By Dr K Mathias, Kiwi CMFnz-er working in North India | May 28 2020
Women in the community in Uttarakhand
Dr Kaaren Mathias is a Kiwi public health physician who has been working with the Emmanuel Hospital Association in India (www.eha-health.org) for the past ten years, with a focus on community mental health. She left India with her family at 12 hours’ notice in mid-March in response to the Covid crisis and is continuing to work remotely.
The Covid crisis in India has been two-fold, firstly the risk of infection by the coronavirus, and secondly, the risks to health and wellbeing associated with the harsh lockdown which has been in place for nearly ten weeks and in place until May 31. The incidence of Covid in India started with very low numbers and slow growth, but the last fortnight has seen a large increase in cases for India with around 5% increase per day and a move from 3,787 new cases a day on May 15th to 7,293 new cases on May 27th.
The rates of death are significantly lower in India than Europe, its young population and demography working as a protective feature in this epidemic that has much higher fatality among older people, as reflected in the age sex graph shown in Figure One below:
Burans, a community mental health initiative in Uttarakhand works in two key field areas: firstly informal and densely populated urban settlements in Dehradun city which are the homes of extremely materially disadvantaged people who are migrants living on the edge, and secondly, Naugaon block, Yamuna valley, which is rural, remote and challenged by limited health services and access to care. I focus here on describing the response of our urban team in Dehradun.
In the communities where we work the biggest impact of the Covid outbreak our team has observed is high levels of anxiety - anxiety related to food and income due to the harsh lockdowns which have stopped all income for the most disadvantaged. Additionally, and increasingly as the pandemic numbers increase in India, anxiety related to Covid infection risks. More acutely, people with psychosocial disability are not able to access their usual medicines due to movement restrictions and fear of police punishment. People most affected by food insecurity are those with disability (psycho-social and other) and people who are daily wage earners and migrants from other states. There are almost no food security issues in rural areas except for migrant workers and returning migrants facing quarantine with no formal facilities.
Challenges we are facing in providing mental health support are three-fold. Firstly, access to people with mental distress in target communities for team members living outside these areas due to movement restrictions and ensuring they have adequate personal protective equipment; Secondly, increasing staff skills in technology e.g. providing psychosocial support via phone, and participating in team Zoom meetings. And thirdly, providing adequate support to team members who have increased mental distress.
We have developed three innovations to respond to the Covid pandemic and lockdown in our community mental health work. Firstly, we have identified 20 community-based adolescents to work as volunteers. They are being paid a daily stipend providing needed cash into their households. They are tasked with providing participatory covid awareness (around handwashing, physical distancing and social isolation guidelines). Additionally, they are receiving training in mental health skills and knowledge during crisis, so they can support vulnerable community members such as people with disability or migrant labourers. The majority have access to a smart phone that they can use for online training resources as we develop them.
Secondly, we have developed online training resources for community-based volunteers and health workers in low-income Hindi speaking communities. These are open source and available on a Moodle platform and able to be completed from home during upcoming weeks of lockdown – and are built from Government communications.
Thirdly, we have developed some fun What’sApp health promotion clips around Covid protection in the community and mental health care.
These are some of the Gospel and Biblical principles that guide us:
- “Let each of you look not only to his own interests, but also to the interests of others” (Philippians 2:4) - We seek to make sure our team feels safe and mentally well and make sure our target community feels safe and has needed skills and knowledge for staying well
- “Is there no balm in Gilead?” (Jeremiah 8:22) - We support with food resources and assist with access to Government entitlements, as well as responding to mental health needs
- “What do you want me to do for you?” (Mark 10:51) - Asking what help is needed and responding. In our most poor communities they were more concerned about food security than mental health, so that is where we started working.
- “Each of you should use whatever gift you have received to serve others” (1 Peter 4:10) - We were given money from a church group to provide food for 500 migrant families. We have also been using assets in the community we know of and that emerge - like the young 16-year-old Hindu girl who joined with two middle aged Muslim women, to start handing out food in a Sikh temple. This team was amazing and fed hundreds of people in the first two weeks of lockdown.
Summing up, the Covid crisis has thrown most aspects of life into disarray for the poorest people in India and as New Zealand returns to many aspects of ordinary life, the chaos in India is likely to continue for many months ahead. It is an honour and responsibility to be part of the response.