PM Modi says the pandemic is not a political issue, it is a human issue. Is that an admission that human concerns have no place in his politics?
The Union Health Minister told Parliament that no one died because of oxygen shortage.
Bihar Health Minister Mangal Pandey echoed him: “A total of 9,632 people have died of Covid-19 in Bihar so far but none of them died due to shortage of medical oxygen.” Gujarat CM Vijay Rupani says the same: No one died for lack of oxygen in our state.”
The project to alter our memory is underway. Dead bodies no longer float down the Ganga in silent accusation; cremation grounds are no longer crowded with pyres; the bright shrouds have been removed from the riverside graves.
The necessary number of tears have been shed on camera for the official number of deaths. Any deaths or tears in excess of these official ones are no doubt a conspiracy to defame India.
TV channels declare that Modi’s tears are humanity and our tears are politics. In the face of this, merely to meet the bereaved, to bear witness to grief, is a political act of defiance.
CPI(ML) comrades in Bihar took up the task of mapping every death in April-May 2021 in around 5000 villages. The methodology they adopted was as follows: they visited homes where deaths had occurred, and filled up a proforma based on family members’ replies as to a) symptoms preceding the death; b) where medical care had been received from an informal doctor, a government facility or a private facility; c) whether a Covid test had been done, and what the result was if so; and d) whether the family had applied for Covid compensation or not, and if they had applied, whether they had received it or not.
A central team comprising CPIML CCM Santosh Sahar, Politburo member Kavita Krishnan, and V. Arun Kumar from the party’s central headquarters joined this survey, in an effort to achieve written and audio-visual documentation of the testimonies of the bereaved. It seemed important that the voices of the bereaved be heard and amplified – even as governments at state and centre, and the dominant media, stopped their ears and covered their eyes.
The central team began its journey on 7 July 2021 with a visit to Pavna village in Bhojpur District. In the course of the next few days the team visited Pasaur (Charpokhri, Bhojpur), Ghusian Kala and Salempur Pokhra (Bikramganj, Rohtas), Bihta (Tarari, Bhojpur), Avgila and Peur (Sahar, Bhojpur), Motha, Sakri and Prasadi English (Arwal), Bhaderia English and Ankuri (Paliganj, Patna), Puraina, Chakia and Shekhpura (Punpun, Patna), Nagwan (Phulwari, Patna), Jaijor (Aandar, Siwan), Daraili Mathia (Darauli, Siwan), Kelharua, Kalyani, Damodara, Cheetakhal and Koharbalia (Guthni, Siwan), Mairwa and Imlauli (Mairwa, Siwan), Hathauji (Nautan, Siwan), Chhotka Manjha and Pathar (Jeeradei, Siwan).
These were all villages where an unusual number of deaths had occurred between April and July 2021. The team visited the bereaved family members of those who died in these villages since April 2021, recording their testimonies. The results of the survey are quite startling, and the testimonies are a rebuke to the powerful.
The Bihar Government has announced a compensation of Rs 4 lakh for each Covid death. But it demands a death certificate which records Covid-19 as the cause of death, in order to claim the compensation.
In village after village, it became clear that an abnormal number of deaths had occurred, and that in most of the deaths, the symptoms of fever, cough/cold, and breathlessness clearly indicated Covid-19 as the cause. Most patients had been unable to get care in a government facility. They had all spent far beyond their means on informal doctors, medicines, private doctors, private hospital beds, oxygen cylinders, and transport from villages to towns and cities in search of care – and as a result, every household we met was deep in debt. But only a small handful had any documentary proof that the patient had died of Covid. Many died before they reached hospitals. A large number were misdiagnosed as typhoid patients even though they clearly had Covid-19 symptoms and eventually lost their lives. Hospital documents often did not name Covid-19; death certificates issued in Bihar stated hear or kidney failure as a cause of death, with very few listing Covid-19 as an intermediary cause. There was no question, of course, of listing lack of money to afford transport and private hospital care; or lack of oxygen or hospital beds as a cause of death. No connections were made between Covid-19, and post-Covid deaths from conditions like deep vein thrombosis. Many destroyed hospital documents, either because they had been advised that anything from the hospital could be infectious, or in sheer despair and anger at the futility of medical care.
The second wave of Covid-19 has waned, but the virus is by no means gone. And the devastation, distress, and trauma wrought by the virus and the absence of basic medical facilities, is still an open wound.
The survey’s findings are being analysed and the report is still in preparation. But here are some of the central team’s observations, with some of the testimonies of the Covid bereaved. We believe that these findings are by no means unique to rural Bihar: the situation would be similar in rural UP, MP, Gujarat and other states.
