These Female Healthcare Workers Are Rural India’s First Defense Against COVID-19

Archana Ghugare’s ringtone, a Hindu devotional song, has been the background score of her life since March. By 7 a.m. on a mid-October day, the 41-year-old has already received two calls about suspected COVID-19 cases in Pavnar, her village in the Indian state of Maharashtra. As she gets ready and rushes out the door an hour later, she receives at least four more.

“My family jokes that not even Prime Minister Modi gets as many calls as I do,” she says.

Ghugare, and nearly a million other Accredited Social Health Activists (ASHAs) assigned to rural villages and small towns across India, are on the front lines of the country’s fight against the coronavirus. Every day, Ghugare goes door to door in search of potential COVID-19 cases, working to get patients tested or to help them find treatment.

With 8 million confirmed COVID-19 cases, India has the second-highest tally in the world after the United States and its health infrastructure struggled to cope with the surge in COVID-19 patients this summer. India spends only 1.3% of its GDP on public health care, among the lowest in the world. The situation is stark in rural areas where 66% of India’s 1.3 billion people live and where health facilities are scant and medical professionals can be hard to find.

India’s ASHA program is likely the world’s largest army of all-female community health workers. They are the foot soldiers of the country’s health system. Established in 2005, a key focus of the program was reducing maternal and infant deaths, so all recruits are women. They have also played an essential role in India’s efforts to eradicate polio and increase immunization, according to numerous studies.

Read More: How the Pandemic Is Reshaping India

But even as health authorities have leaned on ASHAs to quell the spread of COVID-19 in rural areas, where a substantial number of new cases have been reported, many of these health care workers say the government is failing them. Pay was meager to begin with, but some workers have reported not being paid for months. Their hours have increased dramatically, but pay rises, when they have come, have not reflected the increased demands. Many ASHAs have also complained about not being provided adequate protective equipment for their high-risk work.

“They are the unsung heroes who are fighting to contain the unfettered spread of the virus in rural areas,” says Dr. Smisha Agarwal, Research Director at the John Hopkins Global Health Initiative. She argues it is vital to improve pay to boost morale and sustain this frontline workforce.

Ghugare was chosen from her village of 7,000 people in 2011. Since then, she has overseen countless births, meticulously monitored the health of thousands of newborn babies and strictly ensured immunization through door-to-door awareness campaigns. The personal relationships she built over the years have helped in the fight against COVID-19, giving her a good grasp of the medical histories of most of the 1,500 people assigned to her. “It’s all in

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They met in Hawaii and built a life in rural Maryland. This fall, they died two days apart.

When the chief barber retired, Doris took over the first chair. She knew everyone, said her grandson, Jeffrey Grim.

“When she was in the hospital, her respiratory therapist said, ‘Did you cut hair?’ and she was like, ‘Yeah,’ ” Grim recalled in an interview, describing Doris’s hospitalization for covid-19 this summer. The respiratory therapist then said, “ ‘My dad used to take me to you when I was a little boy.’ ”

Doris Bender died of complications of coronavirus on Sept. 3, in Room 4107 of Meritus Medical Center Intensive Care Unit in Robinwood. Jacob had died Sept. 1 in the same hospital, also of covid-19, in Room 4109.

Jacob, who was 83, died at 2:36 p.m.. Doris, who was 81, died at 2:34 p.m.

“Two days apart, two minutes apart, two rooms apart,” said Grim, a PhD candidate at the University of Michigan at Ann Arbor. “It’s really hard to lose both of them at the same time. My family will never be the same. And they were old, but I think we would have had a lot more years with them, if it wasn’t for covid.”

Grim said he isn’t certain how his grandparents contracted the virus. He remembers that the couple came into contact with someone who had the virus, but tested negative shortly thereafter. In August, Doris began experiencing heart attack-like symptoms.

“When they took her to the hospital, as protocol they did a covid test and found out that it was indeed the covid that was attacking her lungs and heart,” Grim said.

