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A revolution is taking place in the lives of rural families in India. Under the Jal Jeevan Mission put forward by the prime minister clean drinking water from tap water will reach every family in India. It was launched on Aug 15, 2019 and plans to do this by 2024. The impact is huge. Out of 180 million rural families only 33 million families have clean drinking water from tap water in the country. Clean water brings life to the countryside and access through individual tap water connection brings a revolution to people's lives in a country of 1.2 billion people. This report in the Economic Times tells us what most of us do not know that with the growth in population from about 300 million after independence in 1947 to 1.2 billion today and the drought conditions in parts of the country, the per capita water availability has fallen sharply today. Dropping from 5000 cubic metres of water per capita in India in 1951 to 1545 cubic metres of water in 2011.  The infrastructure capital to be invested is 3.5 trillion rupees or $ 50 billion. $50 billion in cement, pipes, construction, pumps, equipment, wages, conservation, skill building, knowledge in water management to revive the rural economy. Hit hard by coronavirus it boosts the rural economy. The infrastructure project could be a model for other Asian, African and Latin American countries.  Cholera and other water borne diseases can never be eliminated without clean drinking water from tap water for all families in India. It means so much during this pandemic.  ...

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Countries dependent on remittances of workers overseas are hit hard by the coronavirus. This WSJ report shows the situation in Central America which gets $24 billion in remittances form its workers in the U.S. E Salvador gets $5.6 billion in remittances. This is down by 40% in April central bank numbers show, because of jobs lost in the U.S. by workers from El Salvador who migrated to the U.S.  Unemployment rate for Hispanics in April was 20%. El Salvador depends on remittances more than any other Latin American country as remittances are higher than exports. In some rural areas this means older residents have no money to buy food and depend on charities for food supplies.

Today the situation in India, Pakistan and Bangladesh, and other countries in Asia which depend on remittances of overseas workers is also leading to a difficult time for families dependent for such support.

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The NYT provides a good look at the situation in India in September where cases are over 4.5 million, the world's second largest after U.S. During the lockdown in April and May India had successfully stemmed the coronavirus. After reopening in June a lot has changed as can be seen in this look at the steep curve in June, July, August and September. Cases are now at the rate of 95,000 daily and deaths at 1172 daily as of September 9. The deaths are up 16% and cases up 29% over 2 weeks. Maps show the situation in the states with Maharashtra, Andhra, Tamilnadu, Karnataka, and Uttar Pradesh showing the highest cases. Maharashtra has about 1 million cases and the two states in the south east Andhra and Tamilnadu have about 1 million combined with Uttar Pradesh at about 250,000 cases. Delhi has about 200,000 cases. So that about half of the 4.5 million cases are in three states in the southeast and the western state where Mumbai (Bombay) is located. The increase was seen after increased testing from 200,000 a day to 1 million a day by the end of August, a steep jump being seen in late August and September. At the end of July the coronavirus recovery rate of 70% in India and 90% in Delhi were the favorable signs, until things changed in August with increased testing and the spread to rural areas. India is doing over 1 million tests daily. On September 3, 1.1 million people were tested, taking the total to 45 million tested throughout India.  As in Europe and America the reopening which is essential for the economy and jobs has resulted in a big jump in cases. The laws for lockdown were carefully obeyed without many of the problems seen in America and Europe, the early complete lockdown was implemented with success, and Indian pharmaceutical companies are some of the largest in the world giving the public wide access to essential medicines and drugs. The postal service has functioned remarkably well during the lockdown for delivery of essentials throughout the country, and earlier action to establish bank accounts for each and every individual in the country, has enabled rural Indians to get through this most difficult period. This has given the government some breathing room as it faces the cases from reopening in a vast country of 1380 million people.   ...

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Latin America has made a huge turnaround through successful vaccination drives. Today more people are vaccinated as a percentage of the population in Latin America at 62% than in the US at 56% or Europe at 60%, according to Our World in Data project at Oxford University. There is little resistance to vaccines in Latin America after successful vaccine campaigns against yellow fever and other diseases. During the first year of the pandemic Latin America had one third of the deaths in the world with 8% of the population. Deaths after vaccination drives have dropped to 8%.  Brazil with 617,000 deaths from coronavirus was second only to the US with 800,000 deaths. Brazil is now back to normal after a successful vaccination drive that has 66% of the population fully vaccinated, and 80% with one dose, some of the highest rates in the world, according to Our World in Data at Oxford University. In Colombia with 50 million population about 50% of people are fully vaccinated. Cases have dropped from 30,000 in June to 2000 a day and deaths from 700 daily that month to 50 a day in December 2021. In Buenos Aires, Argentina's capital, 83% of three million population are fully vaccinated, 14% have received a booster. Buenos Aires city health minister says Argentine society has an affinity for vaccination campaigns. "They rapidly accepted receiving them," he says. Yet from the point of view of new variants emerging there is a different situation in rural areas. In industrial states such as Sao Paulo 78% are fully vaccinated, yet less than 40% are fully vaccinated in poor Amazon state of Roraima.   We make it a point to honor the brave reporters in these countries who provide the reports in the WSJ, as we did earlier for NYT Stephanie Nolan's reports from South Africa and Zambia about frontline workers against Omicron in Africa.  Luciana Magalhaes in Sao Paulo, Jenny Carolina Gonzalez in Bogota, and Sylvina Frydlewsky in Buenos Aires and Kejal Vyas writing this report from San Salvador. ...

