Are remote hamlets and tribal villages in Maharashtra ready to deal with the corona pandemic?

These Adivasis (tribals) living in hamlets in Maharashtra's Panshet struggle to avail even the basic healthcare. After the lockdown, many labourers came to these villages from Pune and Mumbai. Villagers are worried as the nearest facility that can treat coronavirus is 40 kms away -- in Pune

Varsha Torgalkar
| Updated: April 27th, 2020


Smita Deshpande and her husband were sitting on a bench beneath a tree outside a sub-centre (SC) in Panshet village, about 40 kms from Pune, Maharashtra. The couple had to trek for 2 kms through a forest from their village, Rule, to reach the Panshet sub-centre in the grueling heat.

Smita, who was covering her face with a stole, said she had been facing difficulty in breathing so they had to come to the sub-centre, the only healthcare facility in that area. The only doctor at the sub-centre examined her and gave her medicines. Smita was dreading the long walk back home, so the couple was resting on the bench.

Most of the Adivasis (tribals) living in the Panshet Taluka belong to the Katkari tribe – a Particularly Vulnerable Tribal Group (PVTG). They generally live in small villages and hamlets in the forests or on remote hills. They usually have to walk long distances as there are no roads and mobile networks here are very week. Under normal circumstances, they have to struggle to avail of even the most basic healthcare facilities. The coronavirus pandemic has added to their helplessness — the nearest healthcare facility that can treat coronavirus is 40 kms away – in Pune.

These villages and hamlets are now vulnerable as a large number of labourers moved back to these villages from Pune and Mumbai after the lockdown was announced on March 24 to contain the spread of coronavirus. Recently, three villages — Panshet, Goradwadi and Deshmukhwadi – had to be quarantined after the Anganwadi Worker posted in the Velhe taluka, 20 kms from Panshet, held a meeting with the Anganwadi worker from Pune, tested COVID positive on March 23.

Smita and her husband Sharad walked down to Panshet as Smita was having difficulty in breathing. Doctor treated and asked her to go home. Credit: Varsha Torgalkar

A skewed doctor to patient ratio in the country

In the public sector, a sub-health centre, or a sub-centre, is the most peripheral and first contact point between the primary health care system and the community. As per the population norms, a sub-centre caters to a population of 5,000 in the plain areas and 3,000 if the area is hilly/tribal/difficult. A sub-centre is manned by one Auxiliary Nurse Midwife (ANM) and a Male Health Worker (MHW).

The Primary Health Centre (PHC) at Karanjavane, under which Panshet sub-centre falls, is 20 kms from Panshet and one has to walk through hilly terrain. There are six beds and there is no ventilator. The hospital that can treat coronavirus-positive patients is in Pune, 45-60 kms away.

Dr Mala Zure, the Taluka Health Officer at Velhe taluka, under which Panshet village falls, said: “The Panshet sub-centre caters to 9,000 people spread across 26 villages/hamlets in an area of 20 kms. It’s a hilly region, and there are forests and water bodies. Four teams of ANM and MHW have been visiting these 26 villages. We had to quarantine 128 people after the AWW tested positive. Around 90 have been released.”

Akshay Ghadge, a youngster who was sitting on a bench outside the Revenue Office at Panshet, said: “At the sub-centre, a doctor can just examine the patients. There are no facilities to give stitches, deliver babies, or treat patients having illnesses like typhoid. There is no way that the doctor here can treat corona patients.” An old lady who was standing close by said the doctor refused to administer her an injection fearing coronavirus.

As per the Census 2011, the population of India is 1210.1 million, of which 833.1 million people live in rural India. The country has 56,231 sub-Centres, 25,650 Primary Health Centres and 5,624 Community Health Centres (CHC) as of March 31, 2017, as per the National Rural Health Mission website.

As per the National Health Profile 2019 report, there are 27,567 doctors at the PHCs, 4,074 specialists at the CHCs, 27,079 health assistants (11,406 male 15,673 female), and 50,099 male and 2,19,326 female health workers (ANM). This comes to one government doctor per 26,333 people, which is much lower than the recommendations made by the World Health Organisation, which says the doctor to patient ratio should be 1:1,000.

