A comprehensive report on the ground realities in Bihar by Anish Ankur, as the second wave of the epidemic rages through the state including its rural areas.

The Bihar government has not only miserably failed to tide over the crisis arising out of the second wave of the Coronavirus outbreak, but is also unable to carry out its simple executive functions. With the governmental administration mired in policy paralysis, things only move when the High Court intervenes. Like the rest of the country, the healthcare scenario in Bihar is also very grim. If on the one hand, the unprecedented surge in the infections is taking a heavy toll on the lives and well-being of the common people, the high cost of Covid related treatment, on the other, has been pushing people below the poverty line. Under these circumstances, judicial intervention seems to be the only solace for the ordinary “nobodies.”

Taking over the role of the executive, the High Court has already started monitoring almost every aspect of the epidemic, from supply of oxygen, availability of hospital beds, cremation of dead bodies to the disposal of the bio-waste. Meanwhile, the deadly coronavirus rampaging through the villages, is instilling palpable fear and panic in rural Bihar with myths and rumours abound about vaccination, amidst a virtually non-existent health care infrastructure.

High Court forced government to impose lockdown 

The state government was forced to impose a statewide lockdown, since May 5 after the intervention of the Patna High Court. Concerns over the spike in Covid related deaths prompted the court to issue an ultimatum to the government to announce the lockdown.

Another crucial intervention of the HC was on the issue of dead bodies floating in the Ganga near Buxar. While hearing a public interest litigation (PIL) on Covid management, the Court sought data on deaths in the entire Buxar district since March 1 of this year. The court also made the order applicable to all 38 districts of Bihar. Disappointed by the lackadaisical approach of the government, a division bench of the High Court questioned the authenticity of the affidavit submitted by the state Chief Secretary, which acknowledged only six deaths in Buxar district since March 1 2021, whereas, 789 cremations were mentioned in the divisional commissioner’s affidavit, at just one cremation ghat, Muktidham Charitravan under Buxar Nagar Parishad between May 5 and May 14. The HC severely criticised the administration over the huge mismatch of data in the two affidavits.

Affidavit of divisional commissioner Buxar Nagar Parishad

The gory visuals of dead corpses and their mass funeral

The Buxar district administration, blaming the UP government for the floating corpses in the river, tried to wash their hands off the matter by saying that the dead bodies in Ganga were from UP. But the people living near the Ganga contradicted the administration’s claims. According to the locals, and as reported in the local press also, many poor people in Bihar, unable to bear the skyrocketing cost of cremation in the wake of the Corona epidemic, are often left with no option but to throw their dead ones in the holy river.

Reports appearing in the media also noted that due to the exorbitant rise in covid related healthcare expenditure, people who have been infected, or whose family members have been infected by the virus, have lost all their savings and possessions. In many cases, despite dishing out all their savings, they were not able to save the lives of their loved ones. With no money left for the funeral, they have no option but to simply throw the dead bodies into the Ganga. Another reason is the absence of electric crematorium not only in rural areas, but even in district headquarters. Even prominent cities in Bihar like Gaya, Darbhanga, Muzaffarpur, Madhubani, Motihari, Bhetia, Aurangabad, Katihar, Kishanganj, Madhepura, Samastupur do not have electric crematorium. Therefore, people do not have any option other than wood pyres, which is a costly affair these days.

The HC is even monitoring bio-waste disposal in Patna city, calling it an issue not confined to private and government hospitals alone, but also encompassing pathological labs and isolation homes. Not satisfied with the affidavit of the Patna Municipal Corporation (PMC), the court sought clarification on the matter with specific answers to its queries, stating that the affidavit seemed to conceal more than it revealed.

“The affidavit says nothing. Do we shut our eyes on the realities,” the Court asked while seeking answers to the queries like ”Is it the fact in Patna? How many people are isolated at home and who is picking up the garbage from these houses? How many tests are being conducted in Patna? How many tons of waste is being generated and collected? Which is the agency dealing with it and where is the waste being taken to? How many are involved with that? How many PPE kits are being given in the city and to whom?”

The bench directed the PMC to file a detailed affidavit regarding bio-waste collection/disposal and steps taken for sensitisation of the people in the matter.

