'Bhagao, Team Ko Bhagao': Frontline Workers in Rural UP Are Fighting Covid-19, Rumours And Opposition From Residents, But They Don't Seem To Relent

"Saara kaam hum hee logan se to hai"

It is on us that this work in the fight against Covid depends.

This is how an ANM sums up over the phone the contribution of herself, her colleagues and ASHA workers in the fight of rural Uttar Pradesh against the Chinese virus during the month of May.

As the Covid-19 wave gradually shifted to rural areas in Uttar Pradesh, the state geared up to check the spread of virus spread by starting a mass rural surveillance exercise. Nigrani samitis were formed.

Nigrani means watch.

The committees would keep a watch on quarantined patients.

Teams of health workers would distribute medicine kits and counselling people living in rural areas on the symptoms, threat and spread of Covid-19 would be part of the drive.

The teams would go to the villages and conduct door-to-door surveillance -- facing several challenges. Their aim would be to make the virus weaken its firming grip on rural Uttar Pradesh.

The drive would have tracking, testing and treating as the three main components. Teams would visit homes in villages. People reporting symptoms related to Covid-19 would be tested.

Those who test positive would be isolated and provided with a medicine kit. Contacts of people who test positive would be quarantined and tested.

People having no signs of Covid-19 would be spoken to and counselled to get vaccinated and follow Covid-19 appropriate behaviour or "protocol" -- the word seemingly accepted in rural parlance now.

Meanwhile, the routine sample collection and testing would continues in the Community Health Centres.

The Times of India has quoted Additional Chief Secretary, Health and Family Welfare, Amit Mohan Prasad as saying: “As many as 89,512 villages were covered in the rural surveillance drill and positive cases were found in 28,742 villages only. Health teams have already reached out to quarantined patients and ‘nigrani samities’ are keeping an eye on them."

The fight against the spread of the pandemic in rural areas would be steered with tracking active cases as the top task.

The World Health Organization (WHO) has backed the state in the fight against the spread of the virus -- "in training and micro-planning for the activity".

The Uttar Pradesh government, it has reportedly said “deployed 141,610 teams and 21,242 supervisors from the state health department to ensure all rural areas are covered with this Covid-19 case finding activity”.

A doctor Swarajya spoke to over the phone says that the reason for the impact of the door to door campaign is simple. People who could not afford medicine, got medicine and intervention. He says, "Gaanv mein jo gareeb janata awaas kar rahi hai, jiske paas dawa ke paise nahin hain, unko bukhar ya lakshan hain, unhone dawa khaae hai, unhe dawa mili hai, us se kaafi rahat hai, to kaafi girawat hai."

The task in the continuing fight against Covid-19 would have not been possible without the action, determination and words of frontline health workers, including the ANMs and the ASHAs.

They have empowered the door-to-door drive and have played a tangible role in making the 3Ts being pursued by the Adityanath government possible on ground. They are not only carrying out the 3Ts but also playing a massive role in the ongoing vaccination drive in the persistent fight against the Chinese virus.

Mostly women, the ANMs and the ASHA workers, have their nose, eyes and ears to the ground and village when it comes to keeping a watch on families or people in the village who may or may not report the presence of symptoms related to Covid-19.

Nigrani is the key word and action.

Having worked in the villages during less stressful times in the pre Covid-19 era, they are aware of families living in the villages, they are aware of the members of these families. The Nigrani-keepers know their action field very well.

Gloves, masks, sanitiser, "poori aasteen ka blouse" (blouses that fully cover their arms) a dupatta for another layer over the double mask, are their weapons of protections for work.

Hidden under the layers of protection is part determination to bring down the spread of disease, part fear -- of catching the infection.

There is more caution. After all, the heath workers too have families and children waiting at home.

"Joota, jab wahan se aate hain to ghar ke andar nahin aate hain, pehle hum us par garam paani daal lete hain, bag dhhone daal late hain."

Shoes are used, when they get home, they don't barge in unless they have santised/bathed, all clothes are dipped in hot water, bags used are washed.

Health workers devoted to bring down the curve of infections in door-to-door work in the state are not only fighting the challenges posed by the spread of Covid-19 in their area of work, but also opposition to their entry to villages.

