Parth M.N.

Vinutha Mallya

Editor

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Lakshima
Devi does not remember the date it happened, but she has a vivid memory of that
winter night. “The wheat crop
was just above the ankle” when her water broke and she went into labour. “It must have been December or January
[2018/19],” she says.Her
family had hired a tempo to take her to the primary health centre in Baragaon
block. The PHC is about six kilometres from their village, Ashwari, in Uttar
Pradesh’s Varanasi district. “I was in a lot of pain when we reached the PHC,”
recollects Lakshima, 30. Her three older children, Renu, Raju and Resham,
between 5 and 11 years old now, were at home. “The hospital person [staff] refused
to admit me. He said I wasn’t pregnant, and the bump on my stomach was due to
an illness.” Lakshima’s
mother-in-law, Hiramani, implored the staff to admit her, but the PHC staff
refused. Finally, Hiramani told them she would help Lakshima have the baby right
there. “My husband was looking for an auto to shift me elsewhere,” says
Lakshima. “But I was too weak to move by then. I sat right outside the PHC, under
a tree.” Hiramani,
in her 60s, sat beside Lakshima, holding her hand and guiding her to take deep
breaths. About an hour later, closer to midnight, she gave birth. It
was pitch dark and freezing cold, Lakshima remembers.

The
baby did not survive. Lakshima was too exhausted to realise what had happened.
“The PHC staff took me in after that, and discharged me the next day,” she says,
recalling how weak and tired she was that night. “If they had paid attention
when I needed it, my baby would have lived.” 

Lakshima
belongs to the Musahar community. One of the most marginalised and poorest of Dalit
groups in Uttar Pradesh, the Musahars face severe social discrimination. “When people like us go to the hospitals,
we are never treated well,” she says.

The
treatment she received that night, or the lack of it, was not new to her, nor
was she alone in it. 

In a
Musahar basti in Dallipur, a couple
of kilometers away from Ashwari, 36-year-old Nirmala explains how the discrimination
works. “When we get to the hospital, they are reluctant to accept us,” she
says. “The staff will needlessly ask for money. They will do everything they
can to discourage us from entering [the facility]. If we get in, we are asked
to sit on the floor. For others, they will bring chairs and talk to them with
respect.”

Musahar
women are therefore reluctant to go to a hospital, says Mangla Rajbhar, a
42-year-old activist associated with the Varanasi-based People’s Vigilance
Committee on Human Rights. “We have to convince them to go to the hospital. Most
of them prefer to give birth to their babies at home,” he says.

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According
to the <a href="http://rchiips.org/nfhs/NFHS-5Reports/Uttar_Pradesh.pdf">National Family Health Survey-5</a>, about 81 per cent of Scheduled Caste women in UP choose to
give birth at a health facility – 2.4 per cent less than the state’s figure. It
is perhaps a factor in the neonatal mortality rate – number
of deaths during the first 28 completed days of life – which is higher among
the Scheduled Castes (41.6) when compared to the whole state (35.7). In a
survey that Rajbhar conducted in January 2022, out of 64 recent childbirths in seven
Musahar bastis of Baragaon block, 35 were
home births. Lakshima
had opted for it, when she gave birth to her son Kiran in 2020. “I hadn’t forgotten
what had happened earlier. There was no question of going back there [PHC],”
she says. “So I paid an ASHA worker Rs. 500. She came home and helped deliver my
baby. She was also a Dalit.” Like
her, many in the state feel discriminated in a hospital or by a healthcare
professional. In November 2021, rapid surveys done by Oxfam India on patients’
rights found that out of 472 people in UP who responded, 52.44 per cent felt
discriminated on grounds of economic status. About 14.34 per cent felt discriminated because of their
religion and 18.68 per cent on  grounds of caste. The biases have far-reaching consequences;
especially in ensuring health justice in a state where 20.7 per cent the people
belong to the Scheduled Castes and 19.3 per cent to the Muslim faith (Census
2011). It
is why when Covid-19 was spreading in UP, many did not get tested for the
coronavirus. “Many of us in the village fell sick last year but we stayed home,”
says Nirmala, remembering the second wave of the pandemic, in 2021. “Who wants
to be humiliated when you are already scared of the virus?”

But
in Chandauli district’s Amdhha Charanpur village, Salimun, 55, could not opt to
stay home when she fell ill in March 2021. “It turned out to be typhoid,” she
says. “But when I went to the [pathology] lab, the man tried to stay as far away
as possible while inserting the needle to draw blood. He was stretching his
hands. I told him I have seen many like you before.” 

Salimun
was familiar with the lab assistant&#39;s behaviour. “It happened because of the
Tablighi Jamaat incident, because I am a Muslim,” she says, referring to the events
of March 2020. At the time, members of the religious group, who had gathered at
the Nizamuddin Markaz in Delhi for a congregation. Hundreds of them tested
positive for Covid-19 later and the building was declared a hotspot. This was
followed by a dark campaign blaming
Muslims for the spread of the virus. It led to several humiliating experiences
for Muslims in UP and across the country.

To prevent such prejudicial treatment, Neetu Singh, a
43-year-old activist, says she makes it a point to walk through the healthcare
centres she visits. “So that the staff knows I am around, and they will treat
patients well regardless of their class, caste or religion,” she explains. “Otherwise,
the discrimination is rampant,” says Singh, who is associated with an NGO,
Sahyog. She works on women’s health issues in Naugarh block, where Amdhha
Charanpur is located.

