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Mysterious Deaths of Mother, Daughter Expose India’s Neglect of Rural Healthcare

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Photos of Subadra Mandawkar (75) and her daughter Surekha Pachkhande (45). Photo: Puja Changoiwala/The Fuller Project

The circumstances of the deaths of two women may help explain why women in India have been more likely to die from COVID-19 than men, unlike in most other countries.
The victims were also pariahs in death, raising important questions about lapses in the India’s pandemic response, ranging from social discrimination to misinformation.
Confronted with the worst pandemic in a century, India’s historical neglect of rural healthcare showed, as it crumbled in spectacular fashion.

Published in partnership with The Fuller Project, a global nonprofit newsroom reporting on issues that affect women.

Wardha, Maharashtra: The two women had been dead for a while by the time their bodies were found. Subadra Mandawkar, 75, and her daughter Surekha Pachkhande, 45, shared a roof with several close relatives, but were not on speaking terms with the rest of the family – or anyone else for that matter.

The two were pariahs in Savangi Zade, a small village in Wardha district, eastern Maharashtra. It is commonly called Savangi.

The bodies of Subadra and Surekha were discovered on the evening of May 2, at the peak of a devastating second wave of COVID-19 that swept across India earlier this year. Mystery shrouds the circumstances surrounding their deaths. But they paint an alarming picture of how easy it is for rural women, isolated in patriarchal systems and with little economic agency, to slip through the cracks during a global health crisis.

At this writing, the pandemic has officially killed nearly 460,000 people in India. But the true number of deaths is estimated to be as high as 4 million – almost 10-times the official tally. Subadra and Surekha could easily be among the uncounted, and their story sheds light on how this number got so high. Their deaths lay bare multiple failures in a collapsing rural healthcare system that has suffered decades of neglect and struggled to cope with a raging pandemic, amidst widespread misinformation campaigns on social media.

The circumstances of their deaths may help explain why women in India have been more likely to die from COVID-19 than men, unlike in most other countries, according to a June 2020 study in the Journal of Global Health Science. Aside from Subadra and Surekha, residents of Savangi recall another similarly isolated mother-daughter pair in neighboring Chandrapur whose bodies were also discovered several days after their deaths.

As in life, Subadra and Surekha were pariahs in death, raising important questions about lapses in the Indian government’s pandemic response. Villagers say frightened police and healthcare officials – swept up in rampant falsehoods about COVID-19 – were too afraid to take the bodies to the hospital for autopsies, so the villagers had to volunteer to transport them themselves.

At the hospital, villagers say medical staff refused to conduct COVID-19 tests on the bodies. The villagers claim a Dalit garbage collector was convinced to do it for some money. The results were positive.

Afterwards, Subadra’s nephew Jagdish Mandawkar says he received a call from a hospital worker, telling him the women had come a week earlier and tested positive. If that were the case, the two women should have been quarantined for treatment.

Two government health officials contacted by The Fuller Project denied the women had tested positive for COVID-19 while alive – one of the officials denied the women had visited the public hospitals in the area at all. But an ambulance driver’s registry, a copy of which was obtained by The Fuller Project, indicates they were taken to a public hospital on that date.

Madhukar Sumatkar, the driver of a state-run ambulance service, remembers the daughter seemed very unwell. But he was struck by the elderly Subadra’s strength as she loaded luggage into the vehicle herself.

“I had heard from the people of the village that she was a very angry, resentful woman – didn’t speak to anyone,” he said. “People seemed to be against her. They could have helped her put her bags in or helped her climb into the vehicle, but they didn’t. That’s why I thought there were differences.”

‘Irritated with life’

The bodies of Subadra Mandawkwar, 75, and Surekha Pachkhande, 45, were found on the evening of May 2 in the small, unpainted brick room to the right. They died during India’s devastating second wave of COVID-19. Despite living in the same home with several members of their immediate family, they had been dead for a while. Subadra’s daughter-in-law, Jijabai Mandawkar, and herson, Suresh,stand outside the family home. Photo: Puja Changoiwala/The Fuller Project

“She filed a complaint against me at the police station,” says Suresh Mandawkar, Subadra’s grandson who lived in the same house as her. “Twice, or thrice. Whatever I’d say, she’d go and complain.”