The Panshet sub-centre caters to 9,000 people spread across 26 villages/hamlets in an area of 20 kms. Credit: Varsha Torgalkar

Migration of labourers after the lockdown

Over six lakh migrant workers may have returned to their villages after the lockdown was announced on March 24, and one among three labour might have been infected with the deadly virus, the government informed the Supreme Court of India on March 31. However, the number is expected to be much higher.

Dr Zure informed that 10,000 labourers working in Pune or Mumbai have returned to their home town in the Velhe taluka. The healthcare at Velhe was stressed in terms of resources, now it’s crumbling. Over 19,000 migrant workers have returned to the Junnar taluka near Pune. Zure said: “Our teams have been monitoring all who have migrated back to villages.”

Not just those who have migrated from cities, the lockdown has added to the woes of residents who had been living here. Sujata Thakar, a resident of Kandave village, for instance, had been suffering from severe neck pain,but didn’t have the energy to walk five kms to the nearest and the only health centre at Panshet. She said: “There’s no petrol in my husband’s bike and petrol is not available anywhere. Public transport is shut because of the lockdown. There are no private clinics nearby.”

There are a total of 10,22,859 (both private and public) doctors registered with the Medical Council of India or State Medical Councils as on March 31, 2017. The allopathic doctors to patient ratio is 0.77:1,000 against the WHO’s recommendation of 1:1000. However, only 34% of healthcare workers (doctors, nurses, midwives, pharmacies, physiotherapy, diagnostic centres, dentists, allopathic doctors) work in the rural areas where 71% of the population resides, as per the study done by the Indian Institute of Public Health, based on the National Sample Survey findings.

Sujata Thakar of Kandave village has neck pain for a few days but cannot go to only sub centre at Panshet 5 kms away. As no transport is available. Credit: Varsha Torgalkar

In total, there were 7.4 lakh AYUSH-registered graduates in the country as on January 1, 2015, which by 2017 may have gone up to 7.6 lakh. Ayush is the acronym of medical systems locally practiced in India such as Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. Over 1.5 lakh Ayush doctors have been called to join the Covid-19 medical team in Maharashtra to provide additional hands during the pandemic.

However, Ghadge, the youngster who was sitting outside the Revenue office, informed: “Four private clinics run by Ayush doctors are not examining patients with symptoms of coronavirus and have been operating for just two hours since the outbreak. They don’t deliver babies or stitch patients up in case of emergencies. Villagers have to travel 50 kms to Pune in case of serious illnesses.”

One of the nurses posted at Panshet sub-centre was wearing a mask and gloves. She informed: “The sub-centre is being disinfected regularly as many patients come here. Every day 50-60 patients arrive, of which 10-15 patients have corona-like symptoms.”

She didn’t have any personal protective equipment (PPE) although she was dealing with those living in three quarantined villages in the Panshet area. When asked when she would be getting a PPE, she didn’t have an answer.

She, however, said: “Almost all the villages/hamlets falling under the sub-centre are in the hill regions. Though we have been provided with jeeps, we still are not able to reach 10-12 hamlets as there are no roads. We have to trek in order to reach these hamlets where 10-15 families stay.”

“If they face emergency health problems, they have to walk down to Panshet. How can we save them if they get infected?” asked Akshay.

A health activist said on the condition of anonymity: “Pune is the second most developed district in Maharashtra, and yet villages around Pune district are in such miserable condition. Can you imagine the conditions of villages that are in the far-flung area?”

Dr Abhijeet Vaidya, who runs Arogya Sena that has been advocating to strengthen the public health for the past 25 years said: “It’s only now that the whole world has realised that the public healthcare can efficiently deal with a crisis like this. People are saying testing is the solution, so private labs that are being given permission to test coronavirus, should reach the rural areas and test people having symptoms.”

He added: “The primary health centre or rural hospitals don’t have enough ventilators that have emerged as a crucial device to save patients suffering from coronavirus. Pune has over 1,800 ventilators. Most of the ventilators are with private hospitals. We need more ventilators.”

He made a pertinent point that people living in such remote hamlets should be provided with food, which will help them boost their immunity as, after all, “food and coronavirus are interlinked”.