Covid dispatches: An account of how quacks ‘treated’ patients in absence of doctors in rural Bihar

While I reported that fewer people were going to Patna’s top COVID hospitals, I also needed to understand the situation in rural Bihar. Who was treating the patients in villages?

To investigate this, Sajid and I travelled together to Arrah (Bhojpur) district on May 8, 2020. In various blocks, clinics were closed, leaving patients to fend for themselves. Abandoned by the system, patients were left in the care of pharmacists or village quacks, commonly known as jhola-chhaap doctors. These ad-hoc rural healthcare providers had become the first line of treatment.

A quack is typically a male who has spent substantial time assisting qualified doctors or working in hospitals before starting his own rural clinic; he is essentially a layman with an elementary knowledge of medicine.

Although there is no concrete data on the exact number of quacks in India, a 2018 report published in Mint estimated that over 1 million quacks were active in the country at the time. In Bihar, which has over 44,000 villages and a predominantly rural population, more than 400,000 quacks are estimated to be operating. In comparison, West Bengal is estimated to have around 100,000 quacks. The numbers for Bihar are significantly higher than those for other states.

The quacks outnumber qualified doctors in India’s heartland, where healthcare is often inadequate.

Bihar consistently struggles with a low doctor-to-population ratio. According to the data released by the Directorate of State Health Services and the National Health Profile in 2018, Bihar had the lowest ratio of doctors to population in the country, with one government-employed doctor for every 28,391 people, compared to the national average of one for every 11,082 people.

This shortage paved the way for quacks to step in, especially in rural areas with little to no medical infrastructure. Since the lockdown was imposed in 2020, the reliance on quacks only increased significantly.

The trust and respect quacks command within rural communities is surprising. During the peak of the second wave, villagers saw them as their only hope, even though they frequently misdiagnosed COVID as typhoid or fever, leading to delays in appropriate treatment, and, in some cases, resulting in death.

But district hospitals were a complete nightmare for people. Take Arrah’s only COVID hospital, for example. Infected patients lay on the floor with no nurses in sight. Six ventilators, purchased with PM CARES funds, remained locked in a room because no one was trained to use them. X-ray and CT scan machines also lay unused in locked rooms.

The situation at Sadar Hospital was so dire that Munna Chaudhary, an attendant, told me, “We drove all the way from Aurangabad, over 110 km from Arrah, to Sadar, but the situation here is so grim. Patients are returning to their villages because the staff refuses to care for them. I’ve been monitoring my brother-in-law’s oxygen levels myself.”

An official from the district administration was equally frustrated.

“We don’t even have enough ward boys to clean the hospital. No one wants to wear a PPE kit for hours on end while working. Workers leave after four days in the COVID ward. There is an acute shortage of staff.”

Even 50 km away from the Sadar Hospital, word had spread that it was nothing short of hell.

To learn more about the villages, we drove to the Sahar block, where, in Pirhap village, I met the sarpanch, Satish Sharma.

“Jo hospital ja raha hai, woh wapis nahin aa raha. Toh logon ne ghar par hi treatment karna shuru kar diya,” he told me. (Whoever is going to the hospital isn’t returning alive, so people have started getting treatment at home.)

In the last 45 days, 30 people had died of COVID in his village.

“There is no point rushing to towns now,” Sharma said.

As we walked through the village lanes, we saw returned migrants and farmers gathering for their evening chats. COVIDwas the main topic of discussion. We knocked on many doors to check on villagers. Along the way, we encountered a quack named Sipahi. He introduced himself as a doctor practising in the village.

We followed him into the house of a 65-year-old woman suffering from gastric issues, despite consistently taking the medicines Sipahi had prescribed on his last visit.

“I always carry medicines like paracetamol, Azithral, Chloramphenicol and Vitamin C tablets with me, so that I can treat people anywhere,” Sipahi told us. He gave the woman some new pills since the previous ones hadn’t worked, and instructed her son to ensure she took them on time.

