What’s at stake? WASH in times of COVID-19 in India

Published on: 22/10/2020

Handwashing instruction for women and young girls (photo courtesy of NEEDS)

I was doing an interview in July 2020 to get a better understanding of the COVID-19 impact in Khunti District, Jharkhand. The first person I spoke with works for NEEDS (Network for Enterprise Enhancement and Development Support) which focuses on nutrition as part of a holistic rural development programme. I asked her what do people think about COVID-19 on the ground, what do people say? She said that “maybe it’s a chuya-chuthkibimaari’ – i.e. a disease that has something to do with untouchability”. 

After the interview, a few questions stayed in my head. Would the IEC (Information Education and Communication) materials compiled for COVID-19 address caste-based politics and the brahminical notions of untouchabilityin India? What will working on the ground look like post-COVID-19? And what do the instructions on COVID-19 i.e. washing hands and maintaining physical distance mean for marginalised populations? 

The following days I spoke to several migrant labourers, frontline workers i.e. the ASHA (Accredited Social Health Activists) and girls and women from Khunti and Chaibasa districts in Jharkhand, to find answers to one simple question. What does COVID-19 mean to marginalised people?

Through the eyes of a young girl 

Zeba (not her real name) is an 18-year-old girl from Khunti, who dropped out of school a few years ago but joined a remedial centre run by NEEDS last year with the hope of completing her education. The day I spoke to her she was apprehensive: “I sat for the matriculation exam this year didi but didn’t get the results. The future looks very uncertain.” With schools coming to a halt and limited interventions of NGOs on the ground, the COVID-19 crisis in India has risked reversing all gains in child marriage with young girls in rural communities becoming more uncertain about their future. 

Between March and August – since the Government announced a lockdown – Zeba and her family received support only once: rice, one kind of pulse, salt, and some oil through a distribution drive on the ground led by Government. When we spoke, all they had in the house was some rice that they had cultivated last year. And they have been growing lady’s finger (okra) in a small patch of land near her house which they have been eating three times a day - boiled, fried and as a curry. This has to provide for the family which includes her father who is unemployed since March 2020 and an ailing relative. 

I asked her how she and her family are managing their hygiene in this tough time. Every time Zeba’s family would manage to get Rs. 50 by selling lady’s fingers they would go and get soap for the family. But managing Rs. 50 was not easy for them and soap seemed to be an added burden. Zeba thinks COVID-19 is a huge illness that has happened because someone ate an insect somewhere in the world. She said that the ASHA didi has spoken about COVID-19 a few times in the village, but Zeba was unable to capture what exactly it was about. “There were no pamphlets or posters given to us didi”, she said. 

Zeba had never received sanitary pads before from any government scheme but since COVID-19, she has received three packets of sanitary pads once. This was meant to be enough for three months according to the ASHA didi. Every packet has six sanitary pads in it. When I asked Zeba if six pads were sufficient for her period, there was an awkward silence. 

The debate on menstruation always boils down to providing menstrual products and dealing with material needs. However, this oversimplified service delivery scheme by Government contradicts their own IEC’s which says one should be changing pads every six hours during periods. This clearly means that one packet of sanitary napkins is not enough to cover one period. Women should really be empowered to get a say in the matter so these stop-gap measures end. 

What will it be like for Zeba the coming period? What will hygiene be like without soap and the one packet of sanitary pads allotted every month? What will she prioritise, food or sanitation?  

Listening to a migrant labourer 

Gandhura Sanga who is from Khunti, said he will forever remember these hard times because he is facing a big food scarcity. The Gram Pradhan, the head of the village, twice held a meeting in the village about the virus. Gandhura couldn’t recall the method taught for handwashing and was not sure about the exact timings of when to wash your hands and for how long. 

The last four years he worked in Maharashtra as a labourer, but since March there was no work so finally Gandhura along with ten other workers booked a truck, paid Rs. 10,000 each and came back to Jharkhand. 

Gandhura doesn’t have a ration card, he applied for one, but it never arrived, so he is not eligible to get rations through the distribution kits provided by Government. Starvation due to non-availability of ration cards is not new in Jharkhand. All Gram Pradhaans once distributed free rations in their constituency to people who didn’t have a ration card, but he did not get that one either. Gandhura has a son who is 3.5 years old and goes to the Anganwadi, a rural health care centre as part of the Integrated Child Development Services provided by Government for nutrition and holistic care for children. But since his return no food has been delivered to his house from the Anganwadi. 

When asked about the protocols of handwashing he said that he can’t afford to buy any soap - so he has been buying 3 kgs of surf washing powder with Rs. 100 and the entire family is using it to wash hands and clothes. And Gandhura can hardly manage Rs. 100 every week from the vegetables he has been selling as the market is scarce. With Jharkhand being one of the states already highly affected by malnourishment, COVID-19 brings in more uncertainty for families and especially for children between the ages of 0-6 years. Handwashing messages seem to be aimed at one part of society, those who can afford the additional costs of soap. For others quality of life remains theory, not practice. 

