Hospitalisations soared in India during a deadly second Covid wave. Now, hobbled by patchy insurance, Indians are turning to crowdfunding to pay the steep medical bills, reports Astha Rajvanshi.
Supraja Reddy Yeruva was unable to breathe properly for days after giving birth to her second child in June. The 27-year-old began showing Covid-19 symptoms during her pregnancy, shortly after visiting a hospital for a routine check-up.
Soon, she contracted a severe lung infection and was admitted in the ICU at a private hospital in the southern city of Hyderabad. A month on, she is still there.
With their six-year-old daughter and newborn son, her husband, Vijaya Yeruva, now anxiously waits for her recovery.
Mr Yeruva is also scrambling to pay a hefty medical bill of nearly 6m rupees (£58,636; $80,615) for his wife's treatment. And the amount goes up by the day.
He used his health insurance, maxed out his credit cards and borrowed from the bank. After exhausting every other option, the 35-year-old turned to Ketto, a crowdfunding platform, and launched a fundraiser.
An engineer with a steady, but modest, annual income of $1,076 (£775), Mr Yeruva said he never imagined asking strangers for money.
"I worked hard to support my family and never asked anyone for help," he said. "Even now, I'm embarrassed to tell people about this fundraiser."
His desperation reflects the plight of thousands of Indian families who now face the collateral damage from India's devastating second Covid wave: crushing medical debt.
Many have turned to crowdfunding to foot the hospital bills - and it has quickly emerged as a substitute for health insurance and government support.
Experts said three of the biggest crowdfunding sites - Ketto, Milaap and Give India - have collectively raised around $1.6bn with the help of 2.7 million donors so far.
Ketto, where Mr Yeruva launched his fundraiser, said it grew four times during both waves, raising more than $40m for some 12,000 Covid-relief campaigns.
"In many cases, crowdfunding became an alternate safety net to fill the existing gaps in the healthcare system," said Ravina Banze and Irfan Bashir, co-authors of the book, Crowdfunding: The Story of People.
Even before the pandemic, the greatest need for crowdfunding manifested in the lives of millions of sick people in India.
Out-of-pocket healthcare expenses drove 38 million into poverty in 2011-2012, according to a 2018 study by the British Medical Journal and the Public Health Foundation of India (PHFI).
There's no data on how many more were pushed to financial ruin by medical debt during the pandemic, but a preliminary study by the Duke Global Health Institute and the PHFI estimates that two-thirds of India's self-employed and half of its salaried workforce could not afford to pay for critical care.
The burden falls heaviest on India's poorest, a group that last year increased by an additional 230 million Indians, according to researchers at Azim Premji University. More than 90% borrowed a median amount of $201 to pay off debts.
India's public spending on healthcare accounts for just 1.2% of its GDP - it's among the lowest in the world, with roughly two-thirds of Indians going without any health insurance.
"Having unexpected medical emergencies is a recipe for disaster when most people live under the constant threat of financial instability," Mr Bashir said.
In 2018, Prime Minister Narendra Modi promised free coverage to half a billion of India's poorest citizens by launching "Modicare", the world's biggest health insurance scheme.
But an analysis by Proxima Consulting found that only 13% of those eligible under the scheme were able to claim insurance when hospitalised for Covid treatment in public and private hospitals.
The scheme does not cover outpatient costs either, which make up for a large part of medical expenses.
In Nagpur city, Chinmayi Hiwase went from hospital to hospital for three days to beg for oxygen and a vacant bed for her 57-year-old father, Rajesh Hiwase. She thought her struggle with Covid was over.
But an MRI scan of her father later detected an auto-immune disorder and mucormycosis or "black fungus". The additional treatment, which includes daily injections costing $94 each, has added to the total cost of $33,633.
It's an unimaginable amount for the 25-year-old, who is a single child and recently graduated. "We were shocked when we saw the bills," she said.
Her father, who worked at a private engineering college, supported the family on an annual salary of $605.
Without health insurance, medical bills have eaten into Ms Hiwase's savings, forcing them to borrow money from friends and, eventually, start an online fundraiser.
So far, the family has raised $11,956, almost half the amount they requested. "I didn't realize how helpful [crowdfunding] could be," Chinmayi Hiwase said, sighing with relief.
"Crowdfunding has essentially given those individuals who can't afford private hospitals an opportunity to get themselves admitted," Ms Banze said.
Donors are often family and friends of those who start fundraisers, but there are also NGOs, celebrities and strangers, in India and abroad, who feel compelled to give.
But donations are often directed towards the most heart-wrenching stories or patients with strong social networks. Ms Banze and Mr Bashir worry that this fosters an environment where people are empathising only with the most severe cases.
"Not everyone is a great storyteller, and not everyone has the most extreme story," they said.
With half the country unable to access the internet, crowdfunding can also create "information asymmetry" by preventing those on the lowest rungs of society from tapping into its power.
Despite donations, Ms Hiwase's financial troubles are far from over. Loans still need to be repaid, and her father's treatment will also take a long time.
"We could barely afford an injection without the help of others," she said. "I don't know what those who don't have that kind of support would do."
In Hyderabad, Mr Yeruva is contemplating selling his assets and even his house to pay for his wife's treatment.
"It will take years for things to go back to normal, but I want to make sure our kids have their mother," he said.
Astha Rajvanshi is a freelance journalist and fellow at the Institute of Current World Affairs,based in Delhi.