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California's economy is going through tough times during the coronavirus. Unemployment is up to over 20% which compares to 14.7% for the U.S., closer to that of New York. The state depends on the tourism industry, agriculture in the San Joaquin Valley, and entertainment industry around Los Angeles for jobs. Tech in the San Jose area does not account for as many jobs. The state also has a public university system and foreign students mostly from China bringing in $7 billion.   Its port system around Long Beach and Los Angeles connects with the Asian economies and China, for goods mainly transported to the rest of the U.S.  All these sectors are the ones most badly hit during the coronavirus.  California now has a deficit of $54 billion and was the first state to borrow from the federal government to pay $13 billion in unemployment claims. Undocumented Californians are not able to collect unemployment because of their immigration status, creating an American version of the informal economy that is found in India and Italy or Spain. California has 83 million people taking plane trips to the state for a tourism industry that normally brings in $145 billion. 600,000 travel industry jobs were lost in the state. Taxes related to travel are a significant source of revenue for cities in California bringing in $12 billion. The only sector that is less affected is the tech industry, yet this makes up only about 10% of the jobs or 1.7 million higher paid but fewer jobs. This tech sector at about just 15% of the California economy GDP, is of a precarious nature with a boom bust pattern, the last boom one that happened since the 2009 financial crisis. It in no way forms a significant support for employment or income for people in California or the U.S., and may even be responsible for distortions in the allocation of capital away from infrastructure and public services, through its disproportionate influence on how the nation's capital is allocated. The broader changes underway during coronavirus are likely to affect the state over many years, as supply chains shift away from China, and as infrastructure and public services investment assume their rightful role again in the nation rebuilding effort, agriculture and rural America become a part of the American renewal story.   ...

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How a small Kansas town of Grinnell in America finds a way to deal with the rural-urban divide and covid anxiety generated in the tumultuous years of 2020-2021, is the subject with pictures of this report in the WSJ. Grinnell is heartland America and its residents find a way to set Kansas and America in the right direction. One one side some resident worried they would end up like Minneapolis or Portland with protesters. An incident of drivers along Highway 70 emptying shelves of toilet paper in neighborhood stores is seen negatively by some  Grinnell residents and leads to forming an Emergency Preparedness Group to prevent outside agitators from creating problems. Others like the Enlightened Ladies Group try to calm things down. Gene Tilton, 84, and his son 63 years, whose family arrived in Kansas in 1880's did'nt see the need for forming some sort of vigilante group. He raises cattle and crops on a 10,000 acre farm. Michael Machen who practiced medicine in Gove County for 35 years also felt the same way and believed law enforcement could tackle the problem if there was one. Sheriff Mesch attended the Gove County emergency Preparedness Group public meeting by invitation in January 2021. This about the time when the Capitol in Washington DC was stormed by protesters and the country was divided after the election. At that time after 19 months of coronavirus deaths, racial unrest and political violence America was on edge, communities all over America were struggling with the idea that the immediate threat they faced was from other Americans not foreign adversaries. The sheriff told everyone at the Emergency Preparedness Group's public meeting where he stood- law enforcement could handle any threat and he didn't anticpate anything his deputies could not handle. He told the Emergency Preparedness Group that he appreciated their sentiment though, if he needed help he would ask, yet concluded that is the only way. From that rebuff by the sheriff the Group paused its activity and shifted its message to offering to help anyone deal with the deep cold spell in February, to cope with snow, tornadoes, fires, rattlesnake bites and similar hazards. They sponsored first aid classes, and a "Homesteader Gardening Class." Soon their idea was "we're here to help people, the last thing we want is for people to be uncomfortable." "Gove County" says Don Tilton, "has moved on." So must America today. ...