Shortage of doctors and health workers

Despite a hue and cry over the shortage of healthcare personnel in the state, nothing has changed on the ground. Now, after so many months into the epidemic, the Bihar government has now started to recruit doctors on contract basis to meet the crisis.

About a month ago, on 28 April, commenting on the basis of the data presented to it by the Bihar government, the HC said, “It is note-worthy that 4,149 posts of specialist doctors and 3, 206 posts of general doctors are vacant. Against a total sanctioned posts of 91,921 at various levels 46,256 posts are vacant. It’s high time the state government looked into this aspect and took remedial measures. We will be taking up this matter in future proceedings.”

Source: May 2020 data presented by the Bihar government in the Patna High court

The number of specialist doctors is further coming down, with many falling prey to the virus during this ferocious second wave. Around 96 doctors have already lost their lives to the virus. The Indian Medical Association (IMA) has recently issued a press release with names and other details of the specialist doctors who lost their lives falling prey to the virus. Bihar has one of the highest number of doctor’s deaths in the entire country from Covid 19. IMA’s Bihar unit has constituted an eight-member committee to look into the causes of the deaths. Even the Bihar Human Rights Commission has taken a suo moto cognizance of the deaths, and directed the health department to present a report.

Further, most of the government hospitals are understaffed and underfunded. The vacuum left by the public healthcare system has been filled by private health clinics and in the rural areas, quack doctors are the only hope, and this has been the reality in Bihar for many years. Consequently, Bihar has one of the most privatized healthcare systems in the country and the high cost of privatised health care is pushing thousands of families into poverty, more so during this epidemic.

Healthcare push to poverty 

It is now an established fact in Bihar that health related expenditure is pushing people below the poverty line. A social activist, Rajkumar Shahi, said, “As per a study, the health related expenses are pushing 3.5 per cent families into the BPL category. NITI Ayog also said that Bihar is the bottom state in terms of health facilities. There is only one hospital bed available for every 1.2 lakh population. District hospitals and primary health centres are in the worst conditions.”

During its 15 year rule the NDA government’s obsession with privatization centered health policy deprived the government health sector of necessary health personnels. If we compare the rural health infrastructure between 2005 and 2020, then it can be clearly seen that the situation in the semi-urban as well as rural areas has gone from bad to worse.

Source: Rural Health Statistics 2019-20, Ministry of Health and Family welfare.

The data clearly shows that the number of government health centers has come down during the last fifteen years. Blaming privatisation for this entire mess, Rajkumar Shahi added, “The policy of privatization and commercialization is the root cause of all the major problems in the health sector. The politics based on neoliberal philosophy have created vested interest groups whose sole motive is to make super profits from people when they are in distress. Take for example the case of the private ambulance services, it has created a parallel system of loot and plunder from patients. Despite Patna High Court’s repeated strictures nothing seems to be changing on the ground.”

Most of the ambulances bought through MP-MLA-MLC funds are dysfunctional. The incident of several dozen ambulances recovered from the private house of BJP leader Rajeev Pratap Rudhi is a glaring example of this cruel reality. Many ambulances are lying idle due to some minor defects. Recently, when a journalist of Buxar exposed the hypocrisy of Union Minister of State for Health and Family Welfare, Ashwini Chaubey, for inaugurating thrice the same ambulance, the enraged minister registered an FIR against him. It should be noted that during the 15 years of NDA rule in Bihar, the health department has always been retained by the BJP.

In a letter to the president of Bihar Legislative Assembly, CPI(ML) activist and legislator Mahboob Alam asked, “Where is the Rs 17,564 cr allocated for health being spent, when there is not any facility at the ground level? Most ventilators from PM Cares Fund are proving to be worthless. In fact, third grade ventilators have been supplied, which were rendered useless even before commissioning. Certainly, huge fraud in the matter cannot be ruled out. The central government should be asked why poor life-saving devices endangering the lives of the people were sent. Government should immediately issue a white paper on both the ambulance and ventilator issues.”

The letter further added “According to the World Health Organization (WHO), there should be one doctor for every one thousand population. While the average population/doctor ratio of the country is 1500:1, in Bihar it is 29000:1.”

People are breaking their fixed deposits to meet health expenditure

In a very strange report coming from the banking sector, it has been said that banks in Bihar are facing frantic withdrawals. People are breaking their fixed deposits to meet the Covid related expenses. Moreover, anticipating a medical emergency, people are keeping cash in hand to meet any contingency.

