Like the rest of the country the healthcare scenario in Bihar in the wake of coronavirus outbreak is grim. If on the one hand the unprecedented surge in the epidemic is taking a heavy toll on the lives and well being of the common people, the high cost of Covid related expenses, on the other, are driving them below the poverty line. Added to this is the apathy of the government. Under the circumstances, judicial activism seems to be the only solace for the common man.

Such is the desperation among the people of Bihar that unable to afford the cost of a dignified funeral for their dead they are forced to throw the dead bodies of their loved ones in the River Ganga. What’s all the more intriguing is that the unprecedented crisis is exposing the deep malaise in the society. The cases of rape of Covid infected female patients in the intensive care units (ICU) that came to light of late point to the inherent fault lines in the system.

Against this backdrop, the Bihar government not only miserably failed to tide over the crisis arising from the outbreak but also is unable to carry out simple executive functions. Under the circumstances, judiciary is the only hope to ameliorate the sufferings of the common man. With the governmental machinery mired in policy paralysis things can only move in the state with the intervention of the state high court.

Taking over the role of the executive, the court has already started monitoring almost every aspect of the corona crisis, from oxygen supply, availability of hospital beds, cremation ghats to bio-waste disposal. Meanwhile, the deadly coronavirus rampaging through villages in the second wave of the pandemic is, in its wake, instilling a palpable fear in rural Bihar with myths and rumours about vaccination campaign and crumbling
healthcare system flying thick and fast.

The state government was forced to impose statewide lockdown since May 5 after the intervention of Patna High Court (HC). Till then, the Nitish Kumar led NDA government was prevaricating on the lockdown. Concern over the spike in Covid related deaths prompted the court to issue an ultimatum to the government to announce the lockdown which it had to oblige.

On the directive of HC, a three-member committee has been constituted to examine the facilities available at the hospitals in Patna. The committee is headed by Dr Umesh Kumar Bhadani of all India Institute Of Medical Science (AIIMS), Patna.

Floating corpses
Another crucial intervention of the HC was on the issue of dead bodies floating in the Ganga near Buxar. Hearing a public interest litigation (PIL) on Covid management, the court sought data of the entire Buxar districts since March 1. The court also made the order applicable to all 38 districts of Bihar.

Disappointed by the lackadaisical approach of the government, a division bench of the court questioned the authenticity of the affidavit submitted by the state chief secretary which acknowledges only six deaths in Buxar since March 1 2021 whereas 789 cremations were mentioned in the divisional commissioner’s affidavit at just one cremation ghat, Muktidham Charitravan under Nagar parishad between May 5 and May 14. The HC severely criticised the administration over the contradiction between the two affidavits.

It may be noted here that the floating corpses phenomenon is not confined to Bihar, there is an outrage of against the development in the entire country.

The Buxar district administration tried to wash their hands off the matter blaming the UP government for the floating corpses saying the dead bodies were coming from UP. But the people living near the Ganga called the administration’s bluff. According to the locals and as
reported in the press, unable to bear the skyrocketing cost of cremation in the wake of Corona upsurge, poor people are left with no option but to drown their dead in the river.

Reports appearing in the media also noted that due to the growing expenditure on the healthcare people have lost all their savings and possessions. However, despite all the
money they expended, they could not be able to save lives of their patient. With no money left for the funeral they have no option but drown the dead bodies into the Ganga.

The HC also reprimanded the state government for not updating its official website with the record of births and deaths saying, “We see no reason as to why the deaths, be it 6 or 789, would not have been updated on the official website. Equally, this would apply to all the districts of Bihar”

The court is even monitoring bio-waste disposal in Patna town calling it an issue not confined to private and government hospitals alone, but also labs and homes, where people were living in isolation. Not satisfied with the affidavit of the Patna Municipal Corporation (PMC), the court sought clarification on the matter with specific answers to its queries saying it (the affidavit seemed to conceal more than it revealed.

“The affidavit says nothing. Do we shut our eyes on the realities,” the court asked while seeking answers to the queries: Is it the fact in Patna? How many people are isolated at home and who is picking up the garbage from these houses? How many tests are being conducted in Patna? How many tons of waste is being generated and collected? Which is the agency dealing with it and where is the waste being taken to? How many are involved with that? How many PPE kits are being given in the city and to whom?

The bench had directed the PMC to file a detailed affidavit regarding bio-waste collection/ disposal and steps taken for sensitisation of the people.

High cost of survival
In a recent report coming from the banking sector, it has been said that banks in Bihar are facing frantic withdrawals. People are breaking their fixed deposits to meet the Covid related expenses. Moreover, anticipating the emergency expenses, people are keeping cash in hand to meet any emergency.

Since private hospitals generally prefer cash over cheque, people are frequently withdrawing money from their bank deposits. So much so that most of the ATMs are reeling
under cash crunch. Bank withdrawals are taking place on such a large scale that some banking experts are of the view that the proportion between the withdrawals and the deposits dipped to 70:30 level a drop of almost 16 per cent.

According to D N Trivedi, joint secretary of All India Bank Officers Association, “Between December 2021 and March 2022 Bihar is predicted to be facing a sharp decline in deposits. This is expected to result in liquidity. Consequently, it will adversely affect the banks’ lending capacity which will have an overall impact on the state’s economy”

Shortage of doctor
Despite a hue and cry over the shortage of healthcare personnel in the state nothing changed on the ground. Now, in the last hours the Bihar government has come in the emergency mode to recruit doctors on the contract basis for a period till Corona crisis lasts.

