- Jagriti Gangopadhyay
Image: REUTERS/Flavio Lo Scalzo |
Introduction
Phrases
such as physical distancing, quarantine and isolation have become a part of
common parlance due to COVID-19. Long before the spread of the novel
coronavirus, institutionalised isolation was a norm not unknown in the distant
past of Europe. Through the sanction of the Church, the sick considered as the
spiritually unclean were compelled to move to institutionalised isolation of
the contagious (Pelling, 1993). Those infected by leprosy, tuberculosis and
malaria were often isolated to prevent the mass spreading of diseases (Porter,
1999). In the nineteenth century, despite coerced isolation, diseases such as
cholera and typhus could not be prevented from infecting a large number of population
across Europe, the United States of America and India. In particular, the
character of the two epidemics owing to these diseases indicated that
traditional patterns of quarantine and institutional isolation was inadequate
to control the spread of the diseases. As a result, instead of isolating
patients, State policies began focussing on external environmental factors and
shifted patients to homecare to contain the epidemics (Pelling, 1978; Porter,
1999).
Presently,
as the COVID-19 cases surge in India and the pressure mounts on hospitals, it
is important to understand and value home care as a major alternative.
COVID-19 and Home-based Medical Care
With
an increase in COVID-19 cases the hospitals ran out of beds and the Ministry of
Health and Family Welfare, Government of India issued guidelines for patients
with mild symptoms and asymptomatic patients to be treated through home
isolation. Recently in Delhi, four out of every five patients who were under
home isolation have recovered. As 80% of the patients were asymptomatic, they
were not hospitalised and recovered while staying at home (Mishra, 2020). Similarly,
in July, 14,800 patients in Mumbai recovered through home isolation (Thakkar, 2020). Given the pressure on
limited hospital beds across India, home care emerged as one of the solutions
for COVID-19 recovery for patients with
mild and asymptomatic patients.
For
most patients, home-cooked food and the presence of other family members within
the house acted as a massive source of support and increased their emotional
wellbeing during their recovery period. In joint families where several members
of the same family tested positive for the virus, the joint family as a unit
provided support to each other (Pathi, 2020). Apart from relying on family
members, help offered by health workers and health professionals through
various forms of technology such as video calls and WhatsApp calls has also
ensured the recovery of many patients in home isolation (Marathe & Marathe,
2020).
Source: The Economic Times |
Seizing
home care as a growing business opportunity, many private hospitals have tied
up with private insurance companies and are providing health care packages for
home isolation of patients. Promoting home care as ‘comfortable’, ‘cost-effective’
and ‘infection-free’, these companies are building home-based medical care as
an industry in India. For instance, Max Healthcare has launched a 15-day remote
monitoring homecare package for patients in Delhi, with starting costs at Rs 333
per day (Mitra, 2020). This package touted as “patient-friendly and affordable”
will monitor the health of the patient. Similarly, Tribeca, a home care company
based in Kolkata, also witnessed a surge in demand since the outbreak of the
pandemic (Roy, 2020). In particular, experts have predicted that with COVID-19,
the home care market will continue to rise (Health Biz, 2020).
Though
home care is being projected as a major alternative to institutionalised care
in hospitals for COVID-19, the home as a
unit of care has always existed in India. What cannot be glossed over, however,
is that it is mostly women, disproportionately so who are the caregivers. Not
only is the majority of informal care provided by family members, but the
majority of family-caregiving is also carried out by women. Family-caregiving
remains a predominantly feminine activity even though with changing
demographics and changes in social structures and norms, men may assume roles
as caregivers.[i]
Spaces of care
Traditionally
in Indian society home care, including home-based medical care, was common.
Over the years, with the development of institutionalised care, there was a
decline in dependency on home care. Notably, post-liberalisation, the
financially stable in India, relied on private hospitals for healthcare
(Tiwari, 2020). As India’s public healthcare system deteriorated, most of the
upper and middle class chose to shift to private hospitals to meet their healthcare
needs. However, with COVID-19, the home has resurged as a space of care.
Identifying
institutional spaces of care as ‘total institutions’, Erving Goffman (1962), in
his book, The Asylum, had explained that while human nature is diverse,
institutional norms within the mental asylums transform the self-perception of
the patient. Similarly, critiquing the hospital, Michael Foucault (1963), in
his seminal book, “The Birth of a Clinic”, argued that the hospital as a space
is professional and lacks a personal touch. Predicting the future of hospitals
to be overtaken by capitalism, Foucault had suggested that gradually hospitals
would turn into a space devoid of any ethics and morality.
