Shownotes

Most of us have seen harrowing images in the media of the havoc wrought by the second wave of the pandemic in India and have heard stories of helpless and desperation from family and friends. The missing piece in this conversation is the impact on rural India - which constitutes above 65% of India. 

In today's episode I speak with Narendranath Damodaran, Executive Director of PRADAN which is leading on civil society response and working tirelessly with frontline workers to support local communities in the second wave of the pandemic. They work in 9,000 remote and backward villages (in 7 states) touching almost 4.5 million lives every day. In this episode we talk about 👇🏾

• The devastating impact of the second wave on rural communities struggling to recover from the first wave
• Rapid Rural Community Response (RCRC) to COVID-19 a civil society coalition formed of 54 CSO 
• Poor healthcare infrastructure in rural India and the need to create local isolation facilities for those who test positive. 
• The fear, social stigma around the disease, vaccine hesitancy
• The importance of protecting those on the frontline 
• The need for immediate cash injection into rural economies through revival of National Rural Livelihoods Programmes 
• The urgency for donors, the private sector and individuals to step up on funding to support the work being done

PRADAN and other civil society organisations do invaluable work by supporting local communities and facilitating government response during times of national crisis - they should be recognised for the pivotal role they play and more importantly have the access to funding to do continue their work. 

Listen to the full episode Apple, Google Podcasts or Spotify

Memorable passages from the episode: 

👉🏾 Last time when the pandemic came and it obviously kind of came as a shock to everybody. But that time it was a fear that it might spread to the rural areas. And then we were kind of bracing for it. But the impact by the time it reached the rural areas, it kind of waned and it was predominantly an urban phenomenon.

But this time, it took us by shock, as you said. And this time the pandemic really moved into the rural hinterland. And as everything in this country, when something goes to the rural areas, it kind of goes into a national black box as it were. The public consciousness of what happens in the rural areas is pretty limited. So there is very limited information on what happens in the larger scenario. So even though currently, as we speak, the numbers are waning, the daily deaths and the daily positivity cases, it is reducing. But when it is going to rural areas and the counting is also limited, so we really do not know. But from our own direct experience from the field, it is rampant in the rural areas this time. And it is actually a very difficult situation right now, as a journalist recently called it, it is a virtual hell out there as it were. And there are reports from alternate media, mainstream media is really not covering it much, but in alternate media to personal reporting, et cetera. One is really able to understand and we can counter verify it in our own personal experience.

👉🏾: Right, you just reminded me, this is an everlasting image. All our collective consciousness, the picture of hundreds of thousands of people trekking back in the heat. Of the last summer, I think really one will never forget it. And we have equally dismal images from this time, but of another kind. In the initial few days we were also kind of in a shock. I mean, as the whole country suddenly went into lockdown and people started trekking back and really hell broke out and we were also not sure what was happening and obviously, in the urban areas, we were also scared, so we were not stepping out. So we were kind of trying to organise our own lives in the beginning, but then we realised that the rural economy was going into a tailspin.

Because there's a huge influx of return migrants and any, and all economic activity in the rural areas that was going on, all stopped. Any of the government programs that we're running like MGNREGA or any other public programs. They all came to a grinding halt. So it was a very difficult situation. People were starving, lots and lots of people just going without food. 

 👉🏾 Fortunately an organisation like us and a very large number of NGOs like us, we have quite a good presence at the grassroots level. That is right in the village through our community resource persons who are members of our self-help groups or are members of our livelihoods programs. So all my colleagues immediately got in touch with them because they are our first, line of defence. So we got in touch with them conveyed to them about the disease, the protocols, and then we asked them to start spreading the word in the village that what this COVID protocol. So our first response was, kind of mass-scale information, education, communication, using multiple means and mostly through mobile phones. And then obviously physically people travelling there and we had vehicles travelling with announcements and with large posters, et cetera. Kind of informing the community as to what the COVID protocol is and how to keep themselves safe.

👉🏾 Then we had all our women community cadre also going around. So this was the first step that we did and this we did across the 7,000 villages we reached out to about 600,000 households. It's about 3 million people roughly. So that is the kind of scale in which we went. But that was not enough information, we had a large number of people starving. So that was a second big area that we had to get involved in. So one thing we did really started doing was we started mobilising resources. We started speaking to our donors and we repurposed our existing monies that we had. You also got fresh resources from a number of donors. So we organised financial resources then bought up dry rations in big scale and then made it into small packets and distributed to over 200,000 households. That was a important thing to be done because people did not have food at home. And next migrants were returning to the villages, and they were obviously not allowed to go into the village because they were coming from the city.

