Lugging their luggage, a team of medical professionals and forest department officials waded through knee-deep water and trekked mountains in early May 2021, to reach their posting area bordering Tamil Nadu and Kerala — the Murugala hamlet in Attapadi, a protected area in Palakkad district, which is home to several vulnerable tribal groups. The Kerala government entrusted the team with a big task: to control the COVID-19 situation in more than 100 tribal hamlets in Attapadi, which, until late April, managed to keep the spread under control. Many tribal hamlets in Attapadi did not officially report any COVID-19 cases in the first wave of the pandemic.
However, those tribal hamlets across Tamil Nadu and Kerala, which managed to escape the first wave of the pandemic with little or no COVID-19 cases, have now found themselves among the worst-hit regions in the second wave. The spike in cases has also posed an increased threat to the already vulnerable group of people. While detection and quarantine facilities have been set up in many tribal communities, the lack of access to infrastructure has added to their woes in this pandemic.
The tribal residents alleged that tourism, and recent Assembly election rallies, majorly contributed to the spread among tribal hamlets. Doctors working in some hamlets also noted that many residents returned home from other villages and neighbouring states due to the lockdown. Due to the lack of employment opportunities, some tribal residents move to neighbouring states or districts in search of employment.
The common challenge doctors face is the sudden spike in cases since many tribal residents are asymptomatic and continue to participate in community activities. Dr Vineet, who works at the Pudur PHC in Attapadi, said that the culture among the tribal people to function together poses a risk and challenge during the pandemic. He said, “The cases have increased in the past few weeks and we are shifting all patients to community care centres to avoid any risk.”
Besides, many are being exposed to COVID-19 only now, in the second wave. Currently, Dr Vineet said he is treating around 70 patients at the PHC and a quarantine centre at Pudur Boy’s Hostel. “However, this is the first time there is a spike in cases in Pudur and the rest of Attapadi. In the first wave, there were only a few cases but now, the cases are continuing to surge, which is mainly since they are getting exposed to the virus for the first time,” he said.
Located 25 kilometres from Mannarkkad Taluk in Palakkad, Attapadi is the worst-affected region in the district in the second wave, with at least 1,000 COVID-19 cases among the residents so far. The medical force was also tasked with educating the residents about the pandemic, apart from treating them. To curb the cases, the doctors in the Attapadi have drafted a strategy of surveillance by randomly testing people in each hamlet. “Fortunately, we managed to reduce the hesitancy among the residents since many are self-reporting and taking the tests,” said Dr Vineet.
According to Raja, a resident of Attapadi, there were less than 100 COVID-19 cases across all panchayats in Attapadi in the first wave. “However, now, more residents are testing positive for the novel coronavirus and the number of cases, so far, have crossed 1,000. Last year, the panchayat officials had sensitised the residents here about COVID-19. This time, the forest department is also monitoring us,” he said.
In Attapadi, most of the families report to the Primary Health Centre (PHC) and COVID Care Centres (CCCs) as soon as they develop cough or fever, he said. “As soon as a person starts developing symptoms of fever, he/she will be tested in the nearby PHC. Once the test shows positive, they are kept in quarantine in the CCCs.” The patients diagnosed with COVID-19 are kept in the COVID care centres for quarantine for a minimum of seven days. A few colleges have also been used as COVID Care Centres. These patients are served food through the community kitchens set up in the region.
The residents in the tribal hamlets of Attapadi are not allowed to quarantine at home, whether they are symptomatic or asymptomatic, he explained. “If cases go undetected, the patients will be identified during the forest patrol or the testing done by the healthcare officials in the hamlets,” added Raja.
Though the process of detection and quarantine are common among the tribal communities, medical infrastructure is a major cause for concern for many people of other tribal hamlets, especially in the Nilgiris. In some tribal areas, the issue of lack of access to the healthcare system and basic infrastructure has only become more pronounced during the pandemic.
In Tamil Nadu, the Nilgiris is one of the worst COVID-19-affected areas among the western districts. In the Nilgiris, which has a high tribal population, 37 people died due to COVID-19 in May, which is the highest reported death toll in the district since the pandemic began. Until then, the district reported only five deaths between January and April in 2021. In early May, the Nilgiris was recording 100 COVID-19 cases per day, and now, the district is reporting 400 cases per day.
Although the officials conduct testing and have set up a quarantine facility at a government college in the Nilgiris, the lack of infrastructure also poses a problem for the patients amid the surge. In Gudalur, many people residing in the forest do not have access to transportation, especially during the lockdown, which restricts them from travelling for medical emergencies or even to pharmacies. Also, for many people residing in interior areas, the Primary Health Centre in Gudalur is two to three kilometres away. They are also forced to travel to Gudalur town even for purchasing medicines, which becomes difficult for those who do not have any means of transportation.
Thangaraj, a resident of Gudalur, said, “The medical officers are reaching out to all the tribal hamlets and are conducting the COVID-19 tests. When a person tests positive for coronavirus, he/she is taken to COVID care centres. However, the problem arises only when the patient develops complications since the infrastructure in Gudalur Government Hospital is limited.” As a result, he said, patients with severe symptoms are forced to travel to Ooty, Coimbatore or Kerala for treatment. “Besides, there are only a limited number of ambulances here, so transporting patients becomes difficult,” added Thangaraj.
He also said that due to some awareness, people understood that there was another COVID-19 spike when the lockdown was imposed. “Since it’s a virus spread, they related it to infections such as smallpox and remained at home during the second wave,” he said. However, he said, the COVID-19 spread is huge among Paniyar and Katunaikar tribal groups, who continue to live as a community. He also said that the spread of infection is higher among these tribal populations could be due to the lack of physical distancing as two or more tribal families share the same makeshift houses.
In the Nilgiris, a few activists working closely with the people have sought the help of the Tamil Nadu Health Department to increase the vaccination drive. In the Nilgiris, Badhri, an activist working with the communities, said, “More tribals are being exposed to the novel coronavirus for the first time since the pandemic began last year. Also, the displacement and other factors are making them more vulnerable to the virus and vaccinating the tribals is the only way out.”