Jacob, who Grim called Pap-Pap, tested positive two days later, on Aug. 14. He was home for two weeks after Doris was hospitalized, but then his condition grew worse.

“All of a sudden, he just went downhill quickly” Grim said. “And we really think that because Grandma was such a caretaker, she wanted to make sure he passed before she was ready to go.”

Grim said that after Doris died, the family found a notebook where she kept count of how many newborn hats she had made for the hospital: 3,241 in all.

Before the pandemic, Doris enjoyed going out to play Bingo with her daughter Theresa on Wednesday nights and playing a Japanese card game called Hanafuda on Sundays, Grim said. She hated staying home during the pandemic, and even called it “jail.”

The couple tended to their garden, where they planted vegetables such as tomatoes, peppers, and squash. Grim said when Doris was in the hospital, the doctors told the family she was delirious and was talking about her cantaloupes being ready. But when Grim visited the garden afterward, he found “two perfectly bright cantaloupes.”

Doris would have turned 82 last week. The family didn’t come together to observe her birthday out of safety concerns. But Grim and his brother, Josh, bought anthuriums, a tropical flower their grandmother loved, to put on her grave.

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Biden vs. Trump: ObamaCare, access to health care in rural US impacts voters’ decisions

Kathleen Wishnick left the hustle and bustle of Sacramento for a new life in the rural deserts of Arizona more than 15 years ago.

She said her family wanted a “place in the middle of nowhere” and they found it in the small town of Arivaca, which boasts a population of about 684 people.

The peaceful setting has its perks, Wishnick told Fox News, but when it comes to health care, access is almost nonexistent.

“The roads when it rains are iffy…sometimes ambulances can’t get in… people said to us, ‘Well you won’t have any health services,’ I said well it’s just a helicopter ride away, but when it happens to you, you tend to rethink that just a little bit,” she said.

ARIZONA’S BATTLEGROUND COUNTIES START TALLYING EARLY BALLOTS

Kathleen Wishnick lives in Arivaca, Arizona, home to around 684 people. She says access to health care can be a challenge, as the nearest hospital is over an hour away (Stephanie Bennett/Fox News).

Kathleen Wishnick lives in Arivaca, Arizona, home to around 684 people. She says access to health care can be a challenge, as the nearest hospital is over an hour away (Stephanie Bennett/Fox News).

Wishnick says the town does have a clinic, but it’s only open certain days a week and has just two doctors. For more advanced procedures or to see a specialist, it involves driving to the closest hospital about an hour away.

With only days until the 2020 presidential election, the topic of health care access, insurance and affordability is front and center in Wishnick’s mind — and she is not alone.

According to the Kaiser Family Foundation, about 2.8 million Arizonans live in areas that the federal government says has a health care shortage — ranking 9th in the country overall.

“I believe everyone in Arizona and across the United States should have access to care,” Dr. Daniel Derksen, associate vice president for health sciences at the University of Arizona and director of the Arizona Center for Rural Health, told Fox News. “We are certainly spending enough as a nation and spending enough as a state to cover every single person with the care that they need, so that they get it when they need it, such as during a COVID-19 pandemic.”

Arivaca, Arizona is about 60 miles south of Tucson (Stephanie Bennett/Fox News).

Arivaca, Arizona is about 60 miles south of Tucson (Stephanie Bennett/Fox News).

THE PRESIDENTIAL ELECTION COMES DOWN TO THESE 9 STATES

Derksen said the Affordable Care Act – or ObamaCare – which former Vice President Joe Biden wants to protect and expand, is a good thing and would be harmful to rural residents to lose.

“We need to make sure that coverage is built upon not torn away … we need to build on the gains made, not throw things away and especially during a time where people really need the health care and access,” he added. “The Affordable Care Act does protect individuals from being charged more or being denied coverage or dropped from coverage once they exceed a certain amount.”

He said that about 20 million Americans could lose their health care – and more than half a million Arizonians – if provisions in the health care act went away.