👉🏾 So they had to be quarantined. So we immediately got in touch with the local panchayat. The local government public health system and arranged a large number of quarantine centres. And then we also supplied the basic requirements, and most importantly food. So we also ran about 350 community kitchens across our project areas where fresh nutritious food was made. So there were two kinds of people. One was the vulnerable people in the village, the very old or disabled people who did not have other people to look after them.

👉🏾 And then we also were regularly in touch with the migrant communities. A large number of them were stuck in their city locations. And they were not able to come back because the public transport was not there. They wanted to get in touch with the relatives. They did not have money, so we were arranging some support for them in the urban areas as well. So there were in a series of steps that we took in order to ensure that some sense prevailed.

And then obviously we did that for about four to five months until you know, kind of the peak came down. And then last but not the least was some kind of livelihood inputs because that was a time when the crops were standing in the field 

👉🏾 So we had to arrange for large-scale marketing of their farm produce and so that they're able to get some immediate cash returns with which they were able to invest more money into the next crop. We also arranged soft loans for them, for investing into the Kharif. One very important area that we got involved in was to restart NREGA Program, you know the Mahatma Gandhi Rural Employment Guarantee program, which provides a hundred days of wages. We did campaigning, not just at the local government level, but also the national level, in order to ensure that the NREGA program restarted. Because that would have been an immediate way of providing cash, you know, ready cash into the hands of the people because that is what they needed most urgently in order to survive as well as to invest.

👉🏾 One more thing we did was at the national level, a large number of us NGOs got together and formed the national network of civil society organisation working on a COVID relief. So we call it 'Rural Community Response To COVID'(RCRC) Network. And through his network, we actually took up a lot of policy influencing work in terms of providing agriculture assistance, restarting MGNREGA. 

👉🏾 Last time, it was a scare that this will spread into the rural areas. And as we experienced the number of incidences in the rural area was reasonably limited the people who travelled back from the cities really did not carry the virus into the village.

There were cases, but very limited, but this time maybe because we became very complacent and there were many so-called super spreader events The states, where PRADAN works mostly in the central and northern belt of the country, the rural health infrastructure is abysmal and if this pandemic explodes in the village we'll not be able to combat it. We'll have to just allow it to take its own course. And exactly that is what is happening now. The system is the most conspicuous by its absence, as we say, there is a large number of infection happening, in our own villages we see more than 50, 60% of the people are positive.

And there are deaths, but it is reported as death due to general seasonal ailments or even typhoid or malaria. So there is a lack of information of exactly what is happening. So whatever is being reported is whatever is you know, people say. There's no real testing happening. 

👉🏾 In fact In some of our project no testing happening. Therefore there's no identification, therefore, no surveillance or any tracking or any appropriate response. In the rural area there's a total absence of any support system as it were, people are kind of feeling as if they have been left stranded nobody to really look at them.There’s an inability of the system to respond because there are hardly anything that exists If there are ambulances, it will not have oxygen. Tests as I said are not happening. So frontline even the doctors, they are doing tele consultations because the demands on them are also very overwhelming. So at the village level, the presence of the system as we see is through the Anganwadi or the Asha worker, the auxiliary health worker. These are the local people they're semi-trained, but they're also working with a lot of risks because they are also getting infected. They do not have appropriate protection kits, et cetera, they're going out of the way I would say risking their own wellbeing and trying to do whatever they can.

👉🏾 So at the village level, there is a gap of any support system and what exists is a lot of fear and people with all kinds of half baked ideas, superstitions, stigma. And a lot of fear as I said about getting tested or even go to the doctor or even going to the hospital. The universal statement that we hear in our villages is, we will not go to the hospital because we've not seen anybody come back from the hospital. So we do not want to go there. We do not want to get tested because God forbid we become positive, we will be ostracised. And, you know, if somebody who falls dead, the dead body also will not be given to us and even at the stage of death we'll not have dignity.

There is fear about vaccination, but they're scared because they've seen people who have vaccinated and also got infected. So there is no correct credibility to vaccination. 

👉🏾 Yes. I could start with saying what are we trying to do. This time also we were taken by a little bit of surprise and shock because if you look at February, the number of infections of the order of 4,000, 5,000. And suddenly by April, it had become 80,000 in the next month, it went up to 400,000.

