a government more concerned about elections than the lives of its people, men and women who are also frontline workers.

And then you have hospitals that are built and widely publicised but add up to nothing. A report by Ayush Tiwari and Basant Kumar in Newslaundry describes how only 50 of the 150 oxygenated beds in a facility inaugurated with great fanfare by Baba Ramdev in Haridwar, Uttarakhand, are operational. They add: "There’s a shortage of doctors, ward boys and housekeeping staff, limiting the facility’s capacity and forcing it to refer patients elsewhere. The facility does not have proper water supply and Covid wards don’t have roofs, risking widespread transmission."

Remember Haridwar only recently hosted a "superspreader" event, the Kumbh Mela.

The situation in neighbouring Bihar is not much better. Pratyush Tripathy, writing in Scroll, illustrates with a set of maps the crisis that is waiting to explode in the state where there are no vacant ICU beds in 18 out of 38 districts. This, in a state that has the lowest Human Development Index in the country and "one doctor for 43,788 persons".

Meanwhile, the government itself has finally acknowledged that the situation in rural India is worrying with 533 districts in the country out of over 700 reporting a test positivity rate of over 10 percent. Dr Balram Bhargava, director general of the Indian Council of Medical Research, is quoted as saying, “India is facing a massive upsurge in Covid-19 cases. The national positivity rate is around 20-21 per cent, and about 42 per cent districts in the country are reporting a positivity rate more than the national average."

Just as the second wave of the pandemic had been predicted, this too should not come as a surprise. Yet, the government and its supporters continue to find ways to divert attention away from this tragic unfolding saga in rural India.

Their latest ploy is the creation of digital spaces that mimic well-known international newspapers' names, but have been specifically tasked to put forth the narrative that the government wants the world to hear. Thus, we have something called The Daily Guardian telling us how hard prime minister Narendra Modi is working to handle the pandemic, and The Australia Today accusing "vulture journalists" of spreading "more panic and despair than the pandemic".

Fortunately, or unfortunately, for the Modi government, neither the Indian nor the international media is persuaded by these deflection tactics. The stories are streaming in, from villages and small towns, and the picture they paint is not pretty. Neither can it be hidden. How long can a government go on denying this reality? How much of spin can it give when there are visuals of bodies floating down the very river it has promised to cleanse?

In fact, the government's response to the disturbing visuals of scores of corpses found floating down the Ganga and washing up in UP and Bihar illustrates its priorities. According to an ANI report, union Jal Shakti minister Gajendra Singh Shekhawat reiterated, "The Modi government is committed to the cleanliness (of) 'mother' Ganga", even as he did not deny the reports about the bodies. Is that all the government is worried about, the "cleanliness" of the Ganga, at a time when in desperation people are abandoning their loved ones in the river because they cannot afford to cremate them?

The reports we have read over this last fortnight are just the tip of the iceberg. There are many more stories waiting to be told even as authorities fail to count, or even acknowledge, how many people are dying from the virus. Here, one has to once again commend the determination with which the Gujarati newspaper Sandesh has persisted in counting the dead in the state and reporting the mismatch between what it has found and the government's official figures.

This report in Newslaundry from Meerut district in UP also exposes the huge discrepancy between the bodies being cremated and the official figures. In fact, the questions about the death count simply refuse to go away and will continue to haunt state and central governments. Not just journalists, but even experts such as the mathematician Murad Banaji have raised repeated questions about the accuracy of the death count. Banaji suggests in this interview to Karan Thapar on the Wire that one million Indians have already died from the virus.

Apart from the pandemic, its spread to rural India ought to remind us that the story of the grossly inadequate health infrastructure is one that has always been there.

India's health system has not crumbled only because of the pandemic. It was barely adequate at the best of times, and in many parts of rural India virtually non-existent. Today, we are being compelled to notice this and acknowledge it because of the health emergency the country faces. But each year, these areas see many such emergencies in the form of other diseases such as dengue, malaria, and encephalitis as well as perennials such as tuberculosis. In states where there is chronic malnutrition and stunting amongst children, exacerbated by the absence of medical intervention, thousands of infants die every year from something that is easily treatable, diarrhoea.

When this crisis is over, although there is no sign of it at present, we must continue to focus on this failed health system in so many parts of India. The pandemic has shown us that gloating about being an "emerging" economy means nothing when people can die from the lack of oxygen during a pandemic, or the absence of clean water at other times.

If there is one lesson we in the media can learn from this terrible year it is that the focus on public health must remain a crucial and relevant part of coverage even in non-pandemic times. As epidemiologist Chandrakant Lahariya points out in the India Forum, India would be much better placed if the government fulfilled its promises of increasing health spending to 2.5 percent of the GDP and investing more in primary health care.

The media, I believe, can play an important role in creating pressure on this and future governments by refusing to take its eye off the state of our public health infrastructure.


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