VSovid-19 is sweeping out of control across India, disrupting major cities like Mumbai and devastating rural areas with extreme poverty and virtually no health care. The harrowing images of funeral pyres set up in public parks, burning an endless line of bodies, are just a glimpse of the tragedy unfolding across the country.
People wait outside hospitals – where there are no more beds or even oxygen – in 100 degree heat with their sick and dying loved ones.
Narendra Modi’s pro-nationalist government is partly responsible for failing to stop the Hindu religious celebration Kumbh Mela which brought 2.5 million people to the Ganges and for continuing political rallies which attracted masses of people . But much more than hypernationalism is responsible for this catastrophe.
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In the 20 years that I have reported on health for the Times of India and trained journalists to cover this beat, I have seen how the health sector was neglected during the growth and development of India.
India’s healthcare system was envisioned soon after its independence in 1947 as a three-tier system that could cover the entire country. It was to have a primary care system at the village level, a secondary care system to cover small urban centers and tertiary care for specialized treatment. Over the years, however, the focus shifted to for-profit tertiary care hospitals, primarily in large cities, with state-of-the-art equipment that provided care primarily to the urban wealthy. The profits of these hospitals, which are used to pay the high salaries of doctors and executives, have taken precedence over attempts to regulate them or to end malpractices, such as overcharging patients or unnecessary surgeries.
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Successive governments before Modi supported this unplanned growth, paying little attention to the health infrastructure that was underfunded, poorly staffed and crumbling. Sushma Swaraj, a senior politician in the Bharatiya Janata Party – the current ruling party – whom I interviewed in 1999 about the party’s failure to emphasize health care in its parliamentary election manifesto, told me said, “Health is a thing for the rich. In India, we must focus on providing bread to the poor.
Leaders of other political parties expressed similar views. Few in government or the old media saw health care as a matter of national importance.
I’ve covered epidemics and pandemics in the past, but nothing as tragic as the spread of Covid-19 in India, and I’ve seen the resulting chaos. In 1994, for example, after reports of cases of pneumonic plague were reported in India, rumors of airborne plague infection prompted thousands of people to flee the western Indian city of Surat and be admitted to hospitals in Delhi. There, as I saw in my report, a specialized hospital for infectious diseases was completely under-resourced. I have also seen families devastated by the AIDS epidemic in Indian villages with little access to testing or treatment and little attention paid to them by the government or the media.
The fact is that the poor in India have struggled to get health care for decades. Most healthcare expenses in India are paid out of pocket and healthcare payment is one of the major things that pushes people below the poverty line. A 2017 study by the Public Health Foundation of India found that healthcare spending was responsible for pushing 55 million Indians into poverty between 2011 and 2012. Up to 90% of the poor have no ‘Health Insurance.
One after another, governments have been promoting medical tourism which entices people from the United States and other countries to come to India’s for-profit hospitals for dental, cosmetic and other procedures. India’s Ministry of Tourism recently expanded its visa regime to allow e-tourism visas for medical tourism, a $3 billion industry that is expected to grow in the coming years.
This has come at the cost of neglecting the vast network of health systems designed to serve the poor, which have always borne the brunt of public health neglect.
The lack of oxygen to treat people with Covid-19 has drawn international attention. But this is not the first time the oxygen supply has been interrupted. Year after year, the northern Indian state of Uttar Pradesh experiences outbreaks of Japanese encephalitis in children, a disease transmitted by mosquito bites. In 2017, 30 children died suddenly in a hospital, possibly due to an interruption in the oxygen supply, although this could not be conclusively proven. It is, however, a reminder of what is happening in hospitals across India that are running out of high-flow oxygen, leading to deaths.
With little to no demand for improved healthcare from the middle class and elites, India’s public healthcare system has been hit hard over the years. Covid-19 has strained it to breaking point and beyond, pushing people from villages and small towns to larger urban centers that are already unable to handle the influx of patients.
In the heat of the moment, it’s easy to blame the Modi government for India’s weak response to the Covid-19 surge. But bringing about lasting change will require a long and careful examination of the planning and neglect of the past 74 years in independent India – both by India’s ruling classes and the media.
Kalpana Jain is the Ethics and Religion Editor at The Conversation US, a former Times of India reporter, a former Nieman Global Health Reporting Fellow, and author of “Positive Lives: The Story of Ashok and other living with HIV” (Penguin Global, 2003).
Hear Jain talk more about his reporting from India on an episode of the “First Opinion Podcast”.