Sameer Dhote, Savangi’s police representative, remembers her as a handful, and said officers never knew what to do about her frequent complaints, which never had any legal basis. Subadra developed a reputation in the village for being ‘insane’.

“Everyone was tired of the old woman,” he says. “She’d file police complaints for the smallest of issues. She would travel to the main police station in Samudrapur, and those officers would call me, asking me what to do with her.”

But Ajay Kude, Savangi’s sarpanch, or village head, recalls things differently.

“Subadra wasn’t insane, she was just irritated with life,” he says.

Subadra was the sole caregiver for Surekha, who had been married and divorced twice. After her second marriage, she developed a chronic illness, her belly swollen with fluid. Villagers described it as jalpeendu, a jaundice-like disease. She was often bedridden, and would frequently stay home for two to three months without leaving.

Subadra was a labourer who used to work on farms for 150 rupees a day. She struggled to do double duty as a caregiver for her daughter, who many Savangi residents describe as immature and childlike, and possibly cognitively disabled.

Once Subadra became too old for farm work, she turned to begging from fellow villagers. The lack of support led to Subadra developing an antagonistic relationship with the rest of Savangi, a tight-knit community of 600 villagers.

Vibhuti Patel, the vice-president of the Indian Association for Women’s Studies, says unpaid care work is the primary driver behind the subordination of women like Subadra. “Anytime there is an emergency in the house, it is the girls and women who have to sacrifice,” she says. “Nobody else feels that they have to take responsibility.”

By the time they died, the mother’s and daughter’s relations with the rest of the family had grown irreparably strained. Suresh, his mother, brother and wife, who all live together, say they hesitated to even peep through the window to check in on the women, despite knowing the two had gone to the hospital days earlier. Eventually, they noticed an odour that became too strong to ignore.

Panic in Savangi

Subadra Mandawkar grandson, Suresh Mandawkar, pointsto the spot where the Subadra and her daughter Surekha Pachkhande’s bodies were discovered in their home as his mother, Jijabai Mandawkar, looks on. Photo: Puja Changoiwala/The Fuller Project

It took hours to find volunteers to take the bodies to the hospital amid the pandemic panic. One of the men who volunteered said his wife made him sleep in the fields that night and wouldn’t let him back inside until he had bathed in the local well.

“The government officials did not do anything,” says Kude, the village sarpanch. “If you touch the bodies, you’ll get corona – that’s what they believed.”

Things did not change after the bodies arrived at Samudrapur Rural Hospital, a state-run facility. Both village sarpanch Kude and village council member Jagdish say officials there insisted family members conduct COVID-19 tests on the corpses themselves.

“The bodies lay there for two hours,” says Kude. “Nurse, doctor, no one was ready to test the bodies to see if they had COVID.”

Kude says the villagers eventually found someone who agreed to test the bodies for Rs 1,500. The man, a scared but desperate garbage collector who came from the oppressed Dalit community, had no training whatsoever in collecting nasal swabs, and had had a drink to prepare himself for the act.

It took hoursto gather enough volunteers among the villagersto take the bodies of Subadra Mandawkwar and
Surekha Pachkhande to the hospital. Praful Zhade, 29, wasthe first to volunteer. Photo: Puja Changoiwala/The Fuller
Project

Jagdish, Subadra’s nephew, says a health official from the district capital Wardha called him twice the next day, May 3. Apparently the women’s positive COVID-19 test results from April 26 from Hinganghat, another public hospital in the same area, had just arrived at the main district hospital. Jagdish was angry: according to COVID-19 protocol, a positive result meant they should have been quarantined and looked after.

Efforts to track down the report produced contradictory statements from the health officials of Samudrapur block, which covers both the Hinganghat hospital where the women were tested and the Samudrapur Rural Hospital where their bodies were taken.

Kalpana Mhaskar, medical superintendent of Samudrapur Rural Hospital, told The Fuller Project that there were no records of the women visiting Hinganghat on April 26, even though ambulance records demonstrate otherwise.

Sunil Bhagat, health officer for the Samudrapur block, says the women did visit, but for Surekha’s other illnesses, and insists they never tested positive for COVID-19. Asked about the villagers’ claim that a Dalit garbage collector conducted the swab tests, he said he did not remember who took the tests but that it was usually the technicians.

