Backward districts, health infra: What mainstream media reportage can help change in 2023

 Broken News

Published in Newslaundry on December 29, 2022

Link: https://www.newslaundry.com/2022/12/29/backward-districts-health-infra-what-mainstream-media-reportage-can-help-change-in-2023

The end of the year usually leads to reflections on the year gone by. But let me break with tradition and instead set out a wish list for the kind of coverage we can hope for in the coming year. This could be wishful thinking given that 2023 is an election year with nine states going to the polls. But there’s no harm in hoping.

Even as the media is as usual dominated either by politics or, as in the case of TV news, nonsensical controversies – such as the saffron bikini drama – manufactured out of thin air to get eyeballs, there are some stories that somehow break through. It’s possible that only those of us interested in these issues read them (here I refer to print and the online portals). Yet, the very fact that a few stories of the kind I am going to highlight make it into print, gives us some hope that all is not lost.

The Mumbai edition of Indian Express has started a series on health care in rural Maharashtra. With the possibility of Covid once again rearing its head in India, health infrastructure is a relevant subject as we know from our experience of the last three years. As the redoubtable Dr Gagandeep Kang, Professor, Christian Medical College, Vellore has repeatedly reiterated, healthcare systems that are already stressed perform badly during an emergency – such as the pandemic we have lived through.

For rural India, the absence of adequate health infrastructure has been a tragic reality even as India struts on the global stage claiming to be a power that the world should reckon with. We remain mostly unaware of the extent of the health crisis in much of rural India because, in recent years, mainstream media has turned its attention away from such issues. 

The series in Indian Express, by Rupsa Chakraborty, begins by focussing on one of the poorest districts in Maharashtra, Nandurbar. Some parts of this district touch the banks of the Narmada river, and many Adivasi-dominated villages in this district were submerged in the backwaters of the Narmada following the construction of the Sardar Sarovar Dam in Gujarat. The story of their struggle for adequate compensation and relocation is well-known. 

The villages that escaped submergence continue to suffer much of the developmental neglect that affected those that had to move. For instance, even today, as reported by the Indian Express, levels of malnutrition and the number of severely malnourished children are higher in Nandurbar than in other districts in Maharashtra. The situation was no different in 1984 when I, then working in the Mumbai edition of Indian Express, first heard about Nandurbar.

Chakraborty assesses the state of the 11 primary health centres set up in the district in the last two years at a cost of Rs 6 crore each. They were brand new two years ago. Today, she writes, their condition is “abject”.

The one she visited in Bilgaon, inaugurated just a year ago in 2021, lacks basic infrastructure like electricity. The medical officer treats his patients using a torch once it is dark. This PHC covers 11 villages with a population of 14,221. The nearest alternative, a better equipped facility at the sub-district headquarters, is 104 km away.

Not just electricity, there is often no water either. After it was inaugurated, the PHC received water from a tanker. But this stopped well before a water connection was installed as late as September this year. Apart from these basic infrastructure deficiencies, the PHC is also poorly staffed, a depressingly familiar story. 

Apart from these PHCs on land, several villages on the banks of the Narmada were supposed to be served by floating dispensaries and water ambulances. Their state is not much better, as described by the reporter. 

She writes, “Over a decade ago, the state government had launched two floating dispensaries to provide healthcare to nearly 20,000 tribals residing in 33 hamlets – inaccessible by road along the Narmada river. These tribals were displaced during the construction of the Sardar Sarovar project…More than a decade later, one of the floating dispensaries has broken down beyond repair and presently lies in a godown. The other, around 20-ft long, is in a rickety shape, with medical staff as well as patients afraid to board it scared that it may capsize any moment.”

The point about narrating these details is that even though the stories are about a particular part of India, they reflect the reality in many parts of this country. Even during the pandemic, although there was some reporting from rural areas, it was inadequate. Most of the focus was on urban India where the media is based. As a result, even today, we don’t have the full story on how people – such as those living in districts like Nandurbar – dealt with the pandemic.  

The last three years have clearly established the need for well-trained health reporters who can understand the science, but also the politics and the economy of health care. For instance, more probing questions need to be asked not just of the government but also of the pharmaceutical industry. And editors need to back reporting that requires going to areas away from the limelight, such as these backward districts, that tell us the real story of disease, health care and survival. 

There are, of course, many more areas that mainstream media should investigate. But to start with, it could look at the state of health care and health infrastructure in India’s most backward districts. Even if the authorities don’t instantly respond to such stories, media scrutiny and civil society pressure represent the only hope for things to change for people living in these areas. 

I cannot end this last column of 2022 without once again reminding readers about journalists who are still in jail. Siddique Kappan, who was arrested in 2020 on his way to cover the gangrape, and subsequent death, of a Dalit woman in Hathras, UP, has finally got bail. But as of writing he continues to languish in jail.

