July 1st, 2021
By Asra Haque
In the third of a series of the South Asia Peace Action Network (SAPAN)’s monthly webinar Imagine: Neighbours in Peace, activists, peacemakers, doctors and healthcare experts from India, Pakistan, Bangladesh, Sri Lanka, Nepal and Afghanistan joined the call for a coordinated and concerted regional response to the COVID-19 pandemic and the myriad dilemmas it has created.
Participants included Bangladeshi public health activist and Ramon Magsaysay awardee Dr. Zafrullah Chowdhury, Indian community paediatrician and public health professional Dr. Vandana Prasad, Nepalese infectious diseases expert Dr. Anup Subedee, Director of Polio Eradication for the WHO Eastern Mediterranean Region Dr. Hamid Jafari, Bangladeshi social activist, feminist, and environmentalist Khushi Kadir, Pakistani artist, educationist and activist Salima Hashmi, Pakistani journalist and SAPAN curator Beena Sarwar, and Indian journalist Mandira Nayar.
Khushi Kabir began with condolences to all those who have lost their family, friends and loved ones to the novel coronavirus disease, and held a moment of silence for regional activists and rights defenders who had recently departed, including Dr. Mubashir Hassan, I. A. Rehman, Nirmala Deshpande, Kuldip Nayar, Asma Jahangir, Begum Sufia Kamal, Anisuzzaman, Madanjeet Singh and Khurshid Shahid.
“After Asma Jahangir passed away, I started to think about all these losses and how we can take forward their legacy. SAPAN is intergenerational, it’s across and within the region, it connects communities and areas like medicine, art, activism, literature…” Beena Sarwar began, talking of the onus and motivation behind creating a regional network for peace and human rights activists.
Following Salima Hashmi’s narration of SAPAN’s mission, Indian journalist Mandira Nayar formally launched the discussion on the existing pandemic situation and its challenges in the South Asian region with Dr. Zafrullah Chowdhury, Dr. Vandana Prasad and Dr. Anup Subedee on the panel.
“COVID-19 has reminded us we cannot walk alone,” urged Dr. Chowdhury. He provided that it is apparent to all people how the virus has impacted their lives, which is why it is important to now consider a togetherness in the response to the pandemic.
“Unfortunately we are living in a world of ‘divide and rule’…” he said, pointing out traveling restrictions among South Asian states. Terming these restrictions irrational under the present circumstances, he reiterated that the pandemic is not a problem that can be solved alone. “One-hundred percent of the population should be vaccinated, but we do not have enough vaccines. We are all one nation, we are similar people. If we put our heads together, we will move faster, thinking faster. Lockdowns will not solve the problem. In Bangladesh, 25 million people moved below the poverty line… the number of poor has increased.”
He also called for food security during lockdowns to prevent malnourishment and starvation, mass-testing at densely populated junctions such as bus stops and train stations, more investment in healthcare and education, and urged developed nations to exercise generosity.
Dr. Vandana Prasad pointed out that inequitable access to healthcare and healthcare services is an old ailment of South Asian states, however this disparity was more visible during the outbreak of COVID-19.
“We need to reflect on why we didn’t attend to these things decades ago as well as what past structures have maintained this kind of inequity which is now so dramatic,” she said. “I hope this tragedy that we have all suffered will make sure that we don’t let these issues become invisible again.”
She pointed out that the economic downturn as a result of the pandemic and lockdown measures has exposed and further exacerbated inequalities, especially among the poor and marginalized communities.
“We are now seeing the gendered nature of the pandemic. Access to vaccines is so much lower in women. If you’re part of the minority groups, and possibly dalit and tribal groups… if you live in states that are not ruled by the center, your access to vaccines is lower. This is the kind of shame that we are seeing: the lack of attention to equity in the past, the playing of politics and profiteering during the pandemic,” she lamented. She further added that doctors need to enter the domain of peace activism just as peace activists need to call attention to the degree of social injustice in health.
Dr. Anup Subedee provided that the second wave has just reached the rural regions of Nepal and that it is spreading in a much more terrifying way than what experts and policymakers had previously anticipated. The situation in rural areas in Nepal is particularly worrying because of the lack of facilities – no polymerase chain reaction kits, no anti-gen tests. And what tests are being performed, there is no guarantee they are being done the right way.
“People are dying without even the dignity of getting a test,” he stated. He held that the outbreak of the novel coronavirus disease has exposed much of Nepal’s systemic failures in responding adequately to this crisis. “The public health system is the great equalizer and we really don’t have a public health system. Whatever we do have – vaccination programs, childhood immunization programs, maternity care programs – even they have been affected. The long term impacts will be documented much later and we won’t know it’s real impact for many years to come.”
On the disproportionate blowback of the outbreak on women, Dr. Chowdhury held that women are the backbone of countries such as Bangladesh and India, and therefore the pandemic affects them the most.
“They have families that are dependent on them, but their security is not ensured. The safety of women is a crucial issue, and the government and the public must ensure that security,” he said.
Dr. Prasad concurred, providing that some four million women frontline workers operate in india, however, half of them are not even considered workers. They do not get wages, social security, or access to personal protective equipment (PPE).
