Updated: September 25, 2020 8:06:17 am
In the isolation room of the Ratnagiri Civil Hospital, where family members collaborate to help patients. (Express Photo of Tabassum Barnagarwala)
Imran Solkar recalls when the first case of Covid-19 reached Rajiwada, a coastal fishing village in the Ratnagiri district of Maharashtra, in March through a contact from Tablighi Jamaat. The communal accusations that followed, in addition to the social stigma and lack of faith in the government health workers, led people to their huts. They simply refused to reveal if they had any symptoms of coronavirus. Some fishermen eventually turned a zilla parishad school into a fever clinic, bringing together three private doctors to provide treatment and counseling for those in need of hospitalization.
However, the horror stories of those found in government facilities still prevented people from showing up for testing. In August, Ali Pagarkar (72) from Rajiwada refused to test for Covid-19 despite having a fever, acute weakness and a chest CT scan showing pneumonia. When he finally agreed and was taken to the Civil Hospital after testing positive, Solkar says, he came back full of scars. During the 10 days he spent in the ICU, Pagalkar said, they did not change his clothes, no ward fed him or touched him, while the same assistant who cared for the corpses brought him food and water without changing his gloves.
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The fear is not limited to villages where facilities are limited. State epidemiologist Dr. Pradeep Awate says that 40 percent of the patients who succumbed to Covid-19 in Maharashtra died within 24 hours of hospitalization, indicating that they arrived after becoming critical. Awareness of the coronavirus remains low and patients don’t take the disease seriously until severe symptoms emerge, he says. “District planning has not addressed these issues. For us they are small problems, but they define the behavior of a patient ”.
Ratnagiri district’s fatality rate is 3% (twice the national average), with 100 new cases every day. It remains one of the few districts in Maharashtra with less than 10,000 cases, but businessman Suhail Mukadam fears that this is due to the unwillingness of villagers to get tested.
General practitioner Atish Khanvilkar, who runs a private clinic in the city of Ratnagiri, says that most of the 100 patients he sees every day have Covid symptoms, but they refuse to acknowledge the same. “We need religious and political leaders to help.”
Dr. Nazia Mirkar, a consultant at the Rajiwada school that is now a clinic, relates that the villagers told her they would give them an injection (of Tocilizumab) that would kill them. Rather than force a test in mild cases, Mirkar says, she begins counseling the moment a faulty chest CT appears. “Our goal is to prevent deaths.”
It’s not just stigma or fear of the unknown that keeps villagers away. There are also practical questions like who will care for your livestock if an entire family is quarantined.
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At Ratnagiri Civil Hospital, where Pagarkar spent 10 traumatic days, relatives continue to sleep outside the ICU, helping patients eat, change and use the bathroom due to lack of staff. “If we don’t go, nobody takes care of them,” says Dhanashree Kate, whose husband Vineet (33) is in ICU.
Umesh Maruti, squatting below, nods. “Most of the ICU patients are sleepy. One night, a boy in the ward asked two patients if they wanted dinner, they both refused and he just left. None of the other patients were offered dinner. “He buys warm water for his mother Rukmini (60) to drink at a nearby hotel.
Ratnagiri civil surgeon Dr. Ashok Bolde says his priority is to appoint the doctors first and then examine “smaller issues.” There are only 16 doctors out of the 50 required in the Civil Hospital. Dr. Ashfaq Gaus, an Ayush physician in the Ratnagiri Health Department, says the “lack of management” adds to the resistance against hospitalization.
Dr. Shashikant Ahankari, from the Halo Medical Foundation in Osmanabad, 400 km away, says they distributed brochures in 70 villages to educate villagers about the coronavirus. “We use rickshaws and loudspeakers to talk about hand washing exercises and social distancing.”
In the district’s Andur village, where 170 people tested positive and seven died as of September 10, Baburao Chauhan, a member of the gram panchayat, says they need trained doctors to speak to and advise patients. The panchayat steps in to help in case someone needs treatment. “We know that it is difficult to convince people to go to the hospital if they have a bad experience,” says Chauhan.
ASHA worker Shakuntala Langde acknowledges that there was a change from the moment when people refused even to have their temperatures taken for fear of showing a fever and ending up in quarantine. Langde began by advising heads of households. “We have come to realize that this is about community participation.”
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