And in Kashmir, Fahad Shah, editor of Kashmir Walla, Sajad Gul from the same publication, as well as Aasif Sultan of Kashmir Narrator, are still in prison under the draconian Public Safety Act.  

A senior Kashmiri journalist told me that up to 50 Kashmiri journalists have had to leave Kashmir and go elsewhere looking for jobs because workinSg in the erstwhile state has become virtually impossible. A Kashmiri journalist told the Committee to Protect Journalists that the media in Kashmir “has reached a breaking point, where journalists are wondering whether it’s worth it to report from Kashmir”.

This then is the other reality that we must remember, and repeatedly highlight, as we go into 2023. We cannot speak of freedom of the press so long as journalists are behind bars just for fulfilling their professional commitments as reporters. Journalism is not a crime.

Why Rahul’s speech should remind Big Media of the other India

 Broken News

Published in Newslaundry on February 3, 2022

Link: https://www.newslaundry.com/2022/02/03/why-rahuls-speech-should-remind-big-media-of-the-other-india

Rahul Gandhi's speech in Parliament on February 2, in response to the union budget, made it to some front pages﹘Indian Express, Telegraph and Hindustan Times, but not the Hindu or the Mumbai edition of Times of India.

While the Hindu ran it across two columns on page 8, TOI did not report it at all in the edition I checked. It was an important intervention, whether you agreed with what he said or not. Then why bury it, or ignore it altogether?

The newspapers that did report Gandhi's speech picked his key point about there being two Indias, one of the rich and the other of the poor.

This is not even a debatable issue any more given the statistics in the Oxfam report on inequality in India. The top 10 percent of the country control 77 percent of its wealth. And between 2018 and 2022, India has apparently produced 70 new millionaires a day, states the report.

That other India, of the poor, was barely represented in the media as a whole on the days following the economic survey and the budget. Many pages, with colourful graphics and illustrations, were devoted exclusively to reporting and comment on the budget. Typically, the most space was given to the responses from industry and the markets.

How many newspapers sent out reporters to speak to poor people to find out whether the budget means anything to them or not?

In the 1980s, when neither private television channels nor social media existed, print media made it a ritual to get the views of the aam janta on the budget. Of course, quite often this vox populi consisted of a quote from the cigarette and paan vendor outside the respective newspaper office. But at least an effort was made to find out what ordinary people thought.

Today, it is evident that media houses calculate that these voices will not sell their product. So why devote space to them?

On the day the budget was presented, I spoke to two men who can be found on a pavement in one of Mumbai's upmarket localities. Shankar is a cobbler, originally from Satna district in Madhya Pradesh. Srinath sells bananas and is from Allahabad (now Prayagraj) district in Uttar Pradesh. Both men have been around for over two decades. Shankar has a room elsewhere; Srinath sleeps on the pavement next to his stall.

Neither had any idea what I was talking about when I asked them about the budget. Did they know that this happened every year, I asked. No, said both.

I explained briefly what it was about. Srinath, who is always ready with a philosophical comment to any question I ask, said, “What difference does it make to our lives what these politicians say? We are barely surviving.” Shankar echoed these sentiments, adding that in his village, people had no work. He had no option but to continue to sit on that patch of pavement and work as a cobbler.

I know two is not a representative sample. But any conversation, even if it is not for a story, with that other India reminds us that for a vast majority of this country, the hectic and loud discussions on television, or the learned op-eds in print on the annual union budget, mean very little.

What Gandhi said will be debated, and ironically the responses to his speech by ministers and spokespersons of the BJP will be reported at length even if what he said was barely covered. But apart from the slanging matches that have predictably followed Gandhi's speech, surely the media can occasionally turn its eyes towards that other India? Speaking to people like Shankar and Srinath might not make for scintillating copy. But talking to them acknowledges that they exist, that they are as much a part of this country as the experts we quote.

K Sujatha Rao, former union health secretary, in her op-ed in Indian Express on February 2, makes a telling comment that ought to be a cue for a media follow up. She writes, “Inequalities have widened. An estimated Rs 70,000 crores have been spent by the people in this short time for medical treatment that the government ought to have provided.” The period she is referring to is the Covid pandemic. The Oxfam report quoted above reiterates this by pointing out that health care in India is virtually a luxury good, only available if you can pay for it.

Yet, given that health reporting has now become one of the most important beats in the last two years, you have to work hard to find the stories that tell us about the state of public health care. Most often such stories can only be found on independent digital platforms.

Take, for instance, this story by Parth M N on the Pari website. He reports from UP about a community of Musahars, the lowest even amongst scheduled caste communities. His story tells us not just about the lack of adequate health infrastructure, but also about deep prejudice, where a Musahar woman is forced to deliver her child on the pavement outside a hospital because the staff will not admit her.

