Weakened by fever and gasping for breath, 47-year-old Vinod Kumar died in an ambulance more than 60km (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 Reuters news agency by telephone, 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 percent 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 pushes India’s total coronavirus cases to more than 20 million this week.
No testing centres
When 36-year-old Pushpa Yadav, who lives in central India’s Madhya Pradesh state’s Shivpuri district, got a fever and cough last month, she was scared she had caught the “wretched” coronavirus.
But getting tested was not easy. The closest testing centre was 10km (6.2 miles) away in Pohri, a small town and the administrative division of Shivpuri.
Pushpa’s family does not own a vehicle. If she needed a hospital bed or had a medical emergency, she would have to travel 24km (15 miles) to Shivpuri on a public bus.
In this remote corner of India, there is also little public awareness about the pandemic. Face masks are rarely seen and many do not know the importance of physical distancing.
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.
‘My sari is my mask’
Bhramari Bai and Meena Bai – both in their late 40s – belong to central India’s Sahariya tribe, which is mainly involved in agricultural labour
The two women work at Shivpuri’s crematorium for 150 rupees a day ($2). With no masks or personal protective equipment, their job is to collect wood for the cremations, which have spiked since a ferocious second COVID-10 wave hit India last month.
“I come around 9 in the morning every day and work till 6-7 in the evening,” Bhramari told Al Jazeera.
When asked why she is not wearing any face mask, she replied: “My sari is my mask.”
In Bikram, a small town outside Bihar state’s capital Patna, 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, nearly 40 out of 100 samples collected 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.
Quacks and concoctions
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 over the 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.”
In Uttar Pradesh’s Bhadohi 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 him 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 many miles away.
In Shivpuri, a private medical practitioner is working in the village of Parichha with no medical degree. “I had treated many people in the last few weeks who had coronavirus symptoms… Some recover, some die,” he told Al Jazeera, requesting anonymity.
“I am not treating patients now because the police doesn’t allow me to open my clinic. Until last week, I was seeing 60-70 such patients on a daily basis.
“Now, when no doctor is treating patients in our village, people are directly coming to medical stores and buying medicines by just telling symptoms to avoid going to Shivpuri.”
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 55km (34 miles) from her village.
He died on April 25 in the ICU, which had a capacity of 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.
Mayank Jain Parichha contributed to this report from Shivpuri, Madhya Pradesh