Most of the government hospitals are understaffed and underfunded. The vacuum left by the public healthcare has been filled by private health clinics and even quacks, in the context of rural areas, over the years. Consequently Bihar has one of the most privatised healthcare system in the country. The high cost of health expenditure is pushing many a family into poverty.

According to Dr Shakeel of Polyclinic, a health centre run by Communist Party of India (CPI), the all-India figure for out-of-pocket expenditure on healthcare is 62 per cent.
The corresponding figure for Bihar is 82 per cent. “Most of the expenses incurred on healthcare, he says “goes into buying medicines and health examination. But Bihar
government’s per capita health expenditure remained a measly sum of Rs 14. This out-of-pocket expenditure on healthcare is pushing 8 lakh people to the below poverty line (BPL) category every year,” he said.

“Bihar government’s overdependence on private sector,” Dr Shakeel pointed out “was adding to the woes of the people of the state. Since the government does all the strategic purchasing from the private sector, public health is deprived of funds to such an extent that people naturally say that private sector is better than the one run by the government.”

The state health sector is facing shortage of medical personnel to such an extent that about 70 per cent of the sanctioned vacancies are lying vacant. When private entities like Milind Gates Foundation can influence the state budget, this is the natural outcome.

SN Area Strength Posted Vacant
1 Urban Area 4418 1544 2874
2 Ruralarea 6944 1270 5674
3 Remote/difficult area 283 63 220
Total 11645 2877 8768

Source: May 2020 data presented by the Bihar government in the High court

On 28 April, commenting on the basis of the data presented to it by the Bihar government, the HC said, “It is note-worthy that 4,149 posts of specialist doctors and 3,206 posts of general doctors are vacant. Against a total sanctioned posts of 91,921 at various levels 46,256 posts are vacant. It’s high time the state government looked into this aspect and took remedial measures. We will be taking up this matter in future proceedings.”

The number of specialist doctors is coming down with many falling prey to corona during its second wave. Around 96 doctors have already lost their lives to the dreaded infection. The Indian Medical Association (IMA) has recently issued a press release with names and other details of specialist doctors have been given. This is the highest number of doctor deaths in
the country. IMA’s Bihar unit has constituted an eight-member committee to look into the causes of the deaths. Even Bihar Human Rights Commission has taken a suo moto cognizance of the deaths and directed the health department to present a report within one week.

Healthcare push to poverty
It is now an established fact in Bihar that health related expenditure is pushing people below the poverty line. A social activist, Rajkumar Shahi, said, “As per a study the health related expenses are pushing 3.5 per cent families into BPL category. NITI Ayog also said that Bihar is the bottom state in terms of health facilities. There is only one bed available for every 1.2 lakh population. District hospitals and primary health centres are in the worst
conditions. Blaming privatisation for the entire mess, Rajkumar Shahi added, “The policy of privatisation and commercialization is the root cause of all the major problems in the health
sector. The politics based on neoliberal philosophy have created a vested interest groups whose sole motive is to make super profits from people when they are in distress. Take for example the case of the private ambulance services, it has created a parallel system of loot and plunder from patients. Despite Patna High Court’s repeated strictures nothing seems to be changing on the ground”.

Even ICUs unsafe for women
Another disturbing feature is that female Covid patients are not safe even in the ICUs. In one such incidents a 45-year-old woman has been raped inside the ICU of a very high-profile hospital in the state capital. This horrendous incident has shocked the conscience of state.

The National Commissioner for Women (NCW) sought investigation into the alleged rape. NCW chairperson Rekha Sharma has written to Bihar's chief secretary and police chief. Daughter of the Covid patient has filed a police complaint against Paras HMRI hospital’ in Patna. She alleged sexual harassment and misbehavior with her mother on the night of May 17.

The girl had earlier uploaded the statement of her mother on a social networking site alleging that three to four persons tied her hands and legs with bed posts before indulging in the ghastly act. The lady died during treatment. The deceased hailed from Kalyanbigaha,
ancestral village of Chief Minister Nitish Kumar.

Meanwhile, female patients admitted in Rajeshwar Hospital and Patnaand Glokal Hospital in Bhagalpur accused hospital staff of sexual harassment. Some student and woman organisations came out against the sexual assaults in hospitals and demanded justice for the victims.

Excuses to exit lockdown
While the lockdown in the state has been extended till May 25, the government is citing select figures to prove that the number of deaths is coming down and the “so-called” second wave is receding. But the assertions of the people belonging to rural areas belie the government claims. These rural folks are giving a very different picture citing numerous examples of death taking place in their areas.

A deep suspicion regarding the vaccination drive has crept into the peoples’ mind. The fear of people is not without a basis. There are reports suggesting that the condition of many deteriorated after taking vaccine shots. Some even died soon after taking both the doses of the vaccine. Since there is no effort to collect the data in this regard, things have become complicated. While almost every village is facing this trauma, no reliable data is available to verify these deaths. The government is simply denying that these deaths were linked to Covid.

The Bihar government is now announcing new initiatives for the improvement and augmentation of the health facilities almost daily. But despite all the assurances the government failed to restore the trust of the common man. Corona crisis has left a deep scar in the people’s psyche. Whether or not the government will be able to give a healing touch to the citizens and win back their faith, only time will tell.

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The opinion expressed in the article is of the writer. Writer is a freelance journalist/journalist based in Delhi

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