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Informal collectives and access to healthcare during India’s COVID-19 second wave crisis

Countries
India
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BMJ
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Neha Faruqui, VR Raman, Jeevika Shiv, Sonam Chaturvedi, Maitree Muzumdar, Vandana Prasad

Background

India was hit by a disastrous second wave of the COVID-19 pandemic that surged since February 2021. The exact magnitude of cases and deaths during this second wave remains a contentious topic, as suggested by huge differences between internal reports of the government and external reports. However, there is no dispute that, although several curbing strategies including a harsh lockdown were introduced during the early days of the pandemic in March 2020, the country now finds itself again in the midst of a crisis. Compared with last year, this time the virus has shown a much higher transmissibility rate, possibly due to a combination of newer variants, coupled with poor regulation and adherence to basic preventive public health measures. Mass gatherings in the form of massive election rallies and religious congregations were also permitted while cases had started increasing exponentially in numerous states of India, and vaccination rates continued to remain low.

Health systems in major cities were overwhelmed with cases even in the first wave, where some hospital wards were dedicated to COVID-19 care, non-COVID care was almost halted and healthcare workers were stretched thin. The second wave now saw a collapse of the system where not just wards but entire hospitals had to be used and expanded for exclusive COVID-19 care and still remained inadequate. In addition, we witnessed the conversion of maidans (open fields), gurdwaras (Sikh religious institutions) and other places into makeshift wards and hubs for accessing oxygen. The crisis revealed the pre-existing cracks in an underprepared health system where people were left to help themselves, gasping for oxygen or drugs and scrambling for hospital beds. However, as with any crisis, human beings rise to find possible ways to cope or are impelled to do so from sheer desperation. It is in this context that informal collectives of individuals and civil society organisations came together with a single aim: try to help as many people access timely and appropriate healthcare. We write from the perspective arising from the experiences of bridging the disconnect between patients and the system during an unprecedented crisis, based on observations and experiences of volunteering for one or more such collectives.

Most of these informal collectives supported health systems through improvised back-end processes. They adopted a multipronged approach covering an array of support initiatives, organised mainly through telephonic coordination for arranging access to medical services. While there are several such collectives across multiple states in India, and the assistance did cover multiple cities, we share some challenges and reflections, specifically in the context of the National Capital Region of Delhi—pooling experiences from involvement of the authors in many of them. These collectives consisted of professionals from multiple backgrounds, such as medical, public health, law, arts and social work who committed their time, energy and often money and materials wholly voluntarily. Patients and families reached the collectives mostly through word of mouth, community networks and the participating volunteers connected with grassroots work.

While some collectives dealt with issues spontaneously and randomly, others had a more systematic approach. This included documenting cases with information such as patient name, age, sex, oxygen saturation level, COVID-19 status, address, phone number, present condition, comorbidities and present requirements. A volunteer then helped the family for their specific requirement. Such volunteers tried to work with families throughout their journey of accessing care. The models of assistance included one or more strategies of responding to evolving needs such as finding medical care within hospitals or organising home care, teleconsultations, financial assistance and psychosocial support, as well as, wherever needed, facilitating post-death services. Most of the cases, especially in the early days of the crisis, reached the collectives at critical stages. The processes of helping not only revealed how further weakened the health system became, but also provided a first-hand account of the harrowing experiences of patients and their families from various social strata. An intricate account of this was shared by authors SC and VP in a BMJ Global Health blog and this editorial expands upon some of the broader challenges and responses encountered by the collectives.