Clear Covid-19 Symptoms
In village after village, we met bereaved people who did not understand how what looked like a mild cold, could so soon snatch away the breath of life from their loved ones. Among Bhojpuri speaking people, we heard the phrase “khokhi-bukhar-hanfi” (cough-fever-breathlessness) most often to describe the symptoms preceding death. We were using the “verbal autopsy” method – a method used by health workers to track causes of death in populations where medical death certification is weak, unreliable, or absent. And it was clear that there were a vast number of deaths in rural Bihar that either not been recorded at all, or had not been recorded as Covid deaths, in spite of the fact that the symptoms preceding the deaths were classic Covid symptoms.
Sairun Bibi (Pasaur): my husband Kalamuddin Ansari (65) had sardi khokhi haanf (cold, cough followed by breathlessness). We took him to hospital but he died before any test could be done or treatment could begin.
Arti Devi (Pasaur): my husband Karan Sah got fever, a cold and cough, and then became breathless. We took him to Ara to see a doctor but we were told to take him to Patna. We didn’t have the money to do that. “Kahin na theek bhail, hanfi na band hua” (He just didn’t get better, and the breathlessness would not stop.”
Mrityunjay (Bihta): My father Kapilmani Tiwari got a mild fever. We gave him medicine, and he ate his meals well. But then his cough continued and he got out of breath. And he died within 5 days. His death certificate prepared by the anganbadi centre says he died of a heart attack.
Sonia Devi (Bihta): My husband Motilal Pasi (60) got bukhar, khokhi-sardi (fever, cough, cold) and then became out of breath. We took him to Kachawa, then Tarari, where they told us to take him to Sahjani for a Corona test but he died on the way. So no test could be done.
Sonajhari (Bihta): My husband Deshlal, an agricultural worker from the Ravidasi caste, got a fever, and a cough. He took medicines and got better, and then went to attend a wedding. He collapsed on his return, and the fever and cough returned. He became out of breath, and died. We did not have any money to take him anywhere for treatment. I have two sons, one 20, one 10.
Mayadevi (Bihta): My husband Manoj Pasi (38), an agricultural worker, got a fever which went away with medicine. But then the cough and breathlessness began. He died on the way to a private hospital. I have a 14-year-old son.
Sohra (Guthni): My husband Swaminath Bhagat (56) got a cold. Then, “dam phulat lage” - he began gasping for breath and he said, “I won’t survive.” We took him to Gorakhpur in UP, and he was admitted to a private hospital there but he died within a few hours, on the same night.
Rinki Gupta (Guthni): My husband Subhash (30) was a plumber. He got fever, a cough – and then “hanfi” (breathlessness). He died within just three days. We never realised he needed to go to hospital, and could not afford it anyway. We have a daughter, and a 3-year-old son with skeletal dysplasia.
Motijharo (Jaijor): Last year my husband Sriram Gond got a cough and breathlessness, and he was treated with asthma medicines. This summer he got a cough and breathlessness again. What could my daughter and I do, alone? He suffered for a month and then passed away.
Oxygen shortage
Sunaina (Pavna): My son Rohit (24) worked in a restaurant in Vapi, Gujarat. He got fever and a cough there. He would speak to us on phone and I told him to sip hot water to ease his throat. But a couple of days later he told me, “I do not feel like talking Ma, I cough so much that I do not have the breath left for it.” They hunted high and low for oxygen – but none was available in private or in government hospitals in Vapi. We were helpless, hearing all this from his friends. The day he died, he called me to tell me he was okay but did not feel like talking.
Chunchun Khatun (Avgila): My one and a half year old granddaughter, Arifa Parveen, born 4 January 2020 got fever and we took her to hospital in Sahar. They told us we can’t treat her, take her to Patna. We took her to a private hospital in Sahar next – there also they told us that we can’t treat such a small baby, go to Patna. So we took her to a private hospital in Patna. They had no oxygen, and as a result she died on 21 April at 2 pm. The doctors did not even touch her. If she had got oxygen she would have survived. The day she died, 5 people died at the same hospital. The papers carried her name in the news – “Khurshid Mistri’s granddaughter died of Corona.” The doctor told us that she had Corona, after she died. He said he didn’t tell us earlier so as not to scare us. But we don’t have any Covid positive certificate. We threw away all her medicines and the medical papers also.
Shraddha (Kalyani): My husband Daya Shankar Bhar, an agricultural worker, had trouble breathing. I have small children, I tried taking him in the night to the government hospital at Guthni. Paisa na kaudi (we had no money). The hospital said they did not have oxygen. We began the journey home but he died on the way.