“Our leaders say the response to the pandemic is bolstered almost entirely by frontline workers – we need to call people out on this. They face problems as healthcare workers and share in the general problems of disempowerment of women in societies and communities,” she said. She noted that domestic and societal violence against women has increased in the past year. “Domestic violence is barely talked about as a health issue. We consider it a major public health issue, and this has dramatically risen with hardly any recourse whatsoever.”
Women’s contribution to unpaid care work has gone up tremendously, she noted, as they are now forced to be sequestered in their homes where they are taking care of the sick, their children as well as themselves. Women are struggling to feed their families in a situation where there is no food available.
“As for women’s access to healthcare, it’s the same old issues: lack of decision-making ability, control over money, mobility (being able to move outside without a male companion) and now, importantly enough, there is a digital divide,” she explained. “E-medicine, telemedicine… it has its place but it is by no means a primary response to this pandemic. We just need solid basic healthcare services to exist that can be supplemented by telemedicine.”
“Women are the majority of frontline healthcare workers in Nepal. We have a large volunteer community healthcare workforce that played a significant role in continuing whatever services that could be undertaken during the lockdown and pandemic. They were not prioritised for vaccine for the longest time,” related Dr. Subedee, adding that even now a majority of women healthcare workers remain unvaccinated among other challenges they face. “There are nurses who can not return to their families because they are taking care of COVID-19 patients. There have been threats of violence against healthcare workers.”
He also delved into the mental health concerns of frontline healthcare workers in the region.
“It has been very stressful for doctors, not because we are unable to provide the care we are meant to provide our patients but because we feel we have failed our community. We also feel like we have failed to function as members of our families. Burnout and mental healthcare is something that needs to be looked into seriously.”
Dr. Subedee considered himself among the luckier ones in the response effort. The same cannot be said for nurses and community healthcare workers who must tend to patients in villages. These women, he provided, are often themselves sick or have ill family members that are in need of care, but are not allowed paid sick leaves and quarantine leaves. Many of them lost their incomes, and neither do they have any social security or extra benefits.
“They faced a higher threat of dying because they didn’t have access to PPEs. They could not return to their families for fear of spreading the disease to them, they could not perform many of the healthcare tasks they are meant to perform because of lack of resources. This has been a very difficult situation for them,” he said.
The panelists agreed that despite the invocation of SAARC’s medical visas, which allows medical professionals to travel between member states, there has not been much effort in the way of building and bolstering a pan-regional coalition of doctors and healthcare experts. Dr. Subedee points out that the reason for this is that the dearth of professionals in comparison to the population and lack of resources mean that doctors here simply do not have the time to pay attention to such matters.
“We have been more focused on our own national or local issues,” he further explained. “There is less awareness of the fact that we share the same wishes, the same deficiencies in our healthcare system.”
Dr. Prasad was of the view that medical professionals in South Asia are not equipped to expand their view of health beyond just medical care.
“There are a lot of associations of doctors that deal with just medical topics but not so much with things that are so critical to health such as democracy, peace and justice. We need more doctors who take the risk to take a step a little beyond medical practice,” she said.
She also asserted that health decision-making and intervention need to be decentralised, and expressed her doubts as to the practicality of doctors from abroad coming in to handle long-term strategies.
“People in villages cannot depend upon what doctors in the cities think. This has been so evident in the pandemic. We got so many things wrong just because of centralisation, technocracy, lack of participation from civil society, public health experts, the community and affected people,” she said. “In terms of correctness of process, I believe decentralisation has to be marked. In terms of alliances and associations… yes, for those that accept their limitations as a starting point. Doctors wield enormous power but they need to recognise how to wield it for the good of all.”
Dr. Hamid Jafari, Director of the WHO’s polio eradication programme in the Eastern Mediterranean region also agreed that the pandemic has laid bare the inequity and disparity brought about by challenges to public health, and this has been most apparent in large public health programmes like polio eradication where the poorest and the marginalized were the most disadvantaged.
“We are not just more epidemiologically and biologically vulnerable, we are also economically vulnerable. So the direct and indirect consequences of outbreaks have devastating impacts on our lives and livelihoods,” he continued. He urged for two calls to action: activism and investment.
“We in public health go through what we call a cycle of panic and neglect. Our health infrastructures are already dismal, so once this crisis is over we will go back to the old ways of neglect. There has to be a concerted effort now, both in the public and private sector, to invest more in public health systems.”
He also detailed lessons learned from the ongoing polio eradication programme in the region, where building resilience among the most vulnerable communities has been key to mobilizing and organizing the response effort. However, investment is still a need of the hour.
“The polio eradication frontline force are first responders in India, Pakistan, Afghanistan and possibly Nepal, and we have lost some of these people who are contract tracing, and doing surveillance for COVID-19, distributing PPE – this is all on the back of a pre-existing investment in the polio eradication programme,” he explained. “What we need is a holistic, across-the-board investment in public health so that when polio is eradicated, we retain a robust public health system that can deal with all kinds of outbreaks, and that always prioritises the most marginalised and vulnerable.”