Ill-equipped hospitals, staff shortages and long journeys to COVID-19 wards add to the difficulties of patients in villages
* Disease overwhelms rural health services
* Shortages of beds, staff, mean long journeys to hospital
* Some villagers resorting to quacks, home remedies
By Anuradha Nagaraj and Roli Srivastava
CHENNAI/MUMBAI, May 5 (Thomson Reuters Foundation) - Weakened by fever and gasping for breath, 47-year-old Vinod Kumar died in an ambulance more than 60 km (35 miles) from his home in India's eastern Bihar state, far from the big cities at the centre of the nation's devastating COVID-19 crisis.
His death last week followed a frantic journey and dozens of phone calls by desperate relatives in search of a hospital bed and oxygen supplies, as a nationwide surge in coronavirus cases exposes the limitations of health facilities in the countryside.
"We admitted him wherever we found a bed. It was a nursing home but wasn't functioning like one. Patients were getting their own oxygen," said Kameshwar Kumar, Vinod's brother.
"The hospital was rationing its oxygen supply to patients and my brother was sinking so we were forced to rush him to another hospital but he didn't make it," Kumar told the Thomson Reuters Foundation by phone, crying as he spoke.
India's COVID-19 crisis has been most acute in the capital, New Delhi, among other cities, but in rural areas - home to nearly 70% of India's 1.3 billion people - limited public healthcare is posing particular challenges.
Ill-equipped hospitals, staff shortages and long journeys to dedicated COVID-19 wards are making it harder for village patients to access treatment as a second wave pushed India's total coronavirus cases to more than 20 million this week.
Less extensive testing and public awareness about the disease's symptoms - especially in the countryside - mean the actual number of infections could be five to 10 times higher than reported, medical experts say.
"The situation has become dangerous in villages," said Suresh Kumar, a field coordinator with Manav Sansadhan Evam Mahila Vikas Sansthan, a human rights charity.
In some villages where the charity works in the northern state of Uttar Pradesh - home to about 200 million people - "there are deaths in almost every second house", he said.
"People are scared and huddled in their homes with fever and cough. The symptoms are all of COVID-19, but with no information available many think it is seasonal flu."
India's health ministry did not respond to a request for comment.
In the village of Kodai, which lies in Prime Minister Narendra Modi's Varanasi constituency, emergency facilities set up during last year's first wave of coronavirus infections were dismantled earlier this year when cases dropped.
"The quarantine centres set up for returning migrant workers were closed and so are the fever camps," Vijay Kumar, a village resident, said by phone.
"Returning migrant workers are going home, falling sick and there is no one keeping track. People are drinking home concoctions and depending on quacks for treatment. Most of them are dying in the process."
Elsewhere, local activists warned that pre-monsoon agriculture activities mean more farm workers are on the move - increasing the risk of contagion in rural districts.
In Bihar's Bikram district, about 200,000 residents of 15 villages have one primary healthcare centre (PHC) equipped for COVID care, with a stock of 12 oxygen cylinders and one ambulance.
As cases multiply from one week to the next, such stocks are woefully inadequate, officials said.
"We have asked for 30 more oxygen cylinders as our stock may fall short," said Om Prakash Kumar, the monitoring and evaluation officer for Bikram, where 150 coronavirus cases were registered over the last 15 days.
In Patna, Bihar's capital, nearly 40 of 100 test samples are testing positive and local hospitals are overrun.
"I get calls for beds every day. But where are the beds? Our in-charge of a primary healthcare centre died last night in a private nursing home as we couldn't find him a bed in a proper hospital," said Krishnakant Singh, who oversees two PHCs in Patna district.
"Just oxygen won't help, we need ICUs (intensive care units) and ventilators. Just breathing has become difficult here," he said.
PHCs are not equipped to handle serious cases requiring hospitalisation, said public health expert Abhay Bang.
"Access to healthcare has increased in the past couple of decades with more health centres, better access to government hospitals and expansion of private hospitals everywhere ... but the issues of quality, cost and ethics remain," he said.
'I LOST HIM'
In Bhadoi district, pharmacist Sagar Sharma has been racing from village to village in recent weeks to distribute anti-fever medication to people who have fallen sick with COVID-19.
"I do what I can. When I see patients who can't breathe or in severe distress, I tell them to go to a hospital," said Sharma, who locals have nicknamed the "jholawala doctor" (doctor with a bag).
He said, however, that many local doctors were refusing to do home visits for COVID-19 patients even though the nearest hospital was located 20 km away.
In western Maharashtra state, Laxmi More had no choice but to take her seriously ill husband to a private hospital with an ICU in Pandharpur, which lies some 55 km from her village.
He died on April 25 in the ICU, which had capacity for 10 patients but was treating 20 at the time, she said.
"I lost him and the hospital gave me a bill of 500,000 rupees ($6,772)," said More, whose husband, aged 46, worked as a driver.
"I'm taking loans from family and local lenders to repay. How am I to raise this kind of money?" she said.
($1 = 73.8300 Indian rupees) (Reporting by Anuradha Nagaraj @AnuraNagaraj; Editing by Helen Popper. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers the lives of people around the world who struggle to live freely or fairly. Visit http://news.trust.org)
Our Standards: The Thomson Reuters Trust Principles.