Another woman tells him how many of them preferred to stay at home when they took ill during the second wave of the pandemic last year rather than go to a hospital. “Who wants to be humiliated when you are already scared of the virus?” she said.

Parth also spoke to Muslims in nearby villages who tell their own stories of discrimination and being compelled to go from one hospital to another to get emergency treatment. As a result, most of them have built up debts due to medical expenditures.

Illustrating Sujatha Rao’s point about the money people have been forced to spend during these pandemic years, Parth writes, “In many of UP’s villages across nine districts, people’s debt grew by 83 percent in the first three months of the pandemic (April to June 2020). The data was gathered through a survey by COLLECT, a collective of grassroots organisations. It recorded that in July-September and October-December 2020, the increase in indebtedness was 87 and 80 percent respectively."

This is the type of granular reporting that is sadly missing from the English print media today, barring an exceptional story. As a result, that other India is vanishing from our consciousness, even though it represents the majority of the citizens of this country.

In the past, election coverage gave journalists an opportunity to understand the real problems that people faced in rural India.

Today, you read endless reports about caste and community calculations and the strengths and weaknesses of various political parties and politicians in the fray. While this has to be reported, do people reading these stories know anything about the region being covered? Do these places have their own histories? What are the sources of livelihood? Is there availability of water? What about public health care facilities? Are they within reach or do most people pay private doctors and fall into debt? And what about environmental issues?

These issues can be integrated into the reporting on elections. They give the reader a picture of parts of India that are otherwise routinely ignored. They come into our line of vision only if there is a major calamity. And, of course, during an election.

Such stories make for much more interesting reading than the routine and predictable. Yet, once again, it is hard to find such reporting in mainstream media. On the other hand, independent digital platforms like Newslaundry, Wire and Scroll are doing this with fewer resources.

While at least some people have appreciated Rahul Gandhi’s reminder of the other India in his speech, it is likely to be forgotten soon. As election day approaches, Big Media is in full form speculating about winners and losers. In the meantime, the Shankars and the Srinaths of this country will still be there, just barely.

For post-pandemic media, public health needs to be the biggest story

 Broken News

Published in Newslaundry on May 13, 2021

https://www.newslaundry.com/2021/05/13/for-post-pandemic-media-public-health-needs-to-be-the-biggest-story

From burning pyres and patients gasping for breath to bodies floating down the Ganga, India has been through another torrid fortnight. The whole world is now aware of the extent of the tragedy unfolding. Yet, our government continues to focus on fixing what it considers to be a "negative" narrative.

A fortnight back, when the focus of international and national media coverage was the desperate situation in New Delhi, where hospitals, private and public, were running out of oxygen and patients were dying not from the disease but from the absence of oxygen supply, we knew already that if we turned our gaze away from the cities, a much more tragic state-of-affairs was unfolding.

That is exactly what has happened. The second wave of the pandemic has inevitably, and predictably, spread to rural India and the devastation here is incalculable. This is so because there is little to no reporting, people are not being tested, not being treated when they finally reach a health facility, and dying not knowing that the "cough and fever" that afflicted them is the novel coronavirus that has already felled lakhs of other Indians.

The reports appearing in the media, mostly print and digital, remind us repeatedly that the Indian health system has not folded because of the pandemic; it was already broken. Although the sheer volume of cases has overwhelmed it even in better-served cities, in much of rural India and in small towns, the existing and abysmal health infrastructure that exists might as well not be there.

What journalists report gives us only a glimmer of the grim reality. Such as this report in the Indian Express by Amil Bhatnagar from Meerut in Uttar Pradesh. What he describes is not the situation in a remote hamlet but at the district headquarters: "A folding cot that a family claims to have got itself, fans that don’t work, a roof that is leaking at several places, and a ward overpowered by the stench of a toilet. As Meerut district climbs to the top of Covid charts in Uttar Pradesh, with 1,368 new cases taking its total active number to 13,941, its largest government coronavirus facility, Lala Lajpat Rai Memorial Medical College, is struggling to keep up."

The situation in UP has become the focus of much of the media attention. Understandably so, as despite chief minister Adityanath's threat to jail those who criticise the work of the state government, the reality cannot be hidden any more. Even members of his party are now publicly complaining about the dismal reality on the ground.

In Varanasi district, one of the four high-burden districts in the state, Jyoti Yadav from the Print reports that people are dying from "cough and fever" without realising it could be Covid because there is no testing. Her reports from Lucknow and Jaunpur tell a similar story. Every day new reports are chronicling the absence of health infrastructure and the price ordinary people are paying.

Most heartbreaking amongst these are the reports of over 700 schoolteachers who died because they had to do poll duty during the recently concluded panchayat elections in the state. This one in PARI, which gives us the full list of 540 men and 173 women teachers who died, is probably the most moving. It illustrates the utter callousness of a government more concerned about elections than the lives of its people, men and women who are also frontline workers.

