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).
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.
***
Jagriti Gangopadhyay is an Assistant Professor of Sociology at the Manipal Centre for Humanities, Manipal Academy of Higher Education (MAHE), Manipal.