‘She needs me’: The COVID positive carers on India’s front line

Nagpur, India – April 21, 2021 was an ordinary night at Sushila’s* house in Nagpur in western India’s Maharashtra state. In the bathroom, a bucket filled up with hot water in preparation for the 93-year-old’s sponge bath; in the kitchen, her night-time beverage – a pot of milk – boiled on the stove, nearly spilling over; and in the bedroom, her blood-pressure medicines were laid out neatly on the bedside table.

Bindu*, the professional caregiver who sees to Sushila through the night, navigated the two-bedroomed house with familiarity, as she tended to the elderly woman she fondly calls Ajji Bai (meaning Grandmother-Madam in Marathi).

Outside, however, things were hardly ordinary. By the end of April, Nagpur had become the sixth worst COVID-hit city in the country. The screeching sound of ambulances going back and forth filled the night air. Even the cacophony arising from the Marathi drama serials that Ajji Bai watched every night from 7pm to 10pm could not drown out the sound.

That night, however, the TV shut off earlier than normal. “I don’t feel well,” Bindu recalls Ajji Bai saying. The thermometer revealed she had a fever of 99 degrees.

“COVID?” the overbearing thought momentarily crossed Bindu’s mind, further triggered by a headline in the newspaper by Ajji Bai’s bedside displaying the 6,000+ new COVID-19 cases recorded in the city the previous day; most hospitals had run out of beds and oxygen.

But she quickly discarded the intrusive thought. “Honestly, I wasn’t very alarmed,” she explains to Al Jazeera over the phone. “Ajji Bai is 93 years old with several health ailments. But it couldn’t have been COVID because Ajji Bai hadn’t stepped out for months. It was only Jairam*, Ajji Bai’s grandson and his wife Tara* who were checking in and bringing essentials. They were taking all precautions, just like the daytime caregiver and me.”

But the call Bindu made to Jairam the morning after was hardly reassuring. Over the course of the night, Ajji Bai had developed a high fever and was coughing. But her cough was hardly as persistent as the one Bindu heard from Jairam on the other end of the line.

In the next two days, her worst fears were confirmed. Ajji Bai, who lived alone, had tested positive for COVID-19 along with her closest relative, Jairam, who began isolating at his own house 15 minutes away. Tara was admitted to the ICU with low oxygen levels. When news about the family testing positive spread in the neighbourhood, Ajji Bai’s daytime caregiver also isolated herself, and ceased her duties for the next few days.

“When Jairam Sir asked me to stay back to look after Ajji Bai, I didn’t think twice before saying ‘Yes’,” Bindu says. “I’ve worked for her for about seven years, and this is the time she needs me the most, especially when all hospitals have refused to admit her as she is quite old.”

An anxious Bindu watched Ajji Bai gasp for breath as men in white set up an oxygen apparatus at home – procured through the family’s political connections. Ajji Bai was married into a rich family of influential, upper-caste landowners, which has made it easier for them to quickly access India’s private, expensive healthcare system that is often out of reach for those without money and connections.

On the front lines of care

As Bindu breathed a sigh of relief knowing that Ajji Bai was getting treatment, she also coughed.

“It was only a matter of time,” she says of her own subsequent COVID-positive diagnosis – after all, she remained beside Ajji Bai, not leaving her house since the night of April 21, and determined to stay on until they both test negative.

Bindu is a short, frail woman with jet black hair. The 45-year-old describes herself as a confident woman – one who did not worry about her own health, even after her COVID-positive status. “I, anyway, only had mild symptoms,” she says, explaining that she felt sure she could perform her caregiving duties even while sick.

Bindu is not the only carer who has stayed on in their employer’s house amid the coronavirus crisis. Much like other front-line healthcare staff; many caregivers in India have continued their duties through the pandemic, risking infection themselves.

Several agencies that provide home care for the elderly in India, such as Care Finder and Anvayaa, continue to operate. “We safeguard our nurses and caregivers and provide them with PPE kits, sanitisers etc,” says Hari Raghavan, a Support Center executive at Anvayaa. “We ensure that the carers are provided with a separate room and toilet within the house. Before moving on to other clients, all of them also have to undergo quarantine.”

But Bindu, who does not work for an agency, sleeps on a cot in Ajji Bai’s room and is only allowed to use a small servant’s bathroom located near the back of the house. Having separate bathrooms, utensils and other spaces for helpers and servants is not uncommon in upper caste and upper-class households, like that to which Ajji Bai belongs to. It is a form of segregation rooted in casteism.

Home caregiving means being at the beck and call of your employer 24/7 ... But there’s no respect for their work.

by Vibhuti Patel, former economics professor

An unrecognised burden

Vibhuti Patel, a former economics professor at the Tata Institute Of Social Sciences in Mumbai, believes that the informality of paid care work stems from its gendered and caste-based nature. Within families, it is the women who have traditionally assumed the unpaid labour of caring. The house is seldom defined as a workplace, and thus the labour performed within it is hardly counted as work.

