Fighting against stigma for child health during COVID-19 in Kolkata
UNICEF quoted an analysis from Johns Hopkins Bloomberg School of Public Health on the effects of COVID, published in The Lancet Global Health journal. “Based on the worst of three scenarios in 118 low- and middle-income countries, … an additional 1.2 million under-five deaths could occur in just six months, due to reductions in routine health service coverage levels and an increase in child wasting." I therefore wanted to understand how, fighting against all the odds, medical professionals are keeping alive a fragile children healthcare system locally.
At the same time, I read about how health care workers were being harassed because of misconceptions related to Covid-19 by their neighbours and landlords because of their work. Some of my friends in healthcare have faced such incidents. I therefore approached the Institute of Child Health (ICH) in Kolkata via a friend who is employed there as a health care worker. Dr Arunaloke Bhattacharya, Deputy director of ICH, loved the idea of photographing the struggle of health care workers of ICH and gave me permission.
Neeladri Ghosh (name changed) is among one of the many unknown healthcare workers in Bengal who continued to provide healthcare services, despite facing social harassment. He shares his experience: "Covid changed the people I knew; my neighbours put a barricade in front of my home. They held the driver who came to drop me from Kolkata captive for several hours. I had to seek help from the local administration."
The WHO released a statement that "some healthcare workers may, unfortunately, experience avoidance by their family or community owing to stigma or fear. This can make an already challenging situation far more difficult."
My first visit to the ICH was visually challenging. Children with different age groups came for treatment. I first went to meet Dr Tarak Nath Mukherjee in the hematology department. He said "At the moment we do not have any crisis in our premises regarding blood, but overall there is an emerging crisis: Blood donation camps did not happen at all because of lockdown. For example, normally 60 to 70 blood donation camps take place per month, but this year only 60 camps happened in four months. In the long term, it will affect patients with thalassemia, especially patients from the rural belt”. Further, he said “Colleagues in my department have faced social stigma, which is saddening”. A lady standing next to Dr Mukherjee said: “Because my husband is a doctor (and on Covid duty) and myself employed are here, we are staying at my father's place and unable to return to my flat. We fear neighbours will object.”
Dr Rina Ghosh, an immunology expert in the hospital, said “Covid emerged as a massive crisis in the child healthcare system. Numerous vaccination camps have been called off in rural and urban areas. I fear in coming years cases related to diseases like pneumonia, measles, chickenpox and whooping cough will surge. Though in India we have eliminated polio, it will affect that too. The vaccination process is hampered because the government has taken staff from other healthcare sectors and put them in Covid duty. The whole immunization process has taken a hit”.
According to Children healthcare expert Dr Prabhas Prasun Giri, “Effects of Covid on children are not that much visible. Kids are mostly asymptomatic. Sometimes a few of them are detected Covid positive when they come here for some other treatment. We have a separate isolation unit for kids with respiratory problems.”
Aradhana Ghosh Chowdhury, Deputy Chief Operating Officer highlighted a more significant problem. She said, “No one prepared for this disease. The initial days were very tough. Arranging staff & patient safety and allocation of personnel were troublesome—many staff unable to return home because there were no trains or buses available. Also, many health carers from the rural areas decided to stay back to avoid social stigma. But now the hospital is facing a financial problem. Because of Covid, there is a considerable drop in (paid) bed occupancy of 60%. Outpatients were closed for a long time; even now only 10% of the patients are visiting. Our expenditure has gone up by 15% because of sanitation and PPE costs related to COVID-19, but charges did not rise commensurately; the patients we serve here are from rural and sub-urban Bengal. They do not have a decent income because of COVID-19 lockdown, so how they can afford the extra cost? We often remove any extra cost, sometimes our doctors pay from their own pocket. At the moment donations have kept us going, but that is not enough for the long run.”
In the next few visits, I came across multiple incidents of social stigma faced by health care workers. Inside the maintenance room, Haranchandra Das (affectionately known as Haru) shares his traumatic experience. He said “My village is in south 24 Parganas district; my family and I have been harassed in various ways. Some people, whom I used to know as friends, stopped grocery and milk supplies. My family has spent sleepless nights. Enforcers came in PPE to catch me as I though I was an animal. They had developed a fear that I am infected just because I work for a hospital.”
Not only health care workers, but patients from rural areas also became victims of COVID-19 stigma. In the Mrinalini Cancer Research Centre I met Nirmal Mondol (name changed) who came from a village in East Midnapore. She said “I have missed chemotherapy dates for my son. He has leukaemia. I have developed a fear that if I come to the hospital for treatment we will get the Coronavirus. Another problem I have faced is no train service available; I cannot afford car cost.”
Inside the premises, I meet another family came from a village in the districts—Head of the family Ratan Biswas who came from a village in South 24 Paraganas. The family is about to start their lunch, Mr Biswas said “I used to work as a daily wage worker in a betel leaf farm. Cyclone Amphan destroyed it and I have lost my income. Now my younger kid has developed an infection behind his ear. We had to take him here. Because there are no train services available, it's very troublesome for us to come here.”
The entire situation was summed up by Dr Arunaloke Bhattacharya, Deputy Director of ICH; he said “Initial days were troublesome. Many of my colleagues need local administrative help. Unfortunately, the local government hasn’t cared about building healthcare infrastructure. Mainstream media spread panic rather than raising awareness. Frontline healthcare workers and regular patients are the real sufferers.”
Ritayan ‘Rikh’ Mukherjee is an independent documentary photographer and nominator for World Press Photo 6x6 program. He is a People’s Archive of rural India Fellow. His work has widely published by different national and international platforms such as World Bank Group, UNDP, Spiegel, Firstpost.
In 2016, Ritayan was nominated as a fellow for The People Archive of Rural India (PARI) and in December 2018, Ritayan was awarded a prestigious Sahapedia Frames Photography Grant. He has contributed to two books – ‘Calcutta Then & Kolkata Now’ by Roli Publication and ‘People Like Us’ by The People’s Archive of Rural India. Currently he is accomplishing his childhood fantasy of living with nomads from the Tibetan Plateau and developing a book on those communities.
Thalassaemia is an inherited anaemia affecting oxygen transport, prevalent in Mediterranean countries and Asia.
More information on the author is available at www.anobservantowl.in and on Instagram: @rikhmukherjee
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