First text: Write up on the state of health communication in India in the context of the pandemic
Second text: A poem
Pandemic and Health Communication
As I write today, new cases are getting reported in some part of the world. In January no one could have imagined that the world will come to an unprecedented halt soon. That the world will face a mammoth humanitarian crisis – international and state borders will be closed, economy will be disrupted, jobs will be lost, people will be quarantined and millions will be forced to practice social isolation to control the spread of a virus.
World Health Organisation (WHO) declared the outbreak of corona virus disease COVID-19 as a Public Health Emergency of International Concern on 30 January 2020. Globally, the virus was gradually spreading and discussions on how prepared countries were to deal with COVID -19, gained momentum by end February. Finally, on 11 March 2020, COVID -19 was characterized as a pandemic by WHO.
India reported its first case of COVID -19 towards the end of January. By the middle of March, the virus had spread to most parts of the country. Like all other countries, the Indian government focused on several containment and control activities. Thermal screening, testing, tracking of contacts were strengthened; and following the traditional public health approach, to infection disease control, those already infected or considered most vulnerable to becoming infected were quarantined. India is home to 1.3 billion people. In an attempt to mitigate the risk of further spread of the virus– the government also mandated that people should practice social distancing or isolation.
As cases of COVID -19 increased, the Indian government was forced to declare a complete lockdown in the third week of March.
Words matter in the absence of vaccine
If there was a vaccine for protection against COVID-19, the scenario would have been very different and less complicated. There would have been firm reassurance of the mitigation of the disease. The absence of a vaccine or cure for COVID-19, exacerbated anxiety, fear and uncertainty. Four decades ago, the world had faced a similar situation during the HIV & AIDS pandemic (in the absence of a vaccine).
In this light, one of the single most important component of prevention strategy, was health communication.
Drawing from the WHO guidelines, the Indian government, within a very short period of time created a plethora of Information, Education and Communication (IEC) materials. These IEC materials are available in various formats – print, audio-visual and electronic. The purpose of these IEC materials is to sensitise people about: mode of transmission of the virus, and various measures which should be adopted by the individual to prevent the spread of virus. The health messages had a two-fold objective: prevention of risk and inducing health seeking behavior among individual.
While these IEC materials are timely and necessary but the messages are confined within a narrow public health framework. Given the situation, it is no surprise that the core focus of the messages is risk prevention. However, history has shown (for instance during the HIV pandemic) that infectious disease has a lot of stigma associated with it and this has horrifying ramifications. The stigma can give rise to discriminatory attitude towards people who contract the virus and their family, care givers and friends. The discrimination negatively impacts people and drives the disease underground.
Address stigma and human rights
COVID 19 has given rise to stigma and discrimination because – it is a new virus, we have insufficient information about it and we are fearful of the unknown. Hence, the tendency is to label or stereotype groups, communities. Such attitude can prevent people from accessing healthcare services – from getting tested and quarantined. Hence, it is essential that IEC materials address the issue of stigma along with messages on risk prevention.
In addition, we have to realise that individual behavior and decision-making capacity are determined by the social context in which an individual lives and this in turn influences their health seeking behaviour. The practice of self-isolation or social distancing (which most of these materials emphasise) is not an option for a large majority of the Indian population. The social distancing is a luxury which can be afforded by the upper and middle class only. For a large part of the society, especially those from the socio economically disadvantaged background staying at home is an extremely difficult proposition. They have to step out of their houses to earn their living. Acknowledging the lived realities of people (slum dwellers, daily labourers, sex workers and others) the language of human rights should be an integral part of our health communication. Our health messages should cover the continuum of prevention, care and treatment. We need to communicate support, empathy and encouragement for our frontline workers (such as healthcare providers, people providing essential services, community leaders).
Reduce inequalities for a sustainable tomorrow
HIV and AIDS epidemic has played a major role in bringing public health and human rights together. Infact, the HIV and AIDS pandemic had revealed the significance and necessity of using a human rights language in health communication. It is disheartening to note that we have yet not incorporated those invaluable lessons in our country’s health communication and disaster management strategy. While one hand the individualistic, risk prevention messages are important, on the other, as the pandemic matures, it is important to ensure that we consciously address issues of stigma and discrimination. The disease should not create factions, deepen existing inequalities and further marginalize people.
The COVID -19 pandemic will have a devastating impact on all the goals of sustainable development. Our success in overcoming the negative impact of the epidemic and achieving the goals of Agenda 2030 will depend on cooperation, solidarity and ensuring the rights of all people.
Every morning machines whistle, pots clang – the bakery is busy
Bread and biscuits are prepared, boxes are packed and workers are happy
Every morning I am baked, wrapped in a brown cover, made ready for sale
I travel to an orphanage to feed children who are lonely and pale.
My world was bright and joyful, till one day
A virus spread across the globe and put lives at bay
The pandemic created fear, triggered confusion and treason
People were panicky- survival was foremost, their behavior lost reason
Government ordered lockdown – protection of the population was key
In the absence of vaccine, social isolation became the p strategy.
Is social isolation pragmatic for all women, men and children?
Context matters but there was absence of detailed thought or discussion
Daily labourers, slum dwellers, elderly, differently-abled, refugees
What will they eat? Where will they go? How will life go on?
Food was hoarded, rights denied – discrimination was blatant
In a bid to protect oneself, othering was evident
As I was being baked amidst confusion – I asked aloud
Where will I go? Orphanage or to the big house?
To big houses to save and sustain lives
I couldn’t believe what I heard, my voice was chocked and I lost words
It is time to rethink – in this time of crisis are we prioritizing lives, and fueling inequities?
As countries struggle for existence, many questions come to light
How do we balance public health and human right?
How prepared are we for risk management, how effectively can we fight?
The pandemic has forced us to reflect, adopt a new approach to life and living
We need to understand our context and focus on systems thinking
I will be backed again tomorrow for lives more ‘important’
But for development to be inclusive and sustainable empathy is most significant.
Sreerupa Sengupta, PhD
Assistant Professor, Healthcare Management
GOA Institute of Management
Commentary received on: 05.04.2020