“If you really want to know, I’ll tell you. The reasons for urban India’s healthcare difficulties are pretty straightforward,” he says. A health professional working at a government run healthcare centre in rural West Bengal, the doctor requested to remain unnamed, citing fear of retribution.

“There is too much apathy in cities. There is no sense of community. In rural India, there is, what we call in Bengali, a desire for haandi khobor, which has a lot of negatives, but when it comes to spreading the word on healthcare, getting medical help to those who need it, it helps hugely. During the pandemic, we didn’t suffer much in rural communities because they were all helping each other out, and helping us with the information. In cities people don’t care.”

There is more that follows, mostly with how a proliferation of private hospitals and medical practitioners has meant government facilities have run dry, not of equipment or infrastructure, but staff and interest. During the onslaught of the second wave of COVID-19 when hospitals in cities were choked by volume, and dried of resources, somehow, testimonies suggest, rural India stayed relatively calm.

Dr Souro Ranjan Basu, the Block Medical Officer at Sarisha, in South 24 Parganas, West Bengal, testifies to this. The Primary Health Centre at Sarisha is a 65 bed facility, and while relatively well equipped to deal with pregnancies, child care, dengue, malaria and the like, has nowhere near the kind of oxygen reserves that may have been necessary during peaks of the pandemic.

Dr SR Basu, the Block Medical officer at Sarisha in South 24 Parganas, says that their ability to deal with patient load stems from experience. Photo by Vaibhav Raghunandan

“Our training on dealing with floods of cases of dengue, malaria and the like, during the season, and our large grassroots medical health working staff like ASHA workers, meant we didn’t have such a huge load,” he says. “Sure all our beds were full during the second wave, but I’d say if we had a 100 cases, only 15 of them required huge amounts of oxygen and therefore had to be shifted to the sub divisional facility. My colleagues in the field went and explained in detail when to bring a patient for hospitalisation, because of which there wasn’t a fight for beds, etc.”

While relative calm presided over certain parts of South 24 Parganas, watching things unfold in other parts of the country was traumatising in and of itself. Remya Molvs, a nurse at the Gosaba rural hospital transferred in the summer of 2018. From Kottayam in Kerala, Remya came to Gosaba with her then six month old son. Her husband, a businessman, stayed back. She hasn’t been home since Christmas of 2019. 

“My mother passed away due to COVID-19, during the first wave,” she says. “I couldn’t go for her funeral, to see her one last time. I haven’t been home for almost two years. My son is now 2, and he hasn’t even seen home.” 

The Gosaba Rural Hospital is the sole primary healthcare facility on the island. Photo by Vaibhav Raghunandan

Living on her own in the staff quarters in Gosaba, Remya had a first hand view of the strange slow burn carnage of the virus in the delta. “In the initial days, the real problem was educating people on why to wear a mask, sanitise, and socially distance,” she says. “But when people started returning home from the cities, many were carrying the virus, and then it spread out here too. Then it got tough when it spread among locals.”

Tapan Karmakar was one of them. A tempo driver in Gosaba, Karmakar caught Covid in May 2021. “I think it was my cousin who came from Bengaluru”. After two days of high fever his oxygen plummeted to dangerous levels. 

“I’m a healthy person,” he says, while out on a morning walk on a road surrounded by mangroves. “I never had any problems. At least none that I knew of. But when it hit me, it was very bad. My kids are very young, and my wife doesn’t have a job so it would’ve been tough… you know.” Karmakar, luckily lives a couple of kilometres down the road from the hospital and so, was rushed over in time. 

He was immediately put on supplemental oxygen, and stabilised within a week. He takes it slow now, and the economic slowdown has also ensured he gets time to recover. “The tourism has decreased so the goods I delivered, mostly to hotels and resorts, has also reduced. I oscillate between thinking, ‘thank god I’m alive at least’ to ‘what kind of life is this, always struggling for money?’ Today it’s more of the former.”

