Pushpa Toraskar, whose mother-in-law was hospitalized with COVID-19 in April 2021, was told she had to pay a $2,070 hospital bill within twenty-four hours. A few hours later, she got another call from the hospital, informing her that her mother-in-law, Parvati, had died from the virus. “We couldn’t claim the body till the dues were cleared,” Toraskar told me, teary-eyed.
As of June 3, India had reported more than twenty-eight million COVID-19 cases and 338,013 deaths—numbers that understate the enormous level of loss that has affected millions of people and entire communities.
As a farmworker, it would have taken thirty months for Toraskar to pay the bill out of pocket. So, like many families in India that now face stiff medical expenses due to the pandemic, she borrowed money from a local lender at an exorbitant interest rate of 10 percent. “I knew we couldn’t afford a private hospital,” says Toraskar, who lives in a village named Nigave Dumala in the Indian state of Maharashtra. “We had to [try to] save her, no matter what.”
Toraskar’s apprehension toward public hospitals stemmed from hundreds of stories of deaths. From her village alone, over ten people died in the district public hospital after being diagnosed with COVID-19. But even the private hospital where Parvati was being treated was running low on essential supplies, to the point where the hospital had asked Toraskar to help obtain antiviral drugs and other medicines. “We ran everywhere and dialed over 200 people,” she says, “but couldn’t find any leads.”
One of the main reasons that Indian hospitals lacked supplies like vaccines is because, while India is a major hub for vaccine production, many of the millions of doses that were created earlier this year were slated specifically for export. So when a second wave of COVID-19 cases swept across the country in March, India—unlike the United States or most European countries—was shipping out far more vaccines than it supplied to its own population.
And although the central government, led by far-right Prime Minister Narendra Modi, curtailed vaccine exports in response to the uptick, its efforts have not been enough to meet rising demand. As of June 3, India had reported more than twenty-eight million COVID-19 cases and 338,013 deaths—numbers that understate the enormous level of loss that has affected millions of people and entire communities.
Though the second wave began in cities like Delhi and Mumbai, it wasn’t long before the virus spread to the countryside, which is home to roughly 833 million people. With India reporting as many as 400,000 new cases over multiple days in early May, the country’s health care system couldn’t keep up, prompting tens of thousands of people to take to social media with dire requests for medicine, ventilators, oxygen, hospital beds, and other essentials.
For Toraskar, who doesn’t own a smartphone, her neighborhood remained her primary support network. And on top of the trauma caused by Parvati’s death, “my husband Krishnat, who is an electrical lineworker, hasn’t been able to earn a single rupee for the past two months because of the lockdown,” Toraskar says.
For more than a year, thirteen-year-old Diksha Kamble has waited anxiously for her mother, Shubhangi, to get off work at six p.m. As an Accredited Social Health Activist, or ASHA, worker, Shubhangi has been tasked with containing the community transmission of COVID-19 in her village of 5,641 people in Maharashtra’s Kolhapur district.
Shubhangi, like the other nearly one million ASHA workers across India, clocks in ten to twelve hours every day in high-risk working conditions with inadequate safety gear.
Each day, Shubhangi monitors the temperature and oxygen levels of community members, asks them about any medical conditions that they might have, and finds suspected COVID-19 cases. She also helps community members access public health facilities, provides essential medicines, counsels families on childbirth preparedness, and much more.
An ASHA worker monitoring the temperature of a community member in Maharashtra’s Kolhapur district.
Shubhangi, like the other nearly one million ASHA workers across India, clocks in ten to twelve hours every day in high-risk working conditions with inadequate safety gear. “Last year, [my village of] Arjunwad reported thirty to thirty-five COVID-19 infections from April to July,” she says. “This year, in April [alone], the village has fifty cases.”
ASHA workers, the backbone of India’s rural health care system, are paid “performance-based incentives” that range from $41 to $55 per month in Maharashtra. “The frontline healthcare workers have to double up as farmworkers to make ends meet because the pay we receive is far lower than the legal minimum wage,” Netradipa Patil, an ASHA worker and activist from the Kolhapur district, tells me in an interview. “Several ASHA workers surveying in containment zones aren’t even given masks, gloves, and hand sanitizers.”
And yet, despite the lack of supplies, ASHA workers are often blamed by their higher-ups when an individual in their allocated area dies from COVID-19, according to Patil.
India’s health care system has long underserved the country’s rural population. For the last three decades, India has spent around 1 percent of its GDP each year on healthcare.
As a result, for the 69 percent of its population that lives in villages, India has only 810 public district hospitals and an average of 0.55 hospital beds per 1,000 people. Also, an astonishing 86 percent of rural Indians do not have medical insurance, making India a country with one of the highest rates of individuals paying out-of-pocket medical expenses in the world.
Sangita Gurav, who works at a primary health care center in Kolhapur, is the only public doctor for fifteen villages with a total population of roughly 80,000 people. As India continues to grapple with a lack of vaccines, Gurav’s clinic isn’t receiving enough doses for her patients. “In the second wave, most of the cases we’ve handled here are the ones who consulted us after a week of testing positive,” she tells The Progressive. “We immediately refer them to the nearest COVID-19 center, but the delay is leading to a higher fatality rate.”
Healthcare officials registering villagers for COVID-19 vaccinations at a clinic in Kholapur.
In May, the Ganges, India’s holiest river, was found swollen with dead bodies in the North Indian states of Uttar Pradesh and Bihar. In February, the far-right government of Prime Minister Narendra Modi allowed the Kumbh Mela festival, the world’s largest religious gathering that happens once every twelve years, to occur as usual. More than three million pilgrims bathed in the river while not adhering to COVID-19 protocols. Later, at least several thousand devotees tested positive (the exact number remains unknown as the government suspended its effort to collect data from the festival).
The devastation caused by COVID-19’s second wave in India is a culmination of populist decisions, scientific ignorance, and years of privatizing health care.
The devastation caused by COVID-19’s second wave in India is a culmination of populist decisions, scientific ignorance, and years of privatizing health care. Frontline health care workers and everyday people are now paying for the government’s ignorance.
“If I test positive [for COVID-19], I will at least get a break,” Shubhangi says with exasperation. Meanwhile, her phone rings yet again. This time it’s a call asking when vaccines will become available in the village.
It’s a good question, one for which she has no sure answer.