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The Times correspondent in Beijing says he sees two Chinas one that is showing technological advancement in 5G, in space technologies, in information technologies, infrastructure building in big cities. The other China is in rural areas away from the big cities, in smaller towns in regions away from Beijing and Shanghai. These areas have suffered neglect and have changed little over decades, with the focus during industrialization on larger cities and the coastal areas. This is evident in the manner health services infrastructure and development of medical personnel and doctors were neglected in the rush towards building manufacturing and infrastructure of road and rail. There is a shortage of doctors and hospitals, health services are costly, and waiting lists for beds at hospitals is huge. Doctors are also not held in high esteem because the focus is on profit in the market economy that has taken over the health sector.  Education of citizenry on respecting the common welfare which is expected and normal in Europe and America has also suffered during the rush to industrialization. Efforts to ban and eliminate use of certain wild animal foods not being respected by fellow citizens can be seen in this context. This caused the SARS virus epidemic and the epidemic today from the coronavirus. Seen from this angle a slowdown in construction, infrastructure building, and a slowdown in the economy, can even be healthy, so that focus can be shifted to better health, better sanitation, and better medical infrastructure including medical human resource capabilities. Investment in public education on health and self enforcement of rules by citizenry for a better society is indispensable for progress. It is in these conditions that the challenge of the national and international emergency of the coronavirus can be seen today. It also provides an opportunity to reflect on progress so far and the needs of the future. These challenges are even tougher than repeating what one has done before such as building more and more infrastructure, as they involve building a better society through public discipline along with investment in health and education services. This provides a lesson for many Asian, Latin American and African countries in the rush to industrialization. Turning over the health sector to a market economy making services costly and distributed unevenly in the population has not worked in the U.S. for the betterment of all citizens and a healthy society. Carrying this over from U.S. to China and not learning from Europe in what Europe has done well in the less costly and broad distribution of health services for the people, is one of the poorer lessons learned. This is also true for India and South Asia, South East Asian countries in their rush towards industrialization.  ...

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WSJ looks at the changes in the way medicine should be practiced in the light of what we have learned from the pandemic.  Medicine practiced before the pandemic and still today relies mainly on a visit to the doctor or specialist who is short of time. There is a shortage of doctors. Patients have many illnesses as a result of decades of neglect of proper nutrition, and exercize habits. Obesity is at about 40% in the U.S. about 30% in the UK and 17% in France, and high also in other parts of the world. These high rates were unknown throughout history and result in many illnesses and increase by four times the vulnerability to the coronavirus. One authority in medicine calls obesity pouring gasoline on a fire for effects of the virus.  A doctor's appointment with doctors short of time with no coordination around a whole range of factors related to obesity, illnesses, health checkups, mental health, is now seen as a heavily handicapped way to practice medicine or for patient healthcare and wellbeing. The alternative is discussed here as the way forward. A  team will be responsible for a patient's care not just an individual doctor. The team would care for general health after a patient's checkup, cover individual illnesses, weight issues, mental health, exercize nutritional needs and other good healthcare habits. Instead of relying on doctors at a time of shortages of doctors the team would be led by nurse practitioners.  A nurse practitioner is someone with a bachelors degree and a masters degree or doctoral degree in nursing with 1000 hours of clinical training. Studies have shown that they are effective and even more effective than individual doctors. Today particularly with the problem of doctors with limited time compounded by the built up problems of decades of bad habits in nutrition and exercize and poor "cultural" habits getting entrenched, there has never been a greater need for a better way to practice real healthcare for a person's wellbeing. Particularly in rural areas with an even larger shortage of doctors the health practitioner led team will play a big role. Patients will under this setting receive more care virtually and get more followup care by phone and video messaging. The numbers tell the story- there are shortages of doctors in USA, Europe, Africa, Latin America and Asia. In the U.S. shortage of doctors is 55,000 projected to 2033 by Association of American Medical Colleges. There are 290,000 nurse practitioners licensed in the U.S. and 131,0000 physician assistants. The goal will be to get an adequate number of nurse practitioners licensed in this decade to take care of these teams. The pandemic has made virtual visits to doctors and nurse practitioners popular. Medicine reimbursement should and would be practiced on the basis of how well a patient is doing not on a fee for each micro service that is delivered. For this to happen the teams led by the nurse practitioner have to commit to patient education of the benefits from good practices and good habits for nutrition, exercize, caring for oneself. A doctor short of time is hardly the person to carry on this patient education which is where the major opportunities for a new system arise. The virtual care also provides a new medium for patient education and awareness of the risks of getting illnesses, preventive actions to be taken in advance. One approach being tested in California and Texas is for a monthly fee for patients more payments by health plans to doctors or healthcare teams if the patient is healthier. Additional health professionals are added to the team including health coaches, dietitians and medical assistants to increase its effectiveness in counseling and education and monitoring.  The nurse practitioner team approach is already being practiced in parts of the U.S. including the example of New Hampshire shown here, and is predicted to be the approach for primary care in the next decade. ...