Imphal Review of Arts and Politics

COVID fight is everybody's fight

Why the Poor End Up Making Poor Healthcare Decisions in the Midst of COVID Needs to be Understood

Watching Manipur public’s response in these harsh and tragic times of COVID-19 pandemic is painful for many reasons. On the one hand, there are so many who continue to break the much-publicised pandemic appropriate behaviour protocols. Most obviously visible is the fact many people continue not to remain indoors during lockdowns and curfews. On the other hand there are sloppy government implementation of the measures it formulates to fight the pandemic, essentially resulting out of either a lack of understanding or else an arrogant disregard of the compulsions that make many break these protocols. A calibration of these behaviours is also vital for there are indeed many stupidly bloated egos, most of them belonging to Manipur’s emerging coterie of fly-by-night nouveau-riche who think they are an exception to the law, therefore exempt even from emergency public restrictions. However, although they are big public eyesores, their numbers are limited. There is a larger number of protocol breakers away from this coterie, constituting of the larger masses fighting for daily hand to mouth survival in Manipur’s stunted and struggling economy where the only respectably paid jobs are generally confined to direct government employment sector. The poor, as the eye-opening statements of Dutch historian Rutger Bregman in his book Utopia for Realists and subsequently also in his TED talk titled Poverty is Not a Lack of Character, It is a Lack of Cash made is that the poor make poor decisions. We are witnessing this now in the midst of COVID, but have been also witnessing for decades in the choice of public leaders, with the larger section swept either by empty rhetoric or else by the price tags on individual votes during elections. No points for guessing that we will again be witnessing this short-sightedness in the state Assembly election seven months from now.

One of the foremost champions of “universal basic income guarantee”, Bregman’s recommendation is, put money in the hands of the poor, just enough to make them secure and free from the binds of the immediate such as hunger, essential bills, healthcare expenses, education, and they will begin to make better decisions in life. In fact a study established that the IQ of a person can differ by up to 14 points depending on which side of the poverty line he is on. His premise is, poverty is not a lack of character as many believe, but a lack of cash. That is, there is nothing fundamentally wrong with those who end up poor, for it is their circumstances which have trapped in poverty not any inherent weakness of theirs. What he has implied is that the success of an economy or its leadership must be defined by their ability to change this circumstance rather than lectures on how the poor can change their own fortunes by changing their outlooks. There are others who have said this in different ways and in different circumstances. American writer Mark Twain for instance was one of those who opposed a government move to shut down government subsidised schools on the plea these were felt to be a waste of money. His timeless remark was: “Every time you stop a school, you will have to build a jail. What you gain at one end you lose at the other. It’s like feeding a dog on his own tail. It won’t fatten the dog”. Bregman’s recommendation then is, as a start, simply put basic income in the hands of the poor and then begin longer term investments, such as in education, skill training, financial management etc. The latter will not make sense if the former and more fundamental need is not met. And as Mark Twain also suggested, this should be made an essential expenditure of the government, with the knowledge this will ultimately save more money and prevent social disharmony. In any case, this expenditure, as former finance minister of Greece and well-known economist Yanis Varoufakis said in his book Talking to My Daughter About the Economy: How Capitalism Works and How it Fails, this would only be fair. If children of rich parents can inherit their parent’s wealth, so must every citizen be entitled to inherit the common wealth of a state, and this can be in the form of “universal basic income”.

This thought comes to mind not so much as an advocacy for “universal basic income” (although we do think it is essential) but because of its relevance in these harsh times brought about by the public health emergency of COVID-19. Why is there so much of violations of lockdown norms in Manipur despite the universal knowledge now that lockdowns are emergency measures to contain the deadly virus from spreading, therefore ultimately eliminating it. This is despite the fact that most would be knowing coming out of their homes while the virus is rampaging is not only a risk for themselves, but an impediment to the larger fight to defeat the disease.

There are however more questions to be asked. It is reasonable to believe that the high rate of COVID infection in Manipur today is on account of the inability of the public to keep by prescribed pandemic appropriate behaviours. For this the remedial measures are the suggestions spelled out above. But the subsequent question is, why is the mortality rate in the state so high, much higher than the national average as well as the rest of the Northeast? This question needs to be probed more critically, and depending on the answer, accountability fixed. The usual and cleverly evasive answer from the authorities concerned has been that this is the result of late hospitalisation of patients or else because of comorbidities that patients already suffer from. It is now time for these answers to be interrogated further. Why are patients not hospitalising early? What is inhibiting them from doing so? Is it because they are afraid of possible expenses, or is it an apprehension that as ordinary people they may not be looked after with respect? Are people in other Northeast states more healthy and carry less comorbitities? The answer to the latter seems in the negative, considering Manipur’s sporting prowess, which indeed is an indicator of general public health status.

As far as the mortality rate is concerned, there would have to be some flaw down the public healthcare chain, and this must be sorted out and if any neglect is found, corrective remedial measures found. It does seem this probably has to do with inadequate professional counselling of patients either in home isolation or at community isolation centres. If physical visits at all these home and community isolation centres are next impossible, there ought to be reliable and easily accessible virtual consultancy facilities designed to monitor the condition of patients so as to reach them appropriate and timely professional healthcare interventions whenever it becomes necessary. Let the government realise that more than textbook remedies, to make strategies work, ground situations also have to be closely studied. Something urgent and meaningful has to be done to end this common nightmare for good.

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