Chapter 2 of the ‘Indian Cities and the Nation-wide Lockdown’ webinar series
The second webinar in the ‘Indian Cities and the Nation-Wide Lockdown’ webinar series, focused on Bhopal and Indore, and the state of Madhya Pradesh more broadly, took place on 28 May. The panelists included Amulya Nidhi of Jan Swasthya Abhiyaan, Pooja Singh of Shukrawar Magazine, Anurag Dwary of NDTV India, and Manu Vyas, Additional SP of Bhopal District. The discussion was moderated by Ankit Jha of YUVA.
The webinar began with Amulya Nidhi of Jan Swasthya Abhiyan speaking about the health dimensions of the lockdown. He mentioned how Madhya Pradesh is already a state with low indicators for health and human development, bordering a number of other states which are in a critical situation. Additionally, if one is to consider the status of the pandemic in this state, the areas surrounding the major cities should be considered as crucial — many of the cases are in the areas around Indore. In this context, and the context of the political instability that the state was seeing, the government plan to deal with the pandemic also kept shifting. A number of transfers and shuffles happened in the health departments midway through the pandemic. The Integrated Disease Surveillance Programme (IDSP) team, whose entire function is to track and manage diseases, was also changed three times. The management of a crucial hospital was also botched.
The mismanagement is present at many levels, he added. The implementation of orders is not taking place, leading to people being charged for treatment even though they were actually COVID-19 patients. On 5 May, an analysis showed that a majority of deaths happened within the first three days of hospitalisation, and positive test results were coming a few days after the deaths. This shows that hospitalisation is already happening too late.
The data being provided is also full of anomalies. In the beginning the government was forthcoming with the data, but once the number of critical cases started climbing, they stopped releasing this data. Missing samples, test results not being given, mismatch in the tallies — all of this has been happening. A part of the reason for this is the unregulated nature of the private sector health system in Madhya Pradesh.
The overall capacity of Madhya Pradesh to deal with this pandemic is also insufficient. Many hospitals don’t have ventilators or oxygen cylinders. There is supposed to be one specific hospital to deal with COVID-19 cases in each district, but as of now there are only nine in the whole state — four in Bhopal, four in Indore, and one in Ujjain. These two months of the lockdown were an opportunity for the government to strengthen the public health system, but that was not done.
Nidhi mentioned how the Jan Swasthya Abhiyaan had provided the government many suggestions. Some things should be instituted as a baseline measure. Free testing, free treatment, and free personal protective equipment (PPE) kits for health workers will make a huge difference and will not be a significant cost to the government. They had suggested over a month ago that a machine to improve testing capacity should be procured. A task force or committee consisting of public health experts, medical universities, journalists, and teachers should be set up from where action can be directed. The current ‘decentralised’ plan should be centralised somewhat. Although what is needed is a collective, coordinated effort, what is happening instead is a very bureaucratic, individualistic approach. It is necessary to involve multiple stakeholders, like the Health Ministry, the government administration, hospitals, etc. It is crucial to move towards this collective approach, and it is also important to pause and review our strategy of Identification — Isolation — Testing — Treatment. As the cases rise, we should be sure of our strategy, and at the current moment, many of us are asking and wondering — how prepared are we really?
The next panelist, Anurag Dwary, of NDTV India said that he would speak about the situation and experiences of the workers of the state, who have been seriously affected. He saw many people returning to Madhya Pradesh from other states, like Maharashtra, Gujarat, and Rajasthan. Some came in autos and taxis, others in buses, others on foot, some had to do it in multiple parts using multiple modes of transport. It is really important to understand these daily-wage workers. In our big cities, they work as auto drivers, shopkeepers, factory workers, and domestic workers. We must see them as productive agents who contribute to the economy. The work they do makes the lives and economy of the country tick. In good times, the middle class is happy to make use of their services, but as soon as there is a problem, suddenly they become a nuisance. It is asked, what are they doing on the streets, they are ruining our cities.
The migrant workers that he spoke to said it would be better to call them atithi mazdoor (guest workers) rather than migrants. All of them expressed pain and hurt. The travel they had to make was difficult and dangerous, especially while trying to carry children, and trying to get food. Many of their employers had not paid them, so they had little money to use; for some, wages were paid annually, and their employers had shunned them away without anything. Even the relief efforts were often not calibrated well. Young children need milk, not bread or biscuits, and that was difficult to come by. After many days, when the government was still not providing them with milk, he and some others organised a distribution of this item. One heartening outcome has been the help received from police officers, government workers, doctors, etc. he added. Many went out of their way to help and assist those who were vulnerable. There was a lot of confusion at first, but the situation is now a little better. There are a lot of people who are willing to help, and that help is definitely needed.