Asmavati (Kalyani): My husband Dina Rajbhar got fever and a cough. We went to a doctor who sent him to the government hospital at Guthni. There they said he had Corona, but there was no oxygen there. They gave him some injection, after which it was as if “ulta saans go gail” – his breath inverted itself, he was struggling to breathe, and then he died. We threw away all the medical papers. I have one married daughter, another 13-year-old daughter and one 19-year-old son who is mentally ill and cannot earn.
Ramsakhi Devi (Jaijor): My husband Satyanarayan Prasad Chaurasia got Corona, the doctors said so but would not admit him to hospital and there was no oxygen.
Soni Khatun (Motha): My husband Shafiqullah Khan (45) was an electrician. He got a cold, cough, fever. We took him to a private local hospital – Mangalam – then to a private hospital in Arwal. They asked us to take him to PMCH Patna because there was no oxygen in Arwal. We took him there but PMCH did not even let him in the door – they did not even let us alight from the vehicle. They said they could not do anything for him. We brought him back to Mangalam – but there was no oxygen even for money. The doctors asked us to take him home to die. I am left with our sons Afridi (11) and Ali Asghar (8). They used to study in a private school, their dad wanted them to study. Now how will I educate them?
Difficulty finding Hospitals
Baby Khatun (Avgila): My mother Moharram Bibi (60) got a cold and cough. My father passed away long ago. My husband is disabled thanks to a workplace injury, and he cannot earn. I have been taking care of my mother, and she was a great help to me, I never had to worry about my kids because she took care of everything. I got her medicines but she became worse. So I took her to a private hospital in Arwal, where we were told that they do not have any care to offer Covid patients, so I should take her to a government hospital in Patna. The Government hospital in Arwal would not admit her either, we were waved away from a distance and told to go away. We just got her home after that. Her hanfni (breathlessness) would not get better. And she died at home. The hospitals would not admit her saying she had Corona but now they won’t give us compensation because she does not have any report saying she had Corona.
Could Not Afford Transport or Treatment
Radhika Musahar (Pasaur): My 16-year-old daughter Sumanti got fever and a cold. We did not have the money to take her to Patna, we just got her the medicines the local doctor prescribed. Last year’s lockdown hit jobs badly, “pet ke aafat ba” (we had a hard time beating hunger). We earn Rs100-200 a day, out of which we spent Rs 50-60 daily on medicines for her. We could not even think of taking her to Ara or Patna: we could not afford to hire a vehicle let alone paying for hospital care. Sumanti did such a lot of work: “ropni-dohni-sohni-kadhni, lakdi-eendhan-khaye ke paani” - sowing, milking, weeding, embroidery to earn; as well as collecting wood, fuel and drinking water for our home. I think of her and miss her all the time – what to do, I gave birth to her, I am helpless and cannot help mourning her.
Purunia Devi (Bihta): My father Madan Sau (55), an agricultural worker, did not have his own land. He worked on the land of others. He had a cough, fever, for eight days. We got him medicines but did not have money to take him to hospital. I’m married, but I am staying with my mother now to comfort and console her.
Radhika Sah (Bihta): My husband Chandarma Sah had fever, cough and breathlessness. I had no money to take him to Ara or Patna. The village doctor gave him some injections. He stopped being able to speak – and then he died. Our 2 sons are migrant workers but lost their jobs in Delhi because of the lockdown. We do not own any fields.
Sita (Bihta): My husband Sudarshan Baitha had fever for two days and then died. We did not have the money to seek any treatment at all.
Debt Trap
Poonam (Chakia): My husband Baiju Kewat was an ironsmith. He got fever and breathlessness, and we got him admitted to Sahara Sandhya hospital in Mithapur. It’s a private hospital where they take a down payment of Rs 1.5 lakh. His hospital care cost Rs 5 lakhs, though he died after just one day. We are badly in debt.
Usman Khan (Gusiya Kalan): My brother Najam (41) used to work in Bhiwandi in Mumbai, but he had been home because of the lockdown. He got diarrhoea and breathlessness. In fact at that time the whole village was down with the same symptoms. We took him to a private hospital in Banaras where he was admitted on June 1. he died on June 12. We ended up spending Rs 8 lakhs and we are deep in debt. Our whole family has been in financial crisis for the past four years or so – ever since demonetisation, GST and then the lockdowns. His wife Nazreen and small son and daughter live with us now. The medical reports show “severe thrombocytopenia, anaemia, GI bleed, Budd Chairi syndrome”, but do not use the word “Covid-19. His death certificate cites “Cardio-respiratory arrest” as cause of death.