At the peak of the crises, Remya started serving long shifts at work, and her son was being taken care of by the house help and her family. The hospital’s small premises were adequate for normal times but meant a Covid ward was out of the question forcing the government to create safe houses for patients. “We weren’t understaffed, but I’d say we were short on supplies and space at different points of time. They arrived, but we knew the trouble taken to procure them, and in many cases NGOs also helped. Every small bit was a boon for those affected.” 

Through Mission Sanjeevani, during the second wave, Oxfam India supplied life saving and critical medical equipment across the South 24 Parganas. These included oxygen cylinders, concentrators, BiPAP machines, ICU beds, patient monitors. Apart from that, masks, safety kits and PPE kits were provided for frontline health workers. Beds, oxygen concentrators, and masks, in huge demand, were catered to by their intervention.

The hospital slowly began operating at a normal pace by December, allowing patients in moderate numbers to come in for general checkups, and clinics. Photo by Vaibhav Raghunandan

“On an island like this, first we had to educate people about sanitisers and masks, but also, make them available. Having them in huge quantities with us was helpful .We distributed them freely…”

Stories of darkness permeate through. Despite the relatively low death rate and infection rate, medical professionals across the country have seen enough grief for a few lifetimes. 

On a busy OPD day at the Kakdwip Sub divisional hospital, the main hall is filled with patients and families, waiting for one of the on-call medics to call them in. Everyone is masked, and everyone tries to maintain as much distance as is respectfully possible. There is a gentle hum in the air, the kind you’d expect at a hospital packed like a market. Dr Barnali Chakravarty recalls a time when the same halls were grim and silent, but never empty. A medico legal, Dr Chakravarty works in emergency response and otherwise serves shifts during the OPD. She was on duty full time during the second wave.

“There were so many patients, who died in front of my eyes,” she says. “By the time they’d come here, or managed to get here at all with blood oxygen in their 30s, we knew it was too late. We’d take them out of the ambulance and wheel them in, and at the door they’d collapse. It was harrowing… we didn’t have time to grieve or give the family some space, it was just… move to the next one.”

And the ambulances were doing exactly that—moving constantly to the next one. A fleet of 15 stand empty in the December winter sunshine in the premises of the hospital at Kakdwip, blocking the narrow road that leads to the main block. But it wasn’t like this in May. Ajay Mondal remembers being on what was essentially a 24-hours shift. A driver, Mondal is usually deployed to transport emergency cases of heart failure, pregnancy and other such, but during the waves, he was exclusively transporting serious cases to the premises.

Ambulances are available aplenty with the crisis solely receding. At its peak, there was a dearth of not just vehicles but also immense stress on drivers. Photo by Vaibhav Raghunandan

“I’m not a doctor. I haven’t got any medical degree, but there were times I could tell from the moment I landed up at a house, that there was no point in doing the journey,” he says. “I questioned myself very often. We’d land up to pick up someone who was definitely not going to make it too long and we’d see or hear about someone else nearby who had a better chance of survival. But we couldn’t do anything to take them to help. We couldn’t make those decisions.”

Those that did, dared. Dr Basu was one of them. Despite an easing of lockdowns, and government enforced protocols, Dr Basu has been urging his colleagues to prepare for whatever wave is thrown at them next, by routinely not just checking supplies but also paying visits to people in the community and generally keeping their ear to the ground. Talking about this in December, he cautioned against easing off, but also the need for a certain degree of control. 

“No need to panic, no need for lockdowns, no need to create fear. Any of that will make the public panic,”he says. “And panic creates problems. In my humble experience, many who rushed in at the first sign of congestion or a cold often ended up as the easy cases, but blocked space for those in need.” 

“People need to exercise control now,” he says. “I know this seems like it’s absolving us and those in charge of our duties, almost thrusting responsibility on the populace, but it’s not. We need your help, to help you.”

Vaibhav Raghunandan is a photographer, journalist and designer. This story has been written as part of an assignment for Oxfam India.

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