And then you have hospitals that are built and widely publicised but add up to nothing. A report by Ayush Tiwari and Basant Kumar in Newslaundry describes how only 50 of the 150 oxygenated beds in a facility inaugurated with great fanfare by Baba Ramdev in Haridwar, Uttarakhand, are operational. They add: "There’s a shortage of doctors, ward boys and housekeeping staff, limiting the facility’s capacity and forcing it to refer patients elsewhere. The facility does not have proper water supply and Covid wards don’t have roofs, risking widespread transmission."

Remember Haridwar only recently hosted a "superspreader" event, the Kumbh Mela.

The situation in neighbouring Bihar is not much better. Pratyush Tripathy, writing in Scroll, illustrates with a set of maps the crisis that is waiting to explode in the state where there are no vacant ICU beds in 18 out of 38 districts. This, in a state that has the lowest Human Development Index in the country and "one doctor for 43,788 persons".

Meanwhile, the government itself has finally acknowledged that the situation in rural India is worrying with 533 districts in the country out of over 700 reporting a test positivity rate of over 10 percent. Dr Balram Bhargava, director general of the Indian Council of Medical Research, is quoted as saying, “India is facing a massive upsurge in Covid-19 cases. The national positivity rate is around 20-21 per cent, and about 42 per cent districts in the country are reporting a positivity rate more than the national average."

Just as the second wave of the pandemic had been predicted, this too should not come as a surprise. Yet, the government and its supporters continue to find ways to divert attention away from this tragic unfolding saga in rural India.

Their latest ploy is the creation of digital spaces that mimic well-known international newspapers' names, but have been specifically tasked to put forth the narrative that the government wants the world to hear. Thus, we have something called The Daily Guardian telling us how hard prime minister Narendra Modi is working to handle the pandemic, and The Australia Today accusing "vulture journalists" of spreading "more panic and despair than the pandemic".

Fortunately, or unfortunately, for the Modi government, neither the Indian nor the international media is persuaded by these deflection tactics. The stories are streaming in, from villages and small towns, and the picture they paint is not pretty. Neither can it be hidden. How long can a government go on denying this reality? How much of spin can it give when there are visuals of bodies floating down the very river it has promised to cleanse?

In fact, the government's response to the disturbing visuals of scores of corpses found floating down the Ganga and washing up in UP and Bihar illustrates its priorities. According to an ANI report, union Jal Shakti minister Gajendra Singh Shekhawat reiterated, "The Modi government is committed to the cleanliness (of) 'mother' Ganga", even as he did not deny the reports about the bodies. Is that all the government is worried about, the "cleanliness" of the Ganga, at a time when in desperation people are abandoning their loved ones in the river because they cannot afford to cremate them?

The reports we have read over this last fortnight are just the tip of the iceberg. There are many more stories waiting to be told even as authorities fail to count, or even acknowledge, how many people are dying from the virus. Here, one has to once again commend the determination with which the Gujarati newspaper Sandesh has persisted in counting the dead in the state and reporting the mismatch between what it has found and the government's official figures.

This report in Newslaundry from Meerut district in UP also exposes the huge discrepancy between the bodies being cremated and the official figures. In fact, the questions about the death count simply refuse to go away and will continue to haunt state and central governments. Not just journalists, but even experts such as the mathematician Murad Banaji have raised repeated questions about the accuracy of the death count. Banaji suggests in this interview to Karan Thapar on the Wire that one million Indians have already died from the virus.

Apart from the pandemic, its spread to rural India ought to remind us that the story of the grossly inadequate health infrastructure is one that has always been there.

India's health system has not crumbled only because of the pandemic. It was barely adequate at the best of times, and in many parts of rural India virtually non-existent. Today, we are being compelled to notice this and acknowledge it because of the health emergency the country faces. But each year, these areas see many such emergencies in the form of other diseases such as dengue, malaria, and encephalitis as well as perennials such as tuberculosis. In states where there is chronic malnutrition and stunting amongst children, exacerbated by the absence of medical intervention, thousands of infants die every year from something that is easily treatable, diarrhoea.

When this crisis is over, although there is no sign of it at present, we must continue to focus on this failed health system in so many parts of India. The pandemic has shown us that gloating about being an "emerging" economy means nothing when people can die from the lack of oxygen during a pandemic, or the absence of clean water at other times.

If there is one lesson we in the media can learn from this terrible year it is that the focus on public health must remain a crucial and relevant part of coverage even in non-pandemic times. As epidemiologist Chandrakant Lahariya points out in the India Forum, India would be much better placed if the government fulfilled its promises of increasing health spending to 2.5 percent of the GDP and investing more in primary health care.

The media, I believe, can play an important role in creating pressure on this and future governments by refusing to take its eye off the state of our public health infrastructure.