Signath Singh (Bihta): My wife Urmila got fever and stomach pain. I took her to Tarai, where she was referred to Patna, where I could get her admitted in a private hospital. She tested positive for Covid-19. She died after 8 days. It cost us Rs 2.5 lakh, I had to take a loan. We have one son. I have not applied for compensation.
Women and children without support
Kanti (Salempur Pokhra): My husband Manoj Rai (35) got a little cough; he took medicines from the village doctor and the cough got better. He never had had a sick day before this. He began to get breathless, but he was eating his meals and I did not really worry. But at night, I was terrified – I never saw anyone gasp for breath as he did. And then he died. I have three small children – two sons Krishna and Sudama and a daughter Rani. They used to go to school, but how can I afford to educate them now? Look at our hut – you can see the rain leaking in. It drips all night.
Kausalya (Damodara): My husband Harihar Bhagat (35) suddenly had trouble breathing one night. I could not help him – could do nothing for him. Villagers told me, he needs oxygen, you will have to buy oxygen – but I had no money. I borrowed just enough money somehow to hire a vehicle to take him to hospital – but I had to watch him die on the way there. I brought him back and arranged the cremation all alone, everyone was too scared to come and help. I have a 12 year-old boy and a five year-old girl, and my in-laws want nothing to do with us. I never thought this would happen to me. You say ‘be strong’ – but where can I find the strength?
Shraddha (Kalyani): My husband Daya Shankar was an agricultural worker. He died for lack of oxygen in the government hospital at Guthni. I have six small boys, and no means to support us.
Phoolkumari (Asaon, Siwan): My husband Amarnath Sah (45) had a cold, fever, cough and breathlessness. He died at home in 3 days. He was a construction worker. I have 2 sons (16 and 14 years old) and two daughters (9 and 7).
Poonam (Pavna): My husband Krishna Kumar had fever, cold and cough, and then trouble breathing. He was never tested for Covid though we did take him to a doctor. He died. I have 11-year-old twin girls, and no means to support myself and educate my children.
Depression
We met many bereaved persons who displayed signs of clinical depression. Some of them seemed to be a serious suicide risk. There is an unacknowledged mental health epidemic in rural India, with the sufferers having no means of treating it.
Arti (Pasaur): She was stony faced, and her neighbour told us she had not been eating or sleeping, “she just looks at her children and weeps”. Arti told us, “my parents live far away and we don’t have phones, so I cannot speak to them regularly. My in-laws do not love me. My husband loved me – but he is gone, love is over now. I do not want to live.”
Poonam (Chakia): My husband Baiju Kewat was a rare man, a lovely man. It is really impossible to find another like him. I cannot sleep, and I don’t know what to do – I feel desperate, like I want to “do something” unspeakable.
Radheshyam (Jaijor): My brother’s wife got Corona and we took her to hospital – first a private hospital and then we managed to get her a bed in a government hospital. We took loans to get her treatment – but still she died. When her dead body came home, my wife Shrimati Devi collapsed at seeing it. She too then had the same symptoms – fever, cough, breathlessness. But I had no money so I could not even try to get her treatment. She died within three days. I am besides myself – bilkul nervousiya gaya hun – I cannot understand anything. What is the point of working when she is gone. What is the point of doing anything now that she is gone. I neither sleep nor eat. I want to take poison.
Tahsin Ahmad (Peur): Tahsin’s mother Shakila Bano (65) died of Covid-19. Her death hit his father so badly that he (his father) was semi-conscious for twenty days. He wept for his wife all the time we were there. Tahsin said his father did not eat or sleep well. Tahsin tried to hold it together, but he was obviously scared for his father and struggling with his own grief.
Deaths Due to Post-Covid Illness
At Bhaderiya English village, we visited a house in which a young 25-year-old man had just died two days before our visit, after suffering a strange, sudden and severe pain his legs. His father-in-law and others had rushed him to four private hospitals, one after another. But he died. His medical papers said he had suffered a “CVA” – a cerebrovascular accident, i.e a stroke. We asked if he had been ill recently but no one thought so. However, we learned that he was a barber and used to work in a saloon in Surat, and had only returned to his village in June. So he had been in Surat at the peak of the Covid second wave in April-May. The sudden and otherwise unexplained stroke was very likely caused due to a recent bout of Covid.
Conclusions
1. The government statistics of Covid deaths are not the correct numbers. The real numbers are 20 to 25 times more than what the government statistics show. The illness of most of the dead started with cold, cough and fever, and progressed with great difficulty in breathing, after which death occurred within 2 or 3 days.