In addition to that, they are working to demolish misinformation, the impact of rumours spread against the vaccine, caregivers and care to fight Covid-19 and bad behaviour.

One ANM (name withheld) told Swarajya over that the villagers oppose their entry, misbehave, get into groups and tell the visiting health workers to back off.

She says, "Bahut samjhaate hain hum, par wo grouping kar lete hain aur kehte hain ki tum hamare photo khichwaaloge aur fir humein gaadi se uttthaloge."

The villagers, she adds, tell health workers that they (the health workers) will take photographs and later get the villagers picked and carried away in vehicles.

She tries to explain the opposition faced by them using one word in English: "Behaviour". "Bahut behaviour karte hain hamare saath. Bahut beizzati kar rahe hain (they are insulting us a lot)," she adds.

What do they do in such situations?

They try to explain more to create awareness on Covid-19, social distancing, the need for protection against the virus, the benefits of vaccination and the need for timely care. They maintain safe distance. They don't argue with the village residents.

Those willing to get tested are asked to come forward. "Samajhdaar log bhi hote hain. Unko samjhaate hain, test karte hain, aur dawa bhi dete hain" (there are some wise people among these, we test them, and provide them medicine).

A doctor working at one of the rural divisions in central Uttar Pradesh told Swarajya over the phone that the door-to-door campaign has thrown up encouraging results as far as awareness in rural areas is concerned.

He counts the awareness created as one of the biggest and effective benefits. "Logon ne oppose bhi kiya hai lekin jagruk hue hain. Oppose kiya hai lekin unko jaankaari to hui hai ki yeh bimari kitni khatarnaak hai aur is se kitna hoshiyaar rehna hai (though the people have opposed but they are now aware about how dangerous the infection can be and know how alert they need to be)."

He mentions that earlier this week, on a particular day, the teams conducted 100 tests in a rural area, 99 tested negative. The one person found positive had no symptoms, but wanted to get tested.

"The decision of this man to get tested was a result of the positive awareness against Covid-19. He was provided the medicines and his progress will be followed up," adds the doctor.

That's not all. During the follow up, if anything concerning comes up in this particular person's fight with Covid-19, a specific team will be notified and efforts will be made to get him hospitalised in case he needs hospitalisation.

He adds that those people who have supported the campaign (those people who have accepted the intervention of health care teams) have been tested. "Testing karke rule out karne ki koshish ki hai ki wo Corona se sankramit hain ya nahin. Agar sankraman mila hai to proper medicine dee hai. Medicine samjhai doctors aur health workers ne. Unko bataya gaya hai ki kaise ghar mein rehna hai mohalle mein nahin ghoomna hai. Sab protocols humne bataye hain (by testing, we've tried to rule out whether they are infected with Corona or not, if found infected then proper medicines have been given to them, medications were explained to them by doctors and health workers and all the Covid appropriate behaviour and protocols were explained by us)."

Ruling out infection, providing medicine, explaining dosage, norms on Covid-19 appropriate behaviour such as not roaming out in the streets or locality.

Teams of five are sent to villages for conducting tests, especially to areas where the number of suspects is a concern.

The biggest challenge mentioned by the healthcare workers over the phone, is people's misconception regarding the health care workers themselves and the test-hesitancy.

"In one of the villages, the ANMs and ASHA workers explained about Covid-19, the threats and other aspects related to the diseases very calmly and affectionately. There were many children in this particular group. We told the women about why protecting the children becomes important in the disease. But they were in no mood listen. They said that we will give them the disease."

What is the reason for misconceptions regarding health workers among people in the rural areas?

The doctor lists two: lack of education; certain 'active' people in communities/groups of people play a role in spreading rumours and misconceptions and people rely on them for information -- falling into the trap eventually.

Aspects that the frontline health workers seem concerned about:

1. Opposition from villagers, bad behaviour, insults they face from people who don't want them to enter villages for crucial work, especially in case of ANMs and ASHA workers.

A doctor mentions that ANMs and ASHA workers and others in the frontline healthcare league do develop fear, cough, cold during work. This makes some of them go on leave. "But only 10 per cent workers would be absent from work for any of these reasons, the 90 per cent are reporting to work. Agar nabbe per cent loag kaam nahin kar rahe hote to itna bada work nahin hota (if 90 per cent workers would not have worked then this huge work would not have happened) ."

