Phalguni Devi has spent a fortnight living in a cattle shed. Looking out on a rainy afternoon in early June, she worries that if the rain does not let up, her fever-like symptoms will worsen.
Devi, 51, shares the shed with a cow and two cats, and this has taken its toll. Herbal concoctions have not worked and the visit to a pharmacist in the nearest town, in the Nijmola valley in the Himalayas, which took an entire day, did not help.
Her husband and adult daughter, aware of the symptoms and dangers of Covid, moved her to the cowshed soon after she developed a fever after the first dose of the coronavirus vaccine.
“My husband had intended to take me to the ANM [auxillary nurse-midwife] in the next village, but the midwife comes only once a month for routine vaccination for children and now for Covid vaccination. Other than that, we do not know what to do or how to get any treatment,” says Devi.
It is not just the lack of medical facilities that plagues the residents of these remote Indian villages. They are so cut off, even information does not make its way there.
Devi’s village, Pagna, is 12 miles (20km) from the main highway to Badrinath, one of the four holy sites in an important Hindu pilgrimage. Nestled in the picturesque Himalayan valley, the village began as a summer getaway for British colonial officers, and has led a secluded existence for more than a century.
With no proper roads and two part-staffed healthcare centres for all 10 villages in the valley, the pandemic that has so gripped India has caused great anxiety among the area’s 16,000 inhabitants.
The nearest hospital is 24 miles away in the town of Gopeshwar. To get there Devi would have to be taken through an ice-cold river on foot and then carried up the hill to reach the road, which is in such poor condition that an ambulance can only reach the first village, nine miles away. A taxi would take two hours and cost more than £50, too much for villagers on meagre incomes.
A week after her fever and cough started, Devi’s husband took her to the pharmacist just outside the valley, who gave paracetamol for the fever and painkillers for her acute backache. The medicines failed to provide relief, presenting the family with a dilemma: should they risk taking her to the hospital where there are Covid patients?
It’s estimated that more than 80% of those living in the valley have had fever-like symptoms in the past five weeks. Most infections were mild, but the stress in the usually peaceful place is palpable.
In early May, when the disease was at its peak, Got them many thanks, Prem Singh, 36, an activist in the next village of Durmi, wrote to the chief medical officer of Gopeshwar district asking him to send a testing team. Despite this and several other calls for help, the first testing team arrived weeks later with only rapid antigen (lateral flow test) kits.
“By the time the teams arrived, the symptoms had already started to go down. With no provisions and zero connectivity, everyone decided to stay at home and drink herbal concoctions. While, thankfully, there were no casualties, and young adults in the village were able to keep a check on every household, we are still quite shocked at the authorities’ indifference towards us,” says Singh.
Locals tried to fend for themselves. Than Singh, who works in procuring medicinal plants for a non-profit organisation, Udyogini, has been distributing leaves of basil and jatamansi – a member of the valerian family – for fever.
Godavari Devi is employed by a state-funded Aangadwadi community centre, and has continued her work despite receiving no government money for three months.
Borrowing essentials from shops, such as wheat flour and raisins, she has been going door-to-door to provide food rations for pregnant women, check temperatures and distribute basic healthcare and hygiene kits.
“We have been asked to buy everything out of our pocket as the authorities have promised that we will be reimbursed. Since April, Aanganwadi has not received any funds, but we are expected to provide supplies each month. In these times, when people do not have any income, we are being forced to use our savings,” she says, visibly upset.
Village heads were asked to buy masks and sanitisers from their annual budget allocations – close to £4,000 for Durmi. But this year’s funds, due to be sent out in April, have not been received. So far, the village head has spent £180 of his own money on buying hygiene kits alone.
Devi says it is not only the pandemic that has them worried, but that non-Covid care has halted. In May, there were three births in the village, and one of the babies died. The mother refused to be taken to hospital, knowing the gruelling distance and that the nearest was over-capacity with Covid patients.
Mohan Negi, president of the village heads’ union for Gopeshwar district’s 610 villages, is critical of the neglect of villagers. A resident of Irani, the last settlement in Nijmola valley, Negi approached the district hospital several times.
“Unlike Durmi and Pagna, Irani has its own ANM centre and a designated pharmacist. But our pharmacist had been sent to Haridwar on Kumbh Mela [thought to be the world’s largest religious mass gathering] duty and, despite the official announcement that the festival has ended, he has not been released. The ANM has a few more villages under her and she is only able to visit us once a month,” says Negi.
Both Negi and Singh say the Covid testing teams arrived far too late. And while vaccination for over 45s began in India on 1 April, the first testing team arrived in Irani on 16 May, and that, too, after much persuasion.
The district authorities, for their part, acknowledge the anger but say they are doing their best with limited resources. Gopeshwar hospital officials say that they are trying hard to provide Covid care to villages, but with only six intensive care beds, 100 general beds and a shortage of staff, they have been overwhelmed by the rising caseload.
Dr Mahendra Singh Khati, chief medical officer at Gopeshwar, says: “April and May have been the worst months since the very start of the pandemic. We have been swamped, but despite that, we ensured mobile testing teams in all the district sub-divisions. Nijmola is a remote and partially inaccessible valley. Taking teams would have meant a fortnight covering each village, thus we built a makeshift centre near the valley.”
Khati says that in the year to March, the hospital had had only 15 Covid fatalities but in the past two months the number swelled to 40. Staff were falling ill, too: 69 healthcare workers contracted Covid in April and May. He contends that despite the challenges, the healthcare workers and mobile testing teams did a tremendous job.
In February, the then chief minister of Uttarakhand, Trivendra Singh Rawat, visited the valley. This was the first time in 70 years that a high-ranking state official had set foot in it.
Rawat announced a dozen development projects for the area, including better roads and the opening of a primary health centre. But these remain promises – no work has started and the villagers continue their uphill battle just for survival.