Instruction for women with children (photo courtesy of NEEDS)

Experiences of frontline workers  

Rukmani Toppo has been a frontline worker, an ASHA, since 1995 in Khunti dedicating her life to women and child health care. Since March she has been busy organising mothers group meetings and taking health surveys from every household. Rukmani also helped in writing several wall quotes to raise COVID-19 awareness in her village. Fourteen migrant labourers who returned to her village were quarantined and she regularly checked them. She said that the grant and delivery kit from Government has stopped since June and no aid has been circulated anymore. Moreover, the Ready to Eat Take Home Ration (THR) packets which were part of the regular service provided to children under 3 years has stopped reaching the village since March. 

Previously she was getting Rs. 2000 for her work and after the first lockdown it was announced that she would get Rs. 1000 extra. However, she never received the money. She inquired if I could help her get the money. Rukmani is 42 years old and has a husband of 60 at home. Both Rukmani and her husband belong to the risk group and until July only received gloves and a mask once from Government. Since then she has been buying her own sanitisers. 

Later that week I spoke to a few other frontline workers from Khunti and Chaibasa. They all shared that the availability of the Take Home Ration has stopped since the lockdown and they have seen many people living in acute poverty since COVID-19. The Jharkhand Government started the Daal Bhaat Yojna providing basic rice and daal as nutritious food to poor people at a reasonable price but that too stopped by June. And so have the Participatory Learning and Action (PLA) meetings to support mothers to take care of hygiene and nutrition for their new born children. In some villages, the Antenatal Care (ANC) service on every 9^th day of the month in the block hospital for pregnant women has stopped, leaving pregnant women extremely vulnerable. The frontline workers interviewed for this article got gloves, masks and sanitisers once during April but nothing since, they have informed their managers but to no avail. 

Fulmoni didi who is also a frontline health worker in Chaibasa Jhinkpani block shared that since the THR was stopped in the last two months, she has seen people living in acute poverty struggle even more. The PLA meetings with the pregnant women and mothers with new-borns which she used to conduct are not happening anymore. Fulmoni said that she has asked people in her area to wash their hands seven to eight times per day, but no soap has ever been provided by Government. 

Every 9^th day of the month she used to take the pregnant women to the block hospital for the ANC but those services have stopped since March. Fulmoni has four children of her own, the youngest being 1 year and 8 months.  She has been conducting home visits, doing regular follow up with pregnant and lactating women and is doing of lot of additional work on COVID-19. She has also not received the extra Rs1,000 promised. The one bottle of sanitiser she received was finished long ago and the one mask she received is worn out. She has informed the Block officers but hasn’t received anything. She is buying her own sanitisers as she realises the importance for her health. She hasn’t got any posters or written instructions on COVID-19 yet to use for instructions on the virus or handwashing in the village. She just tells them it’s some disease and they need to maintain social distance and wash hands every 20 minutes. The Block Office contacted her only once by phone and gave basic information about COVID-19 and told about the extra work related to it. 

Vulnerable communities

The stories highlighted here represent the marginalised. Through this article I have tried to share the realities of people on the ground and what they are struggling with. There has been no consistency on the communication associated with washing hands. Every single person interviewed shared different versions of handwashing protocols. Some said they need to wash their hands twice a day and others said maybe it’s throughout the day, anytime they want to, or every twenty minutes. There is a need to realise universal consistency on messaging around handwashing and COVID-19 to evaluate what knowledge is being transferred to the most vulnerable communities. Dispelling myths on ‘untouchability’ should be a priority to avoid the caste-based divide. 

The Anganwadis being shut, the lack of food for children and the lack of sanitation and hygiene products are very serious issues. Getting soap for handwashing is an added burden in poverty-stricken areas and trying to keep toiletries to yourself is a myth in communities were resources are an issue. 

Closing remarks from NEEDS 

Mr. Murari Mohan Choudhary from NEEDS shared the following: 

‘Handwashing is limited among poor and among those with poor schooling anyway, further crisis of COVID-19 has impacted availability of soap in rural areas. IECs used widely have shown flowing water for handwashing which is actually absent in rural locations, hence message had low or no impact among them. We also observed that during lockdown Government prioritised food materials to needy families but hardly anyone was sensitised enough to supply hygiene materials like soap or sanitary pads.’ 

The point is that we cannot isolate the cause of WASH from the cause of malnourishment, poverty and hunger. With lack of poor resources available even for frontline workers, who are underpaid and buying their own sanitisers and using the same gloves and masks provided by Government since March, we have to prioritise solutions on taking hygiene and sanitation to the last miles during COVID-19 and beyond and in true terms when we say ‘We are all in this together’.