India confronts the crucial stage of COVID-19 pandemic that is intruding into new clusters across the country. It has prompted several rigorous restrictions and preventive measures. The lock down, social distancing, isolation and respiratory hygiene/cough etiquette are recommended as the principle conditions to be adopted nationwide to flatten the curve.
As COVID-19 reaches the cluster of indigenous population in Brazil, Canada and others, it is a note of caution for India to endorse an inclusive approach to shield the indigenous communities. Studies have shown that the impact of such outbreaks could be devastating. However, the vulnerability of these communities in the situation of COVID-19 remains under-addressed.
Among various aspects, the health situation of indigenous communities needs prime attention during such outbreaks. The vulnerability to the infection and mortality increases with age affecting elderly the most. Elders in indigenous communities are the guardians of tradition, culture and customs. They are the reservoirs and carriers of traditional knowledge and healing practices.
The elders mostly attribute the etiology of illness to supernatural powers and unwelcoming deeds done in the past. The practice of herbal medicine, naturopathy and spiritual healing is preferred by the community. Lack of emotional content and spiritual security in the public healthcare system continues to distance them from seeking modern medicines.
The elders in these communities suffer from both communicable and non-communicable diseases including tuberculosis, hyper tension, diabetes mellitus, cardio vascular disease and sickle cell anaemia. These underlying medical conditions and weakening immune system heightens the severity of the infection and increases mortality rate. The spread of COVID-19 among the elders may put the entire generation at risk. It breaks the chain of cultural and linguistic knowledge transmission and wreaks havoc in the community.
The radical transformation in social and environmental conditions including shift in livelihood and food consumption pattern, technological advancements and climate change resulted in various diseases among the succeeding generations. Malnutrition and anaemia are major health issues among women and children of indigenous communities. This lowers the ability to resist infection.
Alcohol consumption is considered as a social ritual among many indigenous communities. A report entitled ‘Situation of Indigenous Peoples and Right to Health‘ revealed that alcohol consumption coupled with the use of tobacco products is highly prevalent among indigenous men. This suppresses the immune response heightening the risks to pneumonia and tuberculosis. Asthma is also commonly seen among both men and women. According to WHO, people with these illnesses are likely to show decreased treatment outcomes if contracted with coronavirus.
These aforesaid health conditions disproportionately affect the indigenous communities and increases their vulnerability to COVID-19.
The focus on availability, accessibility and affordability of health care system provides a holistic understanding about the underlined health situations. These factors are directly linked to the physical, political and economic “remoteness” which have distanced the indigenous communities from the centre.
Lack of adequate health infrastructure and resources, a common feature of the public health system in tribal areas create roadblocks. Indigenous communities face a host of structural inequalities including dearth of testing centres, quarantine and isolation facilities and a massive man power of health care workers which are inevitable necessities to tackle COVID-19.
The Indian Council of Medical Research (ICMR) has approved 122 government and 47 private testing centres, as of March 28. Only a few of these are located in tribal regions. The shortage of proper testing facilities, high waiting time at health centres, poor or restricted road connectivity and terrain would delay the test results further.
An expert committee report on tribal health released in 2018 revealed that about half of the states with indigenous populations have 27-40% fewer health subcentres, primary health centres and community health centres than are necessary. Similar gaps are seen in the availability of health workers.
These factors will make quarantine and isolation, the significant measures for treating and containing COVID-19 highly difficult to be executed.
Besides the structural factors of health conditions and infrastructure, focus needs to be laid on the functional preparedness in terms of response activities and guidelines laid down by government and WHO to combat COVID-19.
Providing access to credible and timely information is one of the preliminary and significant steps for fighting any pandemic, especially with contagious nature. Due to the lack of awareness people might mistake the coronavirus infection for common flu, delay seeking medical assistance and resort to traditional healing practices. This lag increases the virus’s basic reproductive ratio, trigger high person-to-person transmission and community spread. To address these, immediate measures need to be initiated.
Language diversity, illiteracy, lack of access to technology may cause barriers in the measures. The recent efforts of Odisha government to involve frontline workers including ASHA workers, anganwadi workers, panchayat representatives and other community leaders to contain the spread of COVID-19 shall be a possible solution to this. Being the insider of the community, their knowledge and familiarity about the socio-cultural context and other intricacies increases the reach of the information to the grassroots.
Meanwhile, the government and WHO has recommended measures like social distancing, hand washing, home quarantine to minimise and mitigate the spread of COVID-19. Scholars have also criticised these as class privilege.
Historically, indigenous communities have been experiencing social distancing in various ways. The existing physical and economic vulnerability to coronavirus is an evidential outcome of it. As per the social distancing advisory provided by the Ministry of Health and Family Welfare, physical distancing, hygiene, avoiding non-essential social and cultural gathering needs to be maintained.
Communal lifestyle is an integral part of the indigenous communities. Their high interconnectedness aids them to make social, economic and cultural ends meet. Particularly, elders play a vital role in community gatherings including healing ceremonies, governance and other rituals where their participation is difficult to be restricted.
The government guidelines for home quarantine necessitate people suspected for COVID-19 to stay in a well-ventilated single room with attached or separate toilet. The person should avoid sharing household items, they along with the care taker should wear mask and disinfect the items used by the person.
Indigenous communities often live in inter-generational homes. The housing structure is small with less or no separation of rooms. Many are devoid of clean water and sanitation facilities. There is lack of availability and affordability of protective gears and disinfectants, followed by social stigma associated with its usage. Staying in home quarantine for 14 days would constrain them from work and they may be forced to find ways to meet immediate needs over containing the virus.
The lifestyle of most of the indigenous communities does not include the use of soap and hand sanitiser. Usage of these products for maintaining hand hygiene is not part of their daily habits. Moreover, the lack of access to clean water makes the implementation of these practices challenging.
The aforesaid guidelines aids in containing the virus. However, undertaking a sudden behavioural change would be a difficult task. Significant focus should also be laid on bringing together traditional and scientific knowledge to device indigenous-friendly hygiene practices.
Deciphering their vulnerabilities, it is evident that the reach of COVID-19 in indigenous communities would be catastrophic. It is crucial that we adopt a participatory approach to take up distinctness-based measures to overcome the pandemic.
Indhusmathi Gunasekaran and Catherine Elisa John are both M.Phil. research scholars at the Delhi School of Social Work.