Had 90 per cent people not been reporting to work, we would have not been able to push towards a decline (itna bada kaam).

The work segment of door-to-door campaign has another wheel of action within -- the Three Ts -- tracking, testing, treating.

In case of tracking -- the first in the 3T action wheel, a positive case is tracked, his contacts are tracked. "Hum uske poore mohalle to test karte hain, ki kisi aur ko sankraman to nahin hua hai." People in the entire locality (mohalla-street) are tested to rule out infection.

In case of testing, the entire information drill rolls out again, just as it is during the door-to-door awareness campaign. They are asked to inform the teams immediately in case of high-fever and/or any of the symptoms related to Covid-19.

Another doctor points out that fever came up as the most common symptom among people in the rural areas. "Khaansi zhukham itna nahin thha lekin fever bahut logon ko thha, especially in the phase preceding 5 May. Jab se abhiyaan mein dawa gayeen hain, utna nahin hai. Ab kaafi girawat hai (cough and cold was not much prevalent but many had fever, especially in the phase after May 5. From the time medicines have been distributed through this mission, cases are not much, there is quite a drop in cases now)."

Doctors Swarajya spoke to point out that the experience held by ANMs and ASHA workers in the door-to-door and Three T campaigns has come handy.

"Hazaar hazaar ki baadi mein kaam karti hain, unko ghar ghar ka pataa hai. Usee gaanv ki bahu hai ya bachchi hai, to usko maloom hai ki kis karan bukhaar hai." -- they work in areas of population, they know the village and homes, they are the daughters or daughters-in-law living in these very villages.

Poonam (name changed) is an ANM. Her work includes spreading awareness about the Covid-19 vaccines, door-to-door campaign and vaccination. Here is how she is rumour-greeted by some-not-all people in the villages she visits.

"Injection sahi nahin hai." (injection is not correct).

Or,

"Jabse injection laage hain, aadmi bahut mar raha hai." (deaths have gone up with the use of injections).

Poonam didi seems upset at how rumours hinder their work and its cause.

To try and pep her up, I give her a prick over the phone. "Didi, aap loagon ko samjhaate kaise hain, zara bataiye (how do you counsel people on Covid-19?)"

She goes all gutsy. Her voice transforms and she imitates herself to spout the dictums:

• Maine keh diya ki agar yeh injection aap lagwa loge to immunity badhegi aur khatra kam ho jaega (I've said that if you take the vaccine jab, your immunity will increase and the risk will reduce)

Her peppiness takes a turn again. She mentions in a tone of concern and part disappointment that during their survey, when asked if they have any Covid-19 related symptoms (from the list of symptoms stated in the awareness campaign), many people lie about not having symptoms. They hide the symptoms.

She adds, "Log chhupaate hain. Bataate nahin hain (people try to hide and do not tell even if they have the symptoms)."

What does she do in such a situation? What do her colleagues?

She loosens a secret -- in a dramatically hushed tone. "Agal bagal se pataa lagaa lete hain (we find out from the people around)." This year, she has spent nearly 23 years on ground she says.

Her tips to her colleagues and ASHA workers during the door-to-door campaign (which could explain the dedication and nuts and bolts of the campaign):

• pyaar se samjhaao (explain affectionately)

They haven't received many cheers for their dangers-laced work. "Bhagao bhagao team ko bhagao," is a refrain they heard in many areas.

A doctor goes sombre and mentions that there is the fear of infection lurking among them. "Sankraman kab lag jaaye koi bharosa nahin. Halkaa phulka darr to hum logon ko bhi lagta hai apni safety ke liye. Lekin hum sarkar ka kaam kar rahe hain, manavtaa ka kaam kar rahe hain (a bit of fear of getting infected persists but we are doing the work of the government and of the humanity)," the doctor adds.

Their work is for humanity, the state and the government.

Note: Names of frontline health care workers have been withheld for protecting their identity (on request and in case of hesitation).

Names have also been withheld to protect the good work being done by them in the continuing and persisting fight against Covid-19 in India's most populated state, especially in case of opposition to their entry in villages propelled by misinformation and rumours created by certain sections of people and politicians in the state.