India is witnessing a silent migration as more and more people are opting for metro cities for better healthcare facilities. Covid-19 pandemic, which hit the country hard, has further intensified their concerns.
For 64-year-old Anwar Haque and his family, natives of Bihar’s Begusarai, Delhi has been home for the past six to seven years. A chronic patient with severe ailments, including heart and kidney problems, Haque prefers to stay in a metro city preferably for his health conditions.
“I have had a bypass surgery in 2014. I also have kidney problems and I am diabetic. I have to undergo dialysis every now and then. So, I moved to Delhi because there are better health facilities, affordable healthcare and availability of crucial medicines. In my hometown, there are as good as no specialists, shortage of paramedical staff and few private hospitals,” Haque said.
For Haque, the migration to Delhi was primarily to support his deteriorating health. However, Covid-19 has further intensified his concern. “I contracted Covid-19 this year, but luckily I managed to get treatment at a good hospital in Delhi. Here hospitals at least had staff and oxygen supply. In my hometown, there are neither health options nor medical oxygen. There is even shortage of medical staff,” he said.
A doctor from Seemanchal, one of Bihar’s least developed region, narrates the ordeal behind migration.
“In the Seemanchal districts, patients refer to Purnia for their medical treatment. In Purnia, it is very common for patients to be referred to hospitals like AIIMS Delhi. For many of the diseases, doctors don’t prescribe any other hospitals but refer them directly to Delhi,” said Dr Mohd Asrarul Haque, who hails from the region.
“Today a patient came to me with nodules in lungs and it could be cancerous. He has been referred to get treatment in a Patna hospital or AIIMS Delhi. It is a very common trend here. Even if the patient can’t afford costly treatment but has serious health problems, the family somehow manages finance and try to get admission in government hospitals in Delhi,” he added.
Migration from these underdeveloped areas to metro cities is not a new phenomenon. According to the 2011 Census, Uttar Pradesh and Bihar are responsible for the most number of migrants to other states as 20.9 million people moved away from the two states. But, the dominating factors behind the migration was employment, business and education.
On the other hand, studies suggest that a lot of patients from north Indian states like UP and Bihar travel for medical reasons. Data from the India’s premier hospital, AIIMS Delhi shows that out of 13,000 patients, the majority were from Uttar Pradesh (4,165) and Bihar (1,753).
However, some experts said the disparity of medical facilities will not necessarily affect people to migrate. Chinmay Tumbe, faculty member at IIM-Ahmedabad and the author of The Age of Pandemics, 1817-1920: How They Shaped India and the World, said that though medical facilities connect with migration, but the primary motivator remains employment and higher wages.
“There is an issue of quality health but there is also issue of access to health. Though cities have better facilities, it must also be welcoming. Most migrants may not have ID proofs or may be under confident. So more than the quality it is about access. So, they will choose medical facility where they are comfortable with,” Tumbe said.
“There are various ways in which migration connects with health. Primarily people migrate because their employment is good or wage is better. But medical facilities are important in migration. If migrants got sick where will they access medical facilities?” Tumbe added.
Tumbe also points out to the gender difference in accessing medical care as more women prefer going back to their villages. “A lot of women will chose to go back to their villages. Even if there is a good medical facility available, a lot of women prefer going back to villages because they are more comfortable. Even if they might be of low quality but it is accessible,” he said.
The second wave of Covid-19 exposed the disparity in health infrastructure across the country as there was dearth of hospital beds and healthcare facilities. Amid this, images of dilapidated hospital buildings, shortage of medicines and medical staff were reported from Bihar.
Bihar: Premises of Darbhanga Medical College & Hospital (DMCH) waterlogged & polluted, pigs seen roaming around; Administration takes up development work“I’m working here for 26 yrs. Roads are waterlogged after rainfall & we’ve to walk through it to reach DMCH," says a nurse pic.twitter.com/8ovtGqUDqF
— ANI (@ANI) May 22, 2021
The poor health facilities in the state were also reflected in the Covid-19 toll reported from the state. Recently, Bihar revised its fatality numbers and added another 3,951 deaths to the 6,148 deaths it had earlier reported. The state also reported the highest deaths among doctors in the second wave.
According to an ICMR report, Bihar has just 2,792 government allopathic doctors, while UP has 10,754, with number of patients served by one doctor being 43,788 and 21,702 respectively. Delhi on the other hand had 9,121 government allopathy doctors with a better patient to doctor ratio at 2,028.