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‘Weekend Effect’ Affects Survival Odds for Rural Stroke Patients | Health News

By Robert Preidt, HealthDay Reporter

(HealthDay)

WEDNESDAY, Oct. 21, 2020 (HealthDay News) — Stroke patients have a higher risk of death if they’re admitted to a rural hospital on the weekend, a new study finds.

University of Georgia researchers analyzed 2016 data on stroke deaths at U.S. hospitals to learn whether the so-called “weekend effect” influenced stroke outcomes.

“The weekend effect is the phenomenon where the risk of bad or adverse outcomes, such as mortality in our study, increases for those who are admitted to the hospital over the weekend as opposed to a weekday,” said lead author Birook Mekonnen, who was a graduate student in the College of Public Health when the research was conducted.

There was evidence to support the weekend effect in all hospitals. But outcomes were especially poor for rural patients who had hemorrhagic (bleeding) strokes on a weekend, as opposed to ischemic strokes (ones caused by blocked blood flow to the brain).

But the time of week may be just one factor in unfavorable outcomes for rural stroke patients, according to study co-author Donglan Zhang, an assistant professor of health policy and management in public health.

Zhang noted that rural hospitals tend to have fewer resources, including stroke specialists and equipment for particularly severe cases. They also serve a wider area and it’s not uncommon for rural patients to be more than an hour’s drive from the nearest hospital.

The researchers said one way to protect stroke patients from the weekend effect is to invest in telemedicine. They noted that more rural hospitals are joining telestroke care networks, enabling them to connect with specialists and collaborate on treatment for stroke patients.

Mekonnen advised people who are at risk for stroke or other major health problems to look into the telemedicine options available to them. “This may be the new norm,” he said in a university news release.

The findings were published in the October issue of the Journal of Stroke & Cerebrovascular Diseases.

The American Academy of Family Physicians has more on stroke.

Copyright © 2020 HealthDay. All rights reserved.

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Rural Midwest hospitals struggling to handle coronavirus surge: “It just exploded”

Rural Jerauld County in South Dakota didn’t see a single case of the coronavirus for more than two months stretching from June to August. But over the last two weeks, its rate of new cases per person soared to one of the highest in the nation.

“All of a sudden it hit, and as it does, it just exploded,” said Dr. Tom Dean, one of just three doctors who work in the county.

Virus Outbreak Rural Spread
Dr. Tom Dean poses at his clinic in Wessington Springs, S.D., on Friday. Oct. 16, 2020.

Stephen Groves / AP


As the brunt of the virus has blown into the Upper Midwest and northern Plains, the severity of outbreaks in rural communities has come into focus. Doctors and health officials in small towns worry that infections may overwhelm communities with limited medical resources. And many say they are still running up against attitudes on wearing masks that have hardened along political lines and a false notion that rural areas are immune to widespread infections.

Dean took to writing a column in the local weekly newspaper, the True Dakotan, to offer his guidance. In recent weeks, he’s watched as one in roughly every 37 people in his county has tested positive for the virus.

It ripped through the nursing home in Wessington Springs where both his parents lived, killing his father. The community’s six deaths may appear minimal compared with thousands who have died in cities, but they have propelled the county of about 2,000 people to a death rate roughly four times higher than the nationwide rate.

Rural counties across Wisconsin, North Dakota, South Dakota and Montana sit among the top in the nation for new cases per capita over the last two weeks, according to Johns Hopkins University researchers. Overall, the nation topped 8 million confirmed coronavirus cases in the university’s count on Friday; the true number of infections is believed to be much higher because many people have not been tested.

In counties with just a few thousand people, the number of cases per capita can soar with even a small outbreak – and the toll hits close to home in tight-knit towns.

“One or two people with infections can really cause a large impact when you have one grocery store or gas station,” said Misty Rudebusch, the medical director at a network of rural health clinics in South Dakota called Horizon Health Care. “There is such a ripple effect.”

Wessington Springs is a hub for the generations of farmers and ranchers that work the surrounding land. Residents send their children to the same schoolhouse they attended and have preserved cultural offerings like a Shakespeare garden and opera house.