Bank withdrawals are taking place on such a large scale that some banking experts are of the view that the proportion between the withdrawals and the deposits dipped to 70:30 level, a drop of almost 16 per cent.

According to D N Trivedi, joint secretary of All India Bank Officers Association, “Between December 2021 and March 2022 Bihar is seeing a sharp decline in deposits. Consequently, it will adversely affect the banks’ lending capacity which will have an overall adverse impact on the state’s economy.”

According to a report, 20 percent of people are not being able to repay their monthly EMIs. Such is the dire need of the people that a lot of them are applying for personal loans to meet their both ends meet.

Even ICUs unsafe for women 

Another disturbing feature is that female Covid patients are not safe even in the ICUs. In one such horrific incident, a 45-year-old woman was raped inside the ICU of a very high-profile hospital in the state capital. This horrendous incident has shocked the conscience of the state.

The National Commissioner for Women (NCW) sought investigation into the incident. NCW chairperson Rekha Sharma has written to Bihar’s Chief Secretary, and police chief in the matter.  The daughter of the Covid patient has filed a police complaint against Paras HMRI hospital in Patna complaining of sexual harassment and misbehaviour with her mother on the night of May 17. The daughter had earlier uploaded the statement of her mother on a social networking site alleging that three to four persons tied her hands and legs with bed-posts before indulging in the ghastly act.

Meanwhile, female patients admitted in Rajeshwar Hospital and Patna and Glokal Hospital in Bhagalpur, accused hospital staff of sexual harassment. Some students, as well as, women organizations came out in protest against incidents of sexual assaults in hospitals, and demanded justice for the victims.

Commenting on the deep social malaises that this pandemic has brought out in the open, social activist Gopal Sharma said “The unprecedented crisis is exposing the deep malaise prevalent in the society. The cases of rape of Covid female patients in the intensive care units (ICU) that came to light, of late, point to the inherent fault lines in the system as well as in our society. Loot and plunder of distressed people is continuing unabated. From oxygen cylinders to ambulances or life-saving drugs, covid patients are paying exorbitant prices and the government seems to be helpless even as these evil forces operate under its noses.”

Only one percent of the people of Bihar have been vaccinated so far. Due to the constant changing of variants of the Coronavirus, vaccination will have no meaning if the schedule time is not adhered to. Experts believe that the effect of the Covishield vaccine has reduced significantly on the current strain. Further delay in vaccination will prove fatal for Bihar.

The confusion is also being reinforced by the government’s frequent changes in the time gap between the first and the second dose of the vaccine. A deep suspicion regarding the vaccination drive has crept into the peoples’ mind. Fear and confusion spread as the cause of the deaths are not investigated. There are many incidents in which people died within 2-4 days of taking the vaccine. Since there is no effort to collect the data in this regard, things have become complicated.

While almost every village is facing deaths, no reliable data is available to verify the cause of these deaths. There are reports of up to 45 deaths in only one village due to the virus. During preliminary investigation in some villages of Bhojpur, the figure of the dead has been found as follows:

Source: The data presented by CPI (ML-Liberation) in their letter to the Chairman of Bihar Legislative Assembly.

There are many who died with all the symptoms of Covid, but neither the Antigen test nor the RT-PCR test came out positive. Also a large number of people complaining of fever, cold and cough did not visit any hospital. They continued to get treatment from the village quacks and many of them died. The government is simply denying that these deaths are linked to Covid. Many people have also died of non-covid illness due to discontinuation of treatment for common diseases in hospitals.

Another challenge that is being faced by the health system is the rapidly increasing cases of Black Fungus. Also, children have started to get infected. The death of four children, including an infant, in Darbhanga Medical College and Hospital (DMCH) has sent alarm bells ringing.

Even if the second wave recedes in the coming days, experts are already warning of a third wave. With the precarious state of public health infrastructure across the country and the union government’s current vaccine policy, its reluctance to divert central funds to augment public healthcare infrastructure, ensure adequate supply of necessary medicines and equipment to deal with during spikes, things look alarming for the people of the entire country, including Bihar.

The author is a freelance journalist based in Patna.