2. Very few people were able to reach hospitals. A considerable number died on the way to hospital or immediately on reaching hospital. Many people avoided government hospitals due to their decrepit condition, shortage of oxygen and other treatment, fear of quarantine, and fear that the family would not be given the body in case of death. Many poor people could not reach hospital or get proper treatment due to lack of money.
3. Most of the people were treated by rural doctors. Generally there are no treatment facilities available in Panchayat level health sub-centres. Oxygen was not available even in Block level Primary Health Centres and Additional Health Centres. Ambulance facilities were also very poor.
4. Government hospitals refused admission to patients citing shortage of beds and oxygen. People had to take refuge in private hospitals, where they had to pay through the nose. The average expenditure was Rs 1.5 to 2 lakhs. In some cases the expenditure reached as high as Rs 10 to 12 lakhs. There are several families that are bowed down with the burden of heavy debt.
5. Most patients with Covid symptoms were not tested for Covid. They did not get Antigen, RT-PCR or other test facilities at hospitals. Also, despite having Covid symptoms and dying of them, many people's test reports were negative.
6. Many Covid patients in hospitals were labelled as typhoid patients and treated for typhoid. The hospital papers make no mention of the cause of death. We also found family members of some of the dead who destroyed, burnt, or threw away the hospital papers.
7. Some people have applied for the compensation announced by the government. Only a very few have so far got this compensation. The government needs to make significant changes in the compensation policy so that families of all the victims can get compensation.
8. Most of the dead were sole earning members in their homes. Also, some of the aged victims were pensioners and the whole family depended upon the pension for sustenance. All of them should get immediate compensation in view of medical expenses and burden of debt.
9. Family members of the dead, especially women and men who have lost their spouses, are suffering severe depression. They need urgent intervention and care, which is unavailable as of now.
10. The team found that despite more than a year having passed since Covid appeared, there are all kinds of misconceptions among people. The importance of wearing masks, washing hands, and awareness of preventive medicines has not at all percolated to ground level. Fear of vaccination is also very much present. A big reason for this is lack of confidence in the Modi-Nitish governments. However, we found that this fear is gradually decreasing and now there are people who want to get vaccinated but the government has failed to make vaccines available to them.
Recommendations
The Covid second wave has abated but the devastation it wrought is still very much present in rural Bihar. The levels of destitution and distress are dangerously high. Instead of seeking to suppress numbers of Covid deaths and minimise the compensation paid, the Government ought to be looking the bereaved in the eye, and acknowledging its own culpability in the Covid deaths (which are just as much due to the appalling state of healthcare in Bihar and the criminal lack of hospital beds and oxygen as due to the virus). As a measure of this acknowledgement, the Government should pay compensation to the bereaved, without demanding documentary proof of Covid as cause of death. As long as a local elected representative (a member of the village panchayat, or the local MLA), or local health worker (ASHA or anganwadi worker) confirms that a death occurred and that the symptoms included cold, cough, fever or shortness of breath, compensation must be opaid out without further ado.
All talk of “development” in Bihar is a cruel joke if basic healthcare is available only at a steep cost and even so, oxygen and hospital beds and ventilators etc are in short supply. Health infrastructure must be built up in rural Bihar on a war footing, and free healthcare in government hospitals must be guaranteed for all as a right.
Block Level Applications Submitted for Covid Death Compensation
Applications regarding Covid death compensation were submitted under the CPIML banner on 15 July 2021 at Block HQs in Bihar, demanding Rs 4 lakhs compensation without delay for the families of every death in the Covid period.
Covid, lockdown, and inflation have proved back-breaking for the people. This compensation amount is very important in order to enable people ruined by the 2nd wave of Covid to re-start their lives.
The application submission program was carried out at most Blocks in various Districts including Arwal, Bhojpur, Muzaffarpur, Darbhanga, Madhubani, Eastern Champaran, Siwan, Gopalganj, Jehanabad, Gaya and Buxar. CPIML is collecting statistics of deaths that occurred across Bihar between 1 April and 31 May during the 2nd wave of Covid. According to this report, the actual death toll in the state is 20 to 25 times greater than the numbers shown in government data. Only a few families have received the compensation amount so far. Therefore the CPIML is helping people to submit applications for the compensation amount.
CPIML has prepared a list of all the people who died of Covid-like symptoms. Since there were no testing facilities in the villages, most of the people never got tested. CPIML MLAs and other people's representatives said that such deaths should be counted as Covid deaths and demanded compensation for them.