They trust Dean, who for 42 years has tended to everything from broken bones to high blood pressure. When a patient needs a higher level of care, the family physician usually depends on a transfer to a hospital 130 miles (209 kilometers) away.

As cases surge, hospitals in rural communities are having trouble finding beds. A

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Rural hospitals in Midwest face viral surge

WESSINGTON SPRINGS, S.D. — Rural parts of the American Midwest that had previously escaped the worst of the coronavirus are now seeing a surge — and hospitals are struggling to keep up.

Counties across Wisconsin, North Dakota, South Dakota and Montana sit among the top in the nation for new cases per capita over the last two weeks, according to Johns Hopkins researchers. In counties with just a few thousand people, the number of cases per capita can soar with even a small outbreak — and the toll hits close to home in tight-knit towns.

As the brunt of the virus has blown into the Upper Midwest and northern Plains, the severity of outbreaks in rural communities has come into focus. Doctors and health officials in small towns worry that infections may overwhelm communities with limited medical resources. And many say they are still running up against attitudes on wearing masks that have hardened along political lines and a false notion that rural areas are immune to widespread infections.

Even as outbreaks threaten to spiral out of control, doctors and health officials said they are struggling to convince people of the seriousness of a virus that took months to arrive in force.

___

HERE’S WHAT YOU NEED TO KNOW ABOUT THE VIRUS OUTBREAK:

— Britain’s Space Agency is backing a medical drone delivery service that aims to move virus samples, test kits and protective equipment between hospitals.

— A spike in cases in Europe deals a bitter blow to the economy.

— In Germany, Chancellor Angela Merkel warned of “difficult months” ahead as the nation posted another daily record of new cases Saturday.

— Iran announces its virus death toll has reached 30,000.

— AP PHOTOS: India holds digital fashion week amid pandemic.

___

— Follow AP’s pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

___

HERE’S WHAT ELSE IS HAPPENING:

ROME — The Vatican says someone who lives in the same Vatican hotel as Pope Francis has tested positive for coronavirus, adding to the 11 cases of COVID-19 among the Swiss Guards who protect him.

The Vatican said Saturday that the resident of the Domus Sanctae Marthae has moved out temporarily and is in isolation, as are all the people who came into direct contact with him.

The hotel serves as a residence for Vatican-based priests as well as visiting clerics and lay people. Francis chose to live there permanently after his 2013 election, shunning the Apostolic Palace, because he said he needed to be around ordinary people. The hotel has a communal dining room and chapel where Francis celebrates Mass each morning.

The Vatican, a tiny city state in the center of Rome, has beefed up its anti-COVID-19 measures amid a resurgence of the outbreak in Italy. Protective masks are required indoors and out, but Francis has largely shunned them even when holding audiences with the public.

At 83 and with part of a lung removed when he was in his 20s due to illness, the pope would be at

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Rural Midwest hospitals struggling to handle virus surge

WESSINGTON SPRINGS, S.D. (AP) — Rural Jerauld County in South Dakota didn’t see a single case of the coronavirus for more than two months stretching from June to August. But over the last two weeks, its rate of new cases per person soared to one of the highest in the nation.

“All of a sudden it hit, and as it does, it just exploded,” said Dr. Tom Dean, one of just three doctors who work in the county.

As the brunt of the virus has blown into the Upper Midwest and northern Plains, the severity of outbreaks in rural communities has come into focus. Doctors and health officials in small towns worry that infections may overwhelm communities with limited medical resources. And many say they are still running up against attitudes on wearing masks that have hardened along political lines and a false notion that rural areas are immune to widespread infections.

Dean took to writing a column in the local weekly newspaper, the True Dakotan, to offer his guidance. In recent weeks, he’s watched as one in roughly every 37 people in his county has tested positive for the virus.


It ripped through the nursing home in Wessington Springs where both his parents lived, killing his father. The community’s six deaths may appear minimal compared with thousands who have died in cities, but they have propelled the county of about 2,000 people to a death rate roughly four times higher than the nationwide rate.