👉🏾 So the growth curve was so steep that it kind of came like a tsunami. And now it is spread to the villages and it is kind of spread so badly that we do not even know what to do. What also happened this time was the number of infections inside the organisation, PRADAN itself was very high. A lot of my colleagues got infected unfortunately one of my very senior colleague   he succumbed to the disease. So the organisation itself was seriously affected, our people in the field a lot of them have got affected. Our frontline workers, from the self-help groups and the community cadre a lot of them also got affected. So our own response was slow because in the first we had to obviously take care of the wellbeing of our own people. So we did spend a lot of time trying to create the protocols and trying to provide the support, assistance and also dealing with just the disease itself, helping them hospitalise.

👉🏾 But now we've kind of organised our lives in a way. And now we are also realising the seriousness of what is happening in the village. So our interventions will be at multiple levels. First obviously is to give the people in the village, the sense that there is somebody, somebody you can talk to. Give them, a feeling of confidence and also then making them receptive to any new ideas that are coming in. Because currently what exists as I said fear and stigma, in that space, we need to have confidence and receptivity.

👉🏾 My colleagues are regularly in touch with the village people. We're obviously not going there, but through phones and through the community cadre we're trying to instill some confidence in the villagers.

If you break it down, it's not a very serious disease to deal with. 85, 90% of the people do not need to get hospitalised. A lot of things that you can contain at the village level. So containment is our immediate strategy. It's also important to contain locally because that is what will help us reduce the load on the already overloaded the health system, where the number of doctors or beds or equipment or anything is so limited that it cannot take care of large number of people coming into the hospital system.

👉🏾 So we need to contain them at the rural areas itself. Therefore what we need is mass-scale education of the people. So what we're doing is we're trying to create videos and training modules trying to reach out to as many of our self-help group members and community members as possible, to provide them proper information on what is the second wave. Obviously, there's a slightly more infectious strain, but we can deal with it.

It is possible to deal with it provided you follow the basic protocols itself. So that is very important. And since the infection rates are much higher this time, it's very important for people to identify from the very early stage, the day of your getting infected. So this identification of the symptom, and understanding the disease itself is very important. How does one isolate one’s self suppose we start showing symptoms.

👉🏾 But if you're showing symptoms, then there are certain things that you need to do. This is the way you need to isolate. And what we started doing if people are not able to isolate themselves in their homes, which obviously is the best thing to do. 

But in the rural areas, in our villages, it is not possible because you know, in a given household, there are four or five people, the small children, and there are animals and there are one or two rooms. So that is not possible for people to stay away from each other. So we need to maybe create community facilities. Rent or take over a school, which is anyway closed. So take upon a panchayat building, or a government building equip it with beds with basic amenities, water, and the basic hygiene, masks, sanitisers, et cetera. And then housing, those people there. You need to have separate rooms for women, for men for early mild symptoms, moderate symptoms. So it's kind of a little more involved this time compared to the basic quarantines centres we made last time. So here we might need to have oximeters and thermal guns basic equipment and some basic medicines will need to be kept there. We need to provide food to these people. So this is at different stages I'm trying to kind of delineate as well at different levels, what we need to do. 

👉🏾 Hesitancy is very rampant. There is fear, as I said, the fear of the unknown as it were. So the basis of everything is a fear and fear arising from a lack of understanding. And that again resulting from lack of someone actually speaking to the people. There is a huge hesitancy on vaccines because they see people who are taking vaccines and still getting infected and some of them getting infected seriously. I believe there's a lot of education that needs to happen around vaccine also. There is a protocol on when do you get your vaccine and then how do you take care of yourself in the early days after the vaccine? So there are so many things, one needs to do, which nobody's telling them. So I think we need to really educate them. And as we know, that is the only way out,

👉🏾 I mean, there is no option that you cannot take the vaccine. You have to take the vaccine and we have to get everybody vaccinated. So we need to run as many campaigns and education programs as required. And we'll obviously need to ensure that vaccines are there, that is a big challenge in the country today, shortage of vaccines.

👉🏾 But once these vaccines supply starts coming in more steadily we'll need to work with the administration and arrange the vaccine centres as close to the villages as possible. And then maybe literally carry these people in batches to the vaccine centre, get them vaccinated. Now vaccinations are happening, it's also documented so shabbily people once they come back they get a small piece of paper, very rough piece of paper in which they written you're vaccinated. And on the other side, the name of the vaccine is also written, but it's also not very clear, sometimes it's just written COV. Now COV could be Covaxin or...