23 April 2020, NIICE Commentary 4213
Mrittika Nandy
For the last 25 days and more, life in India has come to a complete standstill. People being forced to stay in their homes with the pointed objective of curtailing the spread of COVID-19, has led them to raise doubts on India’s preparedness for COVID-19. This article categorically focuses on understanding the mental health issues that come associated with the global pandemic and how the Indian health care system is trying to offer solutions to these issues. It also aims to incite bigger questions, such as – Is India ready to face another global pandemic in the near future? And is the Indian Healthcare system sophisticated enough to deal with both, the rising cases of Coronavirus and the mental health issues associated with quarantine and workload?
The virus which emerged from China in December 2019 has become a Juggernaut in hampering lives, depleting economies and stagnating the social fabric of a national system. As per the Government sources, the first case of COVID-19 was reported in India on 30 January 2020, and since then, the number has only gone up. Some of the most affected Indian states include Maharashtra, Delhi, Rajasthan, Uttar Pradesh and Punjab.
As of 23 April, there are 20,471 confirmed Coronavirus cases, with 652 deaths. The pace of recovery has been slow but what is India’s most haunted dream is relapsing of the recovered patients into COVID-19 positive cases again. It is an accepted fact that India, with its ever-growing population, will never be able to develop a ‘public’ healthcare system. The same has been reiterated by Indian Prime Minister, Narendra Modi, as well as by doctors, health experts, media reports and researchers. Media reports from South Korea, Brunei, Singapore affirm that more than 200 patients have been tested positive for COVID-19 again, after having recovered. If similar cases happen in India, then it will certainly be a ticking bomb for the country’s ill-equipped and supremely under-funded healthcare system.
The Indian populace is currently arguing upon two streams of thought – either the numbers are not being portrayed correctly, or rapid testing hasn’t been taking places, especially in ‘hotspots’ such as Delhi, Maharashtra, Telangana, etc. The former was acknowledged by Government sources, and online press conferences by Chief Ministers of various states have confirmed categorically that more test kits have been ordered and hotspot-states are being constantly monitored through drones and other surveillance devices. The missing point here is that individuals do not necessarily come forward and report to nearest healthcare centres as the symptoms of COVID-19 are almost alike to that of the Common Flu. This is also primarily because of the stigma attached to being reported and identified as a COVID-19 patient, and the fear of families being put into forced quarantine habitation.
In this line of fire, there are Cabin Crews, Doctors and other frontline workers who have reported loss of self-respect or esteem and have faced humiliation by neighbours, and even by recognised government bodies such as Resident Welfare Associations (RWAs). The mental and physical harassment is such that they have been evicted from their rental accommodations, and have faced vandalism of private property in metropolitan cities like Delhi, Gujarat and Bangalore. The mental maturities of people are so skewed that they fail to appreciate or recognise those workers who are risking their live,s and of their families, to save others.
It has been rightly said, that humans are social animals. The very idea of being forced into isolation has been attached to nothing but demeaning attitudes, stigma and mental harassment, which has led to depression, withdrawal symptoms and even fleeing from quarantine centres. Clouding of thoughts by mental distress of being isolated, has resulted into overlooking the fact that saving life is more important than upholding self-respect. A recent case in Bangalore reported that individuals fled from Quarantine centres, manhandled the police force and created havoc in a public space. How will India manage to deal with the COVID-19 crisis on one hand, and the imposed mental agony and pain on the other?
Health awareness campaigns have already been started by the Indian government – these utilise the power of ASHA (Accredited Social Health Activists) workers and other health workers to spread awareness on Coronavirus symptoms. Technology has also played a fruitful role, especially in case of the the ‘Aarogya Setu Application’, and awareness campaigns have been led through phone calls to enlighten phone users about the disease. Although efforts of the Government are commendable, there is still scope for more testing and surveillance, especially in areas where informal worker/ migrants are residing, as well as in posh societies where families prefer to brush it under the carpet due to the fear of ostracisation from their social circles. Sadly, it is a fact that the ‘Indian form of self-respect’ stems from economic status and social standing within peer circles.
We need to involve psychiatrists, counsellors and even journalists to help in breaking the mental blockade and make citizens work alongside the government in reporting or identifying COVID-19 patients. Resident Welfare Associations (RWA’s) in India, through their communication channels, can also help in spreading awareness on the issue and even organise campaigns for sanitation workers and residents. Even young aspirants in the field of politics can use the power of social media to make a difference.
India’s public healthcare system will always fall short in fulfilling the demands of a growing population. In addition to this, India spent only 1.28 percent of its GDP (2017-18) as public expenditure on health. While India’s per capita public expenditure on health has increased more than twice from Rs. 621 per person in 2009-10 to Rs. 1,657 in 2017-18, it still remains very low. compared to other countries. The United States spends the most on public health – 18 percent of its GDP, which is over USD 10,000 (nearly Rs 70,000), per person annually. The Indian government has aimed to raise expenditure on public health services to 2.5 percent of the country’s GDP by 2025, which would still be very less. With such low expenditures, India’s road map to dealing with health crises at present or even in the future appears bleak.
Moreover, medical expenses of the Private healthcare sector continue to surge ahead of public or government-aided hospital bills. It puts a huge section of the population at the mercy of generic medicines and overpriced services (for the sake of better facilities, which public-funded hospitals are not always able to provide). In case of the COVID-19 outbreak, Indian States turned stadiums, hotels, restrooms and railways coaches into quarantine centres overnight – but will this be enough to meet the demands of the growing population? Governments can ensure that pharmaceutical companies and private hospitals in India can join hands with the authorities and establish hospitals or even construct isolation wards for such pandemics in the future. At the same time, India also needs Health Insurance (similar to United Kingdom’s National Health Service) for all, irrespective of economic status. The ‘Make in India Campaign’, can be implemented in manufacturing surgical kits, medical equipment, masks, protective suits for doctors, medicines and much more. Media and other communication channels must encourage denizens to practice a proper health hygiene, as has been dictated by WHO norms. Apart from these measures, we must note that while expenditures in core sectors of the economy such as Trade, Technology and Defence are important, the health sector is equally significant. If such pandemics keep occurring every now and then, countries will have to transition from geopolitical diplomacy to medical diplomacy too.