Salimun cites more experiences. Her daughter-in-law,
Shamsunisa, 22, experienced complications during childbirth in February 2021. “The
bleeding would not stop. She became weak,” says Salimun. “So the staff nurse at
the PHC asked us to take her to the Community Health Centre in Naugarh town.”

At the Naugarh CHC, an Auxiliary Nurse Midwife examining
Shamsunisa damaged one of her stitches. “I shouted in pain,” says Shamsunisa. “She
raised her hand to slap me, but my mother-in-law held it and stopped her.”

The CHC staff refused to treat her and told the family
to find another hospital. “We went to a private hospital in Naugarh where we
were told to go to Varanasi,” says Salimun. “I was worried for her. She
continued to bleed and we could not get her treated for a whole day after the childbirth.”

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Finally, another private hospital in Naugarh admitted
her the next day. “Some of the staff members there were Muslims. They reassured
us, and the doctors treated her for the next few days,” says Salimun.

When Shamsunisa was discharged a week later, her
medical expenses tallied up to Rs. 35,000. “We sold some of our goats for Rs.
16,000,” says Salimun. “If we hadn’t sold it in a hurry, we would have got at
least Rs. 30,000 for them. My son Farooq had some cash saved, which took care
of the remaining expenses.”

Farooq, 25, Shamsunisa’s husband, works as a labourer
in Punjab. So do his three younger brothers. They struggle to make ends meet
and send home some money. “He [Farooq] could not even spend enough time with [baby]
Gufran,” says Shamsunisa. “But what do we do? There is no work here.” 

“My sons have to migrate to earn money,” says Salimun.
In Naugarh, where tomatoes and chillies are cultivated, landless workers like Farooq
and his brothers would earn only Rs. 100 for a full day’s work. “And half a
kilo of tomatoes or chillies to go with it, twice a week. That is hardly
anything,” says Salimun. In Punjab, Farooq earns Rs. 400 for a day’s labour,
but he gets work only 3-4 times in a week. “We barely managed to survive after
the outbreak of Covid-19. There wasn’t even enough to eat.”

The family has stopped cooking both dal and vegetables on the same day. “It
is the same with rice and roti,” says
Salimun. “It is either one or the other. This is the situation with everyone
here. Most people have had to borrow money just to survive.”

In many of UP’s villages across nine districts, people’s
debt grew by 83 per cent in the first three months of the pandemic (April to
June 2020). The data was gathered through a <a href="https://www.communitycollect.info/community-monitored-accountability">survey</a> 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 per cent respectively.

The dismal situation forced Lakshima to start toiling at
a brick kiln merely 15 days after giving birth to her youngest child in the last
week of December 2021. “I am hoping that the employer will see our situation
and pay us some extra money for food,” she says, cradling the newborn. She and
her husband, Sanjay, 32, each earn Rs. 350 per day at the brick kiln, which is
located in Devchandpur, about six kilometres from their village. 

During her pregnancy this time, Mangla Rajbhar
counselled Lakshima against giving birth at home. “It wasn’t easy to get her to
agree. I don’t blame her for that,” says Rajbhar. “But she agreed eventually.”

Lakshima and Hiramani were prepared this time around. At
the first sign of the staff’s reluctance to admit Lakshima, they threatened to
call Rajbhar. The staff yielded. Lakshima gave birth to her baby inside the
same PHC, just a short distance from which she had lost her child over three
years ago. In the end, it was those few metres that made all the difference.

Parth M.N. reports on public health and civil liberties through an independent 
journalism grant from the Thakur Family Foundation. The Thakur Family 
Foundation has not exercised any editorial control over the contents of 
this reportage.

‘People like us are never treated well’

‘आमच्यासारख्यांशी लोक कधीच चांगलं वागत नाहीत’

’ہمارے ساتھ کبھی اچھا برتاؤ نہیں کیا جاتا‘

'ਇਸ ਸਮਾਜ ਨੇ ਸਾਨੂੰ ਕਦੇ ਇੱਜ਼ਤ ਨਹੀਂ ਬਖ਼ਸ਼ੀ'

'মানুহৰ পৰা আমি কোনোদিন ভাল ব্যৱহাৰ নাপালো'

'మాలాంటి వాళ్లకు ఎప్పుడూ సరైన చికిత్స దొరకదు!'

'અમારા જેવા લોકોની ક્યારેય બરોબર દરકાર લેવામાં આવતી નથી’

'আমাদের মানুষ বলেই মনে করে না'

‘ನಮ್ಮಂತಹ ಜನರನ್ನು ಎಂದಿಗೂ ಸರಿಯಾಗಿ ನಡೆಸಿಕೊಳ್ಳುವುದಿಲ್ಲ'

‘ଆମ ଭଳି ଲୋକମାନଙ୍କୁ କେବେ ମଧ୍ୟ ଭଲ ବ୍ୟବହାର କରାଯାଏ ନାହିଁ’

'ഞങ്ങളോടൊന്നും ഒരിക്കലും നന്നായി പെരുമാറാറില്ല'

'எங்களைப் போன்ற மக்கள் சரியாக நடத்தப்படுவதில்லை'

‘इस समाज में हमें कभी इंसान नहीं समझा गया’

Varanasi

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‘People like us are never treated well’

In Uttar Pradesh's Varanasi and Chandauli districts, discrimination of marginalised communities affects their access to healthcare. For Lakshima and Salimun, the pandemic has brought on even more hardship

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