Coexisting with Covid: Time for a Bottom Up Approach

It is a good time to remember that Indians have lived for decades, if not centuries, with highly contagious and extremely lethal diseases like small-pox and cholera, and others less lethal, like tuberculosis or malaria. From the little that we know about this virus it is unpredictable, highly contagious but not extremely lethal. It can be fatal, but then it has been asymptomatic for many. We cannot wait till we achieve herd immunity or find a cure or vaccinate the entire population as none of these are likely to happen soon. Our best bet is probably that the virus ‘disappears’ on its own as happened with the Spanish flu. But a better bet is to evolve a model of co-existence based on caution while we wait for a ‘flattening of the curve’. Now that the central government has issued its top-down ‘restriction and permission’ based directives we probably need to balance these with some ‘bottom-up’ actions to reclaim some of the normalcy we have lost. Communities have survived with contagious diseases with far less knowledge and resources in the past, so it may be possible to find ways to do so now as well. While we maintain physical distance, the emphasis on social solidarity is crucial to build resilience. A bottom-up approach would be ideal for managing many of the issues emerging during the pandemic.

The sudden implementation of the lockdown failed to factor in that nearly 40 percent of our population lives outside what they call their home. It is only natural that the domestic migrant workforce, much like their counterparts abroad, want to return to the security of their homes in this time of distress. The belated measures being taken to support the migrants travel back to their homes are necessary and welcome, but are they enough? Are we sure that the returning migrants, among whom are many women and children, will be welcomed back by their communities? Fear of the virus, dinned in over the past month and a half, has created a sense of panic and uncertainty. The news has been replete with examples of stigma and violence against people who are possibly exposed to the virus. The violence against health workers has been particularly shocking. In the red zones, the need for physical isolation continues to be high so that the infectivity can be reduced, and the curve can be flattened. But if neighbours start viewing each other with suspicion and fear, stigma, intolerance, and violence will just be a step away.

We are in a health emergency, and the health system is overwhelmed by this one virus. However, we cannot afford to forget the other diseases and health conditions which require attention. The foremost probably is maternal health care. An estimated 70000 deliveries take place every day in our country, and during 40 days of lockdown there would have been more than a two and half million births. There is sporadic news of how ambulances are not available or how pregnant women are being turned away from hospitals. Would the Maternal Health tracking system, developed by the Ministry of Health and Family Welfare, have an estimate of where those deliveries took place; or how the estimated two and half lakh or more emergencies were handled?

One of the worrying features of the lockdown has been the news of increasing violence against women and children. The National Commission on Women has reported that they had a two-fold rise of complaints received. The Childline has reported a fifty percent increase in reports of child abuse and there are many other reports of individual cases of violence. Women are facing a disproportionately high burden of keeping the household running. A household that probably has more people, for much more time creates its own complexities. Food and financial resources are extremely scarce. There may be older people who need care and attention as well. Children are not able to go out, either to schools and colleges or to play. All these stress factors increase the likelihood to violence against women and children. Do we have the necessary support services available?

The impact of the Covid 19 pandemic on men, especially those who have lost their livelihood opportunities cannot be underestimated. The gender roles that men are socially trained and brought up to perform are to be the providers and protectors of their family. The virus and the associated lockdown have disrupted their ability to perform these roles. We already know that men are not good at coping with loss and in the last decade or more we have seen rising suicides, violence, alcoholism, and other forms of substance abuse. There is emerging experience from across the country of how men and boys can be creatively engaged in the home space in a more equitable fashion, to strengthen their coping and resilience. Are we sure that kick-starting the economy is the only way that men can be supported?

Researchers working on social change have noted that catastrophic disruptions like wars and disasters are times when social relations can change. New forms of social organisation and approval systems emerge as the old order gets suspended to manage the emergency. This pandemic has already led to many upheavals. As we rebuild our society top down authority cannot become the only way to organise ourselves. Equality and decentralisation are embedded into the constitutional ethos in India, and a bottom up approach is an opportunity to reinforce these values. We are an incredibly diverse society, with different languages and cultures, different ways of eating, greeting, praying, and grieving. A decentralised way is the only way to build coping and resilience amid this diversity.

The good news is that the necessary structures and mechanisms exist and can be activated. In rural areas, a plethora of community organisations have been developed over the years to deliver development to the grassroots. These include women’s self-help groups, village health nutrition and sanitation committees, ward committees and sectoral committees of the panchayat and many community functionaries like the ASHA and the Anganwadi worker. In urban spaces there are clubs, societies, and Resident Welfare Associations. These and many more such organisations can be activated to welcome the returning migrants and provide contextually relevant guidance for their rehabilitation. The messages of infection, disease and death can be supplemented with messages of optimism and hope and of equality and solidarity. Neighbours can become support groups for each other, and men and boys helping hands in the household. The millions of women panchayat members and self-help group leaders can provide the necessary leadership. Traditional resource persons like the dai, can be roped in to be part of a triaging system where routine care is provided with sensitivity and concern at home while all emergencies get the necessary care in the hospital. Trust has to the cornerstone and social solidarity the core message for us to rebuild our society bottom up. Managing the virus can be left to the experts, but we need take charge of our own lives. And the state needs to partner with us.

Dr Abhijit Das