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 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 of Covid, moved her to the hut soon after she became ill after her first dose of 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. 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. Even information struggles to make its way there.
Devi’s village, Pagna, is 12 miles (20km) from the highway to Badrinath, one of the four holy sites in an important Hindu pilgrimage. Nestled in the Himalayas, 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 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 their meagre incomes.
Devi’s husband first took her to the pharmacist just outside the valley, who gave paracetamol and painkillers. The medicines didn’t help, 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 symptoms in the past five weeks. Anxiety in this usually peaceful place is palpable.
In early May, when the disease was at its peak, Prem Singh, 36, an activist in the 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 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.
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 wheat flour and raisins from shops, 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 arrived. So far, the village head has spent £180 of his own money on hygiene kits.
Devi says non-Covid care has also 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, he says: “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.”
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 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 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 a health centre. But these remain promises – no work has started and the villagers continue their uphill battle just for survival.