The next panelist, Pooja Singh, from Shukrawar Magazine spoke about journalism during the pandemic. She said that we must ask how we are to live with and deal with the pandemic. Most people in our cities live in highly congested areas, and while politicians may come and ask people to practice distancing and then leave, the question worth asking is why, after 70 years, the only option for so many people is to live in overcrowded settlements? This is especially relevant because of how dangerous a virus can be in congested and crowded areas.
On reporting during the pandemic, she spoke about how challenging it could be. Many journalists still don’t have masks, gloves, or other equipment, and while it is necessary to keep reporting, it is also necessary to maintain their health and well-being. She too echoed the point that the data that is being given is full of anomalies, and sometimes explanations are given, but sometimes they are not. The whole political problem has further worsened the situation.
The fact is that the pandemic situation was downplayed in Madhya Pradesh. Many ministers and government officials took it too lightly, even saying that it was an overreaction. The timing of the lockdown and the new government also raises the question as to whether the government was willing to sacrifice the health and well-being of its citizens just to claim power in the state. If even the health ministry officials contracted the virus, one can imagine how lightly it was taken. Even in terms of contact tracing, it is not clear how the virus entered Madhya Pradesh. This is a huge problem and has had enormous consequences. The government handling of the Bhopal Memorial Hospital issue was also terrible — it suddenly declared it a COVID-19 centre, leaving hundreds of the existing patients stranded. Every time the government is asked to respond they say either ‘we will let you know’ or ‘we are looking into it’.
The government has treated this as any generic disaster and responded much too late. This has caused people to panic as well. There are also reports of corruption and mistreatment of patients. Even testing is not being done sufficiently.
The situation of workers is very dire. There is not a tree on the highway below which people are not resting. The really sad thing is how late the government acknowledged this crisis. The question is, for how long can voluntary kitchens feed these vulnerable people? What they need is employment, money, and a better life. We must understand in this pandemic that the ground reality is very important, and the ground reality of Madhya Pradesh is very poor.
After this, Manu Vyas, the Additional SP of Bhopal district spoke about his experience of policing in the last few months. Being posted in Old Bhopal, he spoke about the challenges of ensuring social distancing, especially now that markets have opened. He said that initially it was very difficult as awareness among the people was poor. They were not accurately informed about the disease and all its details, and they did not really trust the administration or the police. Since Old Bhopal is a very active and crowded area, with many institutions, there would always be people moving around, and many of them would be essential workers. He also spoke of the Ramzan period and how helpful and cooperative the people had been. It was with their cooperation that everything went past smoothly.
He also spoke about the challenges of the police force and police officers, many of whom were not able to go home for over 30 days, and had to be on call constantly. The increase in containment centres meant a lot of work for all of them. He also pointed out the help from volunteers and non-profits, in providing information, distributing rations, etc. Many volunteers have worked throughout the night with them. In one case, they were able to successfully distribute food to a full train of people who had not eaten for very long. He mentioned that they had set up a system with a central point from where action could be taken and rations distributed.
After this, the question and answer session took place, and many important questions were raised by the viewers.
On the topic of how public facilities can be improved in the long run, Amulya Nidhi said that one way is to look at the examples of other places. Spain nationalised their hospitals, Cuba already had nationalised healthcare and was able to even send doctors abroad. Even Kerala managed the situation very well. It was a simple approach: increase testing capacity; strengthen the public health system; designate dedicated COVID-19 hospitals in the public health system. At least in Madhya Pradesh, it is very important to treat this as a long-term issue, and take on human resources and infrastructure development for the long-term, not just the next three months as is currently being discussed. This is a very good opportunity to actually strengthen the public health system.
On the topic of community-level management, it was suggested that instituting ward-level and village-level committees would be the best way to have people build confidence and also be more invested in the process, rather than being passive recipients to the actions of the government. Both in villages and at the ward-level in cities, a People’s Community Health Plan would be a good way to involve the community and actually ensure correct implementation. There are provisions for Mohalla Sabhas in law — perhaps they should be taken more seriously.
On the topic of workers and worker rights, the question of the relaxing of labour laws was also brought up. Most agreed that this was not the right step at this time, and that it would only lead to more exploitation of workers. These would make it difficult to actually enforce any kind of protection against overworking, mistreatment, non-payment of wages, etc. In the name of attracting investment, these laws would only end up hurting the people of Madhya Pradesh. With so many people returning to the state and the villages from other states and cities, this would be detrimental to their health and lives. What is really needed is to strengthen the rural economy, to ensure work and livelihood for people here. After all, even to call them migrant workers is really a misnomer — they are Madhya Pradesh’s own workers. It is because they could not find work here, because the state could not provide for them, that they had to leave to find it elsewhere. They are very hurt, feeling like they have been pushed away from the cities where they built the roads, they built the buildings. The need of the hour is to focus on the people of the state and their well-being, and take concrete actions so that they can support themselves and each other.
To watch the complete webinar, click here.
Compiled from the original webinar by Andrew deSouza