The
private hospitals are often associated with efficiency, technology, safety and
hygiene. However, private hospitals can also become lonely and professional
spaces devoid of any emotional attachment for the patient. Against this
backdrop, the home emerges as a space of care which meets the emotional as well
as physical requirements of patients. The family provides psychological
strength. Scholars of family sociology have written extensively on how the
family in India, acts as a huge support system during times of crisis (Desai,
1964; Shah, 1973; Madan, 2011). Indeed families can be a “haven in a heartless world”. But
this view of the family is limited in certain crucial respects. First, many
families, rather than based on love and consent, are based on coercion. Real
families are often characterised by disagreements, and in the extreme, by
violence. In these families, the idea of the home as a unit of care may lead to
a greater burden on caregivers, usually women. Second, even in loving families,
women are made vulnerable by the unequal division of labour in the family, by
assumptions about child-rearing and household responsibilities.[ii]
Home
care and family support in India, have emerged as alternatives to
institutionalised care during the COVID-19 pandemic. However, there do exist dimensions
of home care that needs to be taken into account. Most importantly, issues of
inequalities and disparities between homes. What kind of homes do a vast majority
of people in India live in? Or issues of burden of caring - who cares in the
family? Despite its limitations, home as a space for care needs to be explored by
the state and other players and mechanisms for efficient, accessible and
quality home care.
References:
Desai,
P.I. (1965). Some Aspects of Family in
Mahuva; a Sociological Study of Jointness in a Small Town. New York: Asia
Pub. House.
Goffman,
E. (1962). The Asylum. Anchor Books:
USA.
Foucault,
M. (1963). The Birth of a Clinic.
Presses Universitaires de: France.
Health
Biz. (2020). India’s Home Healthcare market is seeing a steep rise as Covid-19
hits hard. Accessed at https://healthbizinsight.com/indias-home-healthcare-market-is-seeing-a-steep-rise/
Madan,
N.T. (2011). The Hindu Householder: The
T.N. Madan Omnibus. New Delhi: Oxford University Press.
Marathe,
A. & Marathe, A. (2020). Covid-19:
Why home isolation is a critical pillar. Hindustan
Times. Accessed at https://www.hindustantimes.com/analysis/covid-19-why-home-isolation-is-a-critical-pillar/story-FyWZlsgwKPIv58jyDSIwUP.html
Mishra, A.K.N. (2020). 90% of people in home
isolation recovered: Govt. Economic Times
Health World. Accessed at https://health.economictimes.indiatimes.com/news/diagnostics/90-of-people-in-home-isolation-recovered-govt/76101605
Mitra, P. (2020). Hospitals are now providing home care
services for COVID-positive patients. Indian
Express. Accessed at https://indianexpress.com/article/lifestyle/health/hospitals-are-now-providing-homecare-services-for-covid-positive-patients-6466991/
Pathi, K. (2020). Coronavirus: “Our home turned into
a hospital overnight”. BBC News, Delhi.
Accessed at https://www.bbc.com/news/world-asia-india-52976190
Pelling,
M. (1978). Cholera Fever and English
Medicine 1825–1865. Oxford University Press: Oxford.
Pelling,
M. (1993). Contagion, Germ Theory/Specificity. In W.F.Bynum and Roy Porter
(eds) Companion Encyclopedia of the
History of Medicine, 2 vols (pp: 309–334). Routledge: London.
Porter,
D. (1999). Health, Civilisation and the
State. Routledge: London.
Roy,
S. (2020). In Covid-19 times, elderly care services firms come to aid of the
old & frail. Hindu Business Line. Accessed at https://www.thehindubusinessline.com/news/in-covid-19-times-elderly-care-services-firms-come-to-aid-of-the-old-frail/article32074150.ece
Shah,
A.M. (1973). The household dimension of
the family in India. New Delhi: Orient Longman.
Thakkar,
M. (2020). Treated 14,800 Covid-19
patients in home isolation since July 9, claims Mumbai civic corporation. Hindustan Times. Accessed at https://www.hindustantimes.com/mumbai-news/treated-14-800-covid-19-patients-in-home-isolation-since-july-9-claims-mumbai-civic-corporation/story-fcQ4KxHc2ODyzCq9DU6nDP.html
Tiwari, P. (2020). Indians have only themselves to blame for the health disaster. Al-Jazeera. Accessed at https://www.aljazeera.com/indepth/opinion/blame-collapse-india-health-care-system-200701093556860.html
[i] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804270/, accessed on 4th October 2020.
[ii] https://plato.stanford.edu/entries/feminism-family/, accessed on 4th October 2020.
Dr. Jagriti Gangopadhyay has a Ph.D. from the Indian Institute of Technology (IIT) Gandhinagar. Currently, she is an Assistant Professor at the Manipal Centre for Humanities, Manipal.
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