Sipahi wasn’t the only quack in Pirhap. Another one, Sourab Kumar Sharma, also worked there. Both had built a dedicated and loyal patient base over the years.

Sourab Kumar Sharma had gained experience by working at Arrah’s Sadar Hospital, observing doctors and nurses for a long time, before starting his own practice. “I was an ICU in-charge at Arrah’s Sadar Hospital for two years,” he said.

Back in my village – Rasulpur in the Mahendragarh district of Haryana – too, people were falling sick.

My mother shared various conspiracy theories that she had heard while working in the fields.

“Beta, bukhar ho rakhya hai sabke. Koi kahe hai ki China ne ye bukhar apne desh mein chhod diya,” she told me over the phone. (Everyone has a fever. Some say that China has spread this fever in our country.)

Thirty kilometres from my village in Haryana is Manethi, where my bua (paternal aunt) lives. She also spoke of a mysterious fever that had gripped her village.

“Typhoid ho gaya hai logon ko.” (People have contracted typhoid.)

With no testing facilities available in the villages, people called it different names – a mysterious fever, typhoid – or even thought it to be just a common cold.

Far away from home, I was anxious for my folks in Haryana. In my dreams, I saw only dead bodies, SOS messages and hospitals. My phone gallery now had over 1,000 photos of cremation grounds, dead bodies strewn in hospitals and grieving families.

Back in Pirhap, upon seeing us, the villagers covered their faces with gamchhas.

They had heard that surgical masks carried germs and could cause disease, so they preferred gamchhas. “Modi-ji bhi gamchha pahante hain. Unko virus kuch nahi karega toh humko kya karega.” (Even Modi-ji wears a gamchha. If the virus doesn’t affect him, it won’t affect us either.)

Arrah, a rural district with twelve blocks and a population of 27 lakh, had 54 active cases on April 5, 2021. By May 9, the number had risen to 830. Yet, the district was testing only about 2,000 samples a day on average. A large section of the rural population was suffering from COVID-like symptoms, yet only a limited number of test samples were collected. The reported active cases reflected only those within the sample group, while countless others were left unaccounted for.

District Magistrate Roshan Kushwaha insisted that patients coming to Sadar Hospital were not being turned away.

“Even if we don’t have a bed, we will provide oxygen. We have patients coming from Patna and Bihta as well. We have also roped in six private hospitals. But the numbers have been overwhelming for the past 15 days.”

When asked about the rural population left to fend for themselves, he replied, “For the rural belt, we have primary health centres and community health centres. We have prepared kits with treatment protocol medicines. We are testing people at the village level and distributing the kits.”

As Sajid and I travelled to other villages, we consistently observed quacks treating the patients with COVID-like symptoms.

We met a general physician in Khaira market, who introduced himself as Dr Mukesh Kumar. Khaira is a town located approximately 30 km away from the Arrah district headquarters.

“I treat 90% of them. They recover with the help of the COVID-19 medicine kit. But the remaining 10 per cent have breathing problems. I refer them to Sadar hospital.”

Dr Mukesh Kumar ran a makeshift clinic in a shuttered shop with just a bench for patients to sit on. Located in a lane at the back of the market, his clinic, despite its dubious appearance, had become a lifeline during the second wave.

We also tracked down a quack named Mangal Singh, who was operating from the same market as Dr Mukesh Kumar.

“I wanted to become a doctor, either by studying or practising medicine,” Singh told us. Mangal Singh couldn’t get into a medical college and ended up with a bachelor’s degree in Zoology. He now introduced himself as Dr Mangal Singh, and made a decent living as a quack.

When we spoke to the district magistrate, he mentioned plans to circulate two-minute video clips by renowned doctors in the district on how to handle mild COVID-19 cases. This initiative aimed to educate not only government-affiliated rural healthcare workers but also the quacks.

Excerpted with permission from Faith and Fury: COVID Dispatches from India’s Hinterland, Jyoti Yadav, Westland.