“If someone tests positive anywhere in our area, we get a call without fail,” Bhagat said. “If you test positive anywhere in the block, the relevant authorities are informed and we act on it.” He insisted they couldn’t have tested positive.

Jagdish says the official who called him said the women left in a rush after they were tested. He thinks they were likely in a state of panic, believing COVID-19 was an automatic death sentence.

There was little to reassure them otherwise. Around them, India’s healthcare infrastructure was collapsing in spectacular fashion, confronted with the worst pandemic in a century.

A perfect storm for rural women

A view of the rural hospital in Samudrapur. Photo: Puja Changoiwala/The Fuller Project

India’s public health spending has stagnated for the past decade at around 1% of GDP, one of the lowest in the world. Under the Narendra Modi government, disinvestment in public health has accelerated. Amid one of the gravest health crises on the planet, India’s health budget was just 0.34% of GDP, compared to 4% to 10% of GDP in OECD countries.

This has been particularly damaging to rural India. Home to 66% of the country’s population, it has only 20% of its doctors. Community health centers in rural areas suffer an acute shortage of surgeons, OB-GYNs and physicians. With three-quarters of health infrastructure, medical staff and other health resources concentrated in urban India, villagers on average live four to five years less than their urban counterparts.

Pandemic misinformation has found fertile ground among people with little faith in a crumbling healthcare system. India is the world’s top source of misinformation about COVID-19, according to a study in Sage’s International Federation of Library Associations and Institutions Journal.

Dhote, the police officer, said many villagers believe stories about doctors murdering COVID-19 patients to steal their organs. Other rumours include stories about vaccines containing pig meat (offensive for many Muslims) or cow blood (offensive for many Hindus), and that they cause infertility. A survey conducted by the news site The Quint in rural areas of Uttar Pradesh, Madhya Pradesh and Bihar showed that 27% of respondents believed death was an “expected symptom” of getting the vaccine.

India isthe number one country in the world for COVID-19 misinformation. Rumorssuch as doctors killing COVID-19 patientsto harvest their organs gain widespread traction through Whatsapp and Facebook. Forty two percent of respondentsto a survey of rural India by The Quintsaid they believed death was an “expected symptom” of getting the vaccine. Photo: Puja Changoiwala/The Fuller Project

Rural women are particularly vulnerable to misinformation. The adult literacy rate for women in rural areas of India is 50.6%, compared to 74.1% for rural men, and 76.9% for women in urban areas. Fear of the vaccine is much higher among rural women than rural men (61% to 49%), according to The Quint’s survey.

In Maharashtra, where Savangi is, only 0.04% of pregnant women had been vaccinated as of October. Women in Savangi, many of whom believe rumors that it’s unsafe to get a vaccine within five days of menstruation, are much less likely to get the jab — 70 men in the village have received a first dose of the vaccine by October, compared to 55 women.

In Savangi, these factors played out as a shortage of basic supplies such as oximeters and vaccines, an environment of fear and panic, and widespread scepticism toward treatment and vaccination – a perfect storm for isolated rural women like Subadra and Surekha.

Kalpana Vaidya, who has been a health worker in Savangi for 25 years, had tried to convince the mother and daughter, who were both illiterate, to get vaccinated.

“The old woman just wasn’t ready to listen,” she says. “She seemed afraid.”

In the end, Subadra did go to the hospital. The purpose of rural healthcare is to act as a support system for people like her – a rural widow who did double duty for decades as farm hand and unpaid care worker. Instead, like many of the estimated 3.5 million uncounted COVID-19 deaths in India, Subadra fell through the cracks. After returning home from the hospital, she did what she’d done for much of her life: continue to look after her daughter.

When their bodies were found, Surekha was on the only cot in their threadbare room. She had been dead for a while, insects already on her bloated flesh. On the floor next to her, draped in a pink sari, lay Subadra.

Puja Changoiwala is an award-winning independent journalist and author based in Mumbai. She writes about the intersections of gender, crime, social justice, technology and human rights in India.

The post Mysterious Deaths of Mother, Daughter Expose India’s Neglect of Rural Healthcare appeared first on The Wire Science.

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