This is the first piece in a series titled “The Rural Front Line,” by Yogesh Jain and Naman Shah, about the COVID-19 pandemic. Jain and Shah are both doctors working with Jan Swasthya Sahyog, a public-health initiative based in rural Chhattisgarh. Over the course of the series, they will address the issues they witness on the ground while dealing with the virus, and discuss how policy decisions affect the lives of India’s rural residents.
On the first day of a three-week nationwide lockdown, Jan Swasthya Sahyog’s hospital, in Ganiyari village of Chhattisgarh’s Bilaspur district, remained largely empty. In a place like Ganiyari, an empty hospital does not mean that less people are ill; it means the ill are simply not getting medical care. At 8 pm on 24 March, Prime Minister Narendra Modi had announced a 21-day nationwide lockdown to curb the spread of the COVID-19 pandemic, effective from midnight. With just four hours’ notice, the lockdown left both the JSS and its patients unprepared to face the many problems it created.
JSS is a community-based health programme in rural Chhattisgarh that was founded in 1996 by a group of postgraduate students at the All India Institute of Medical Sciences in Delhi. Over the twenty years since the hospital at Ganiyari was set up, JSS became an integral component of public health for patients from across rural Chhattisgarh and Madhya Pradesh, providing care for over fifty thousand patients per year. Working in a region marked by deprivation, JSS provides preventive, primary and complex healthcare where little else exists. The 100 beds at the hospital are permanently oversubscribed, and families lie sleeping throughout the corridors as the healthcare demand tragically requires several days of waiting just to be seen. The consequences of the national lockdown in such an institution are grave and may be irreversible.
On the morning of 25 March, the usual bustle at the registration counter was missing. A typical Wednesday is crowded because it is a clinic day. New patients are investigated at length and old ones return for check-ups and to collect medicines, among other reasons. At the JSS hospital, many conditions cannot wait to receive medical attention because diseases present themselves in advanced stages, in worn bodies with little reserve left. These delays occur not because people are irresponsible, but because obtaining food and caring for others takes precedence over securing their health, until the latter comes in the way of the former. As a result, the routine becomes urgent, and the urgent becomes emergent.
A regular clinic day would normally bring between three hundred and four hundred patients to the hospital, and at least ten new admissions. On 25 March, the numbers came down by around ninety percent across clinics, emergencies, deliveries and surgeries. The hospital saw between thirty to forty patients at the clinic, and just two new patients admitted to the hospital. The operating theatre schedule had only one entry when it was usual for the list to stretch beyond the board. The cases of patients with recalcitrant infections such as tuberculosis and leprosy are particularly concerning, because the interruption in these treatments, forced by the lockdown, will be disastrous, including the possibility of developing drug resistance.