On May 15th 2021, AID had a call with community organizers of AID-India, which is working in 2000 villages in various districts of Tamilnadu. AID-India’s field workers are creating awareness about COVID-19 and encouraging vaccination, as well as conducting door-to-door screening of home-quarantined patients and distributing rations to the needy. They continue this work despite great personal risk of infection to themselves: 3 of AID India’s 23 block coordinators are affected by COVID currently. Their accounts alert us to the alarming spread of COVID in rural Tamilnadu, compounded by a lack of awareness and acceptance of the risks of COVID, overwhelming vaccine hesitancy, and inadequate health facilities.
COVID spread and medical infrastructure
Selvam and Vimala work in 27 villages of the Thirupporur block which has ~45000 people. They report that around 15 families in a street with 100 families are affected by COVID. The entire region has 2 primary health centres with one doctor each, who can only dispense basic medicines and don’t have any oxygen beds. 15 of the 27 villages are Irular tribal villages with no health care facilities. The residents have to travel 20-30 kms in the absence of transport facilities to visit the nearest health centre. While the people from the Irular tribes were not affected during the first wave, this time, they are affected as well and there has been one death so far. Access to COVID testing is very limited, and in the Thirupporur Govt. hospital, testing closes at 11 am with only 150 tests per day which take 2-3 days for processing.
Siva, the coordinator for 33 villages in Tiruvannamalai reports that villagers have to travel 15-20 kms to access COVID testing, which is not even conducted daily. Here, pulse oximeters and infrared thermometers provided to volunteers to conduct door-to-door screening have proven to be life-savers. Details of potential cases are shared with local health inspectors, and this screening led to the early identification of 106 cases, of whom 55 were sent to the hospital. However, medical facilities are scarce, with only one COVID centre for 3 district blocks. The biggest hospital is completely full with no oxygen beds available. Patients have to sleep under trees and wait their chance to be rotated through the single oxygen bed that is being shared by all. There is an urgent need for oxygen concentrators and oxygen beds. AID India is working to make available oxygen beds in coordination with local private practitioners.
Cases as well as deaths are being under-reported in several places. In Sivagangai Govt. Hospital, a volunteer noted that due to the lack of beds, doctors were reluctant to tell patients even if they tested positive. 130 individuals had been asked to isolate at home without any explanation of physical distancing, or a confirmed COVID test report. Only very severe cases are admitted to hospitals. In Ranipet, a volunteer pointed out that every 2 days there was one death in the villages, but there were reports of hospitals issuing non-COVID death certificates upon family request to conduct funerals which was causing more disease spread.
Caste tensions in some of the villages are hindering the pandemic response, with reports of separate COVID camps for Dalits, and upper caste communities refusing to release information about COVID cases in their villages.
COVID awareness and vaccine hesitancy:
Most field volunteers report that there is great reluctance among people to even admit that they have COVID. They often refuse to accept help from fear of ostracization, instead preferring to self-medicate with medicines from local pharmacies or home remedies. There needs to be greater awareness about giving basic medicines at the right dosage to children. Volunteers noted that only 3 out of 10 people were wearing masks in many places, and had only reduced going out because of lockdown. They had no awareness about spreading COVID or getting it in crowded places. People are scared for their lives and are afraid to go to streets with known COVID cases, but they do not wear masks to protect themselves.
Volunteers are facing a roadblock in the form of widespread vaccine hesitancy, as well as shortage of vaccines in some places. There are no takers for the vaccine even if there are a lot of cases or deaths in a village. In the remote tribal villages of Kalvarayan hills, ASHA workers and nurses went to distribute vaccines, but they had to struggle to find takers for even 10 injections. This is despite there being 78 reported cases in the Kavarayan hills, which was completely unaffected during the first wave of COVID. In Thiruvannamalai district, the government made vaccination compulsory to avail the 100 days job scheme which brings in much needed income to the villagers. But people boycotted the scheme and decided they would rather suffer the loss of income instead of being forced to get the vaccine. AID-India workers got the vaccine themselves to create awareness, but reports of them falling sick with side effects has scared everyone. Family members who get the vaccine are also scaring others, and in one case, the death of a local doctor after vaccination has stoked fears. Many ask volunteers conducting vaccination awareness campaigns for assurances that they won’t fall ill. Addressing this vaccine hesitancy is an urgent need and a core focus of ongoing AID initiatives.
Loss of livelihoods due to the lockdown, as well as while self-isolating due to COVID, is a major concern. Several field volunteers reported dire conditions in their neighborhoods and have been distributing dry ration kits with requests for more support. There have been concerning reports of children left alone struggling after both parents tested positive. The livelihoods of people selling flowers and produce in trains and bazaars has been destroyed. In Sholingar, the livelihood of the Narikkuravar community which sells craftsworks has been affected. One lakh families resettled in Chennai work as domestic workers or in wedding halls, and their livelihoods have been majorly affected. In the Kalrayan hills, people usually migrate for work, but this has stopped because of the lockdown. 500 families here were given dry rations as well as medical kits by AID workers. The general feeling among villagers is to barely survive by eating gruel and somehow make it through the pandemic with loans.
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