“This has led to the overall devaluation and even dehumanisation of paid care work. Despite several calls by civil societies and policymakers; no bill has been passed to regularise domestic and care work at a national level,” Patel says. She strongly believes this to be because most political representatives are from upper castes and classes, and they benefit from the feudal nature of this unrecognised work.

Attempts to organise the care workforce through private agencies has not been beneficial. “The underlying attitudes remain the same,” Patel adds.

Kiran Saini, who has been a paid caregiver for the last 15 years validates this. “The agency I work for has provided us with some safety equipment, but they take most of the cut from the money. In times of conflict, the agency usually sides with the family.”

Bindu is paid 7,500 rupees ($101) per month for her nighttime duties. However, she has not negotiated a higher rate with her employer for the current full-time service. “It doesn’t look proper to do this when the family is going through a crisis. I’m sure they will give me more money. They even paid for my test,” she says.

With that assurance, Bindu has been working round the clock: bathing Ajji Bai, emptying her bedpan, helping her eat, sit and walk. She checks her temperature, puts cold compresses on her forehead to bring the fever down and even monitors her oxygen levels. She has not done that for herself.

“I have manageable symptoms, but I’m worried about Ajji Bai because of her comorbidities. I have to stay alert at all times,” she says.

This has been exhausting for Bindu, especially in a setting where the lines between work hours and rest hours are blurred.

“Home caregiving means being at the beck and call of your employer 24/7. Contracts agreeing upon specific duties, number of hours and wages aren’t provided,” Patel explains. Currently, with healthcare staff being hard-pressed, it is community health workers (called ASHA workers) and caregivers that help those in need. “But there’s no respect for their work,” Patel adds.

Romanticising labour

Bindu realises this but she does not have time to give it much attention. She only finds some time to rest in the afternoon; when Ajji Bai naps. She lies down on a mat in the living room with walls plastered with pictures of Ajji Bai’s family, mainly her great-grandchildren.

Bindu says it reminds her of her own family. She was the third child among five siblings, growing up in a small village called Dhantoli, just outside Nagpur. It was an “uneventful” and “short-lived” childhood for Bindu who was married off as a 13-year-old.

Her husband is a mechanic in Nagpur, and together they have a 30-year-old daughter, who works as a domestic helper. They live with extended family in a small four-room “pucca” house on the outskirts of the town. Her husband has hardly had any work over the last year due to the COVID lockdowns and the couple needs to save up a lot of money for their daughter’s marriage, so not working is not an option, Bindu says.

Bindu cannot see her family at the moment, but she manages to call them both every afternoon.

“I haven’t told them that I have COVID. I just said that Ajji Bai has been unwell and I’m required for service. I don’t want them to worry,” she says.

Bindu misses them but says she does not regret her decision. “Why should I risk their health by going back?”

I want (the government) to account for what is happening in the country right now and realise that we have to live with the consequence of their every action.

by Bindu, caregiver

Now Bindu has her meals with Ajji Bai. They talk about the storylines of Marathi serials and discuss updates about COVID-19. But the conversations are not always pleasant. Sometimes Ajji Bai can be “rude”.

The attitude Bindu describes is hardly surprising. Instances of physical, mental and even sexual abuse by some employers are quite common in domestic and care work in India. Bindu denies being subject to any such incidents but says that “all the shouting and scolding is typical in their jobs. I’m used to it.”

She adds that Ajji Bai has hyponatremia that has worsened with COVID. It makes her confused and obsessive. One day Ajji Bai angrily started throwing things around. “She often yells at me. I feel frustrated, but endure it because she’s old and ill.”

To many, Bindu’s selfless service seems almost heroic. The country has seen many instances of such “heroism” by ordinary people and healthcare staff, especially over the last month during which India has witnessed its deadliest COVID wave yet.

But the romanticisation of this labour fails to account for the helplessness it stems from, says labour rights researcher and lawyer, Bajinder Maan. He believes it discounts the government, which should not only have done a better job at controlling the spread of COVID-19, but should also have invested in and safeguarded the health and care economy so that such conditions of precarious labour would not be created in the first place.

According to reports, “India spends less than one per cent of GDP (gross domestic product) on care work infrastructure and services.” Patel says that the need of the hour is the regularisation of care and domestic labour to protect workers’ rights. An education that nurtures the values of empathy from a young age is also important.

Bindu resonates with the thought and hopes for more robust and secure working conditions from the government. “I want them to account for what is happening in the country right now and realise that we have to live with the consequence of their every action.”

As she worked through these consequences, she looked forward to the day when she would be able to go home.

Finally, on the morning of May 5, after both she and Ajji Bai tested negative for COVID, Bindu returned home. But not for long.

“I am going to rest through the day but will resume my night-time caregiving duties this evening,” she says. “With her family still in recovery, Ajji Bai needs me.”

*Names marked with an asterisk have been changed to protect the person’s privacy.