Panagarh rural hospital is a major government health care facility in West Bengal state's Paschim Bardhaman district. On June 4, dozens of people were seen huddled together outside a section of the hospital to get tested for COVID-19.
"People in these villages are very aware of COVID symptoms, especially after the recent wave of infections. They are by themselves turning up at the hospital to get tested," said Mridula Banerjee, a nurse at the hospital.
The staff attending to patients at the rural hospital are mainly nurses. A lack of doctors has forced nursing staff to step up. "We are here for the patients more than the doctors themselves," said a nurse at the hospital, who asked not to be named.
Nurses have played a key role in India's fight against COVID, filling in the gap left by a dismal doctor-patient ratio in hospitals nationwide.
But female nurses in rural areas face unique barriers which impede their work, said Sunita Harkar Shalla, head of operations at the Child Heart Foundation, an NGO based in Delhi.
"Usually there are no toilets or water in rural hospitals. Added to this is bad road connectivity, lack of internet, phone signals and safety measures, which deter female nurses from contributing effectively," she explained.
Many nurses also face opposition from their families, she added.
Banerjee said that family support wasn't a concern for her as she's a single mother. "My daughter contracted COVID along with me when the virus spread to our area, but we were both confident that we would recover."
COVID affects mental health of nurses
Arnab Halder, a nursing assistant at the hospital, is mainly responsible for administering oxygen to patients in the COVID ward and assisting doctors and nurses with stitches following a surgery.
"When I joined this hospital in 2019, I used to weep when I saw blood. After this second wave of COVID infections, I don't feel anything when I see a dead body. I've gotten used to it," he said.
Halder pointed out that the rural hospital has a five-bed isolation facility for COVID patients, but when cases become critical, patients are referred to a larger government hospital. He added that the hospital could save many lives because it procured oxygen from a local gurdwara, instead of relying on other channels.
"We had as many as 20 COVID cases a day in April, and this trend lasted till the first week of May. Now, we have 3-4 cases a day," Halder said.
The pandemic has left a deep impact on Halder's mental health. He is scared of contracting COVID. "The hospital has a staff of 30 people. At least six of us got COVID when cases shot up in May. I was working in the COVID isolation ward at that time and I also had to attend to my roommate as he had COVID. Each day, I prayed for my life, before coming to work," Halder explained.
Halder's friend and roommate, Uday, who is responsible for conducting COVID tests at the hospital, recovered from the disease last week. "We [colleagues] were testing each other using the rapid antigen test, just for fun. My test result came positive, which meant I was asymptomatic. I isolated myself for 14 days and then came back to work. I keep wondering how many people I would have infected had I not taken the test," Uday said.
Non-COVID services hit
COVID-related facilities — for testing, vaccination and isolation — in the Panagarh rural hospital are confined to three different areas of the hospital. The non-COVID care section is relatively quiet.
According to Banerjee, non-COVID facilities have been hit badly during the last two months. "Before COVID spread rapidly, it was normal for people to seek medical help for problems like diarrhea or typhoid. Once COVID cases shot up, people were too scared to come to the hospital and only came here when they couldn't handle the situation at home," she said.
"The staff and hospital capacity were limited, so we triaged cases. For example, pregnant women were only admitted and treated when they were in the final stages of their pregnancy."
Non-COVID sections of the hospital continue to see little footfall in June, even after a drop in COVID cases. The immunization room for babies is in a decrepit condition, while the bedsheets in wards haven't been changed for days.
A man approaches Banerjee for medicines, without wearing a mask, and he is promptly denied service. "People follow COVID protocols when we make it clear that we won't help them otherwise. They leave us no choice but to be strict with them," said Banerjee.
Health workers reduce burden on hospitals
At the other end of the hospital, COVID inoculations are being carried out in full swing. The hospital has been administering nearly 150 doses of Covaxin, a vaccine against COVID developed by the Indian pharma firm Bharat Biotech.
Padma, a community health worker, is judiciously noting down details of each person and corroborating it with the information she has received from the local administrative body.
She said that the Panagarh hospital wasn't overburdened with cases because community health workers spent a considerable amount of time spreading awareness about the virus.
"We used tactics like scaring people with news about death and the long-lasting consequences of COVID. This helped us tackle issues like vaccine hesitancy in certain communities," she underlined.
Hospitals in rural areas across India are currently burdened with a rising number of COVID cases.
According to a report by the NGO Center for Science and Environment (CSE), 53% of fresh cases and 52% of new deaths from COVID in May were reported from rural areas. The report added that community health centers in rural India need 76% more doctors.