Rural counties across Wisconsin, North Dakota, South Dakota and Montana sit among the top in the nation for new cases per capita over the last two weeks, according to Johns Hopkins researchers. In counties with just a few thousand people, the number of cases per capita can soar with even a small outbreak — and the toll hits close to home in tight-knit towns.

“One or two people with infections can really cause a large impact when you have one grocery store or gas station,” said Misty Rudebusch, the medical director at a network of rural health clinics in South Dakota called Horizon Health Care. “There is such a ripple effect.”

Wessington Springs is a hub for the generations of farmers and ranchers that work the surrounding land. Residents send their children to the same schoolhouse they attended and have preserved cultural offerings like a Shakespeare garden and opera house.

They trust Dean, who for 42 years has tended to everything from broken bones to high blood pressure. When a patient needs a higher level of care, the family physician usually depends on a transfer to a hospital 130 miles (209 kilometers) away.

As cases surge, hospitals in rural communities are having trouble finding beds. A recent request to transfer a “not desperately ill, but pretty” sick COVID-19 patient was denied for several days, until the patient’s condition had worsened, Dean said.

“We’re proud of what we got, but it’s been a struggle,” he said of the 16-bed hospital.

The outbreak that killed Dean’s dad

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Rural living, chronic illness and COVID-19

PRAIRIE, Miss. (AP) — COVID-19 hit Prairie native Shirley Judd suddenly and hard. One day in late August, she felt fine; the next, she could barely move.

As soon as the symptoms struck, Judd called her aunt to take her to West Point to see a doctor, where she tested positive for COVID-19.

“When I got home, I had to go straight to bed. I couldn’t even sit up or do anything. I had headaches starting off, and I was just shaking, throwing up,” Judd said. “After about four days, or five, that’s when my throat got so sore I couldn’t swallow. I couldn’t eat anything.”

She visited another doctor in Houston on Labor Day and received shots and antibiotics. By Wednesday, her condition worsened. She was losing weight, and her mouth was swollen. At approximately 8 a.m., she checked into the North Mississippi Medical Center in Tupelo for treatment.

What made Judd’s experience more harrowing was that she has multiple sclerosis, a chronic illness that affects the central nervous system. Judd is 53 and has been on disability for the condition since 1987. She has had two hip replacements because of MS, and changes treatments every two years. She receives infusion treatments every six months and thought her initial illness resulted from MS flaring rather than a COVID-19 diagnosis.

The Centers for Disease Control and Prevention have long said people with underlying medical conditions and older adults are at increased risk for severe illness from COVID-19. While the National Multiple Sclerosis Society website states that current evidence suggests MS doesn’t increase the risk of dying from the COVID-19, possible long-term consequences of MS, age and higher levels of disability can increase the risk of being hospitalized for COVID-19.

Judd’s primary concern was maintaining her household while recovering, and she’s grateful family members stepped in to help. Family friend Lee Thomas did most of her cooking and cleaning, and cousins Yolanda Ewing and Chris Ewing helped bring supplies and food to her.


“Everything and everybody was really good about helping me out until I got straightened out and could get around,” Judd said. “That was a blessing.”

Judd also received financial support from Okolona-based nonprofit Excel Inc. by applying for the COVID-19 Support Fund, which is available to people affected by COVID-19. The organization paid her water and light bills while she was recovering.

“With Excel, I appreciate what they did because at the time, I couldn’t do anything,” Judd said. “It was a blessing and a miracle.”

Judd is also Black and lives in a rural community, both factors the CDC claims might require extra precautions against COVID-19. As of Oct. 11, Black Chickasaw residents of Non-Hispanic and unknown ethnicity were 49% of Chickasaw’s 777 cases since March 11, according to the Mississippi State Department of Health. The U.S. Census Bureau estimates Black people are approximately 45% of Chickasaw’s population. Statewide, Black people account for 48% of COVID-18 cases as of Oct. 4, despite only representing 38% of the

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