The word stigma is derived from a Greek word which referred to a type of marking or the tattoo that was cut or burned into the skin of criminals, slaves, or traitors in order to visibly identify them as blemished or morally polluted persons. These individuals were to be avoided particularly in public places and is in fact considered a matter of shame.
Stigma and Medical Problems:
It has a deep-rooted history and represents a global phenomenon which becomes prominent from time to time. Perhaps the most notorious historical figure to bear the blame of stigma was Mary Mallon (Typhoid Mary). During the early 1900s, she was shunned and captured by local authorities for her role in spreading typhoid. Mary represented a healthy carrier of typhoid and unknowingly spread the disease to people for whom she prepared meals. Mary underwent a great deal of trauma, and hardship as a result of her unfavourable condition and her permanent label (i.e., Typhoid Mary) signifies the stigma she endured.
Prior to the social activism of the 1960s and 1970s, African-Americans were the target of stigma. In an era when infectious disease predominated, black Americans were often portrayed as capable of infecting others specially, the white American population with venereal diseases like syphilis in early 2000’s. Misconceptions related to HIV-AIDS are in our recent memory and a number of well-known personalities like Rock Hudson divulged his disease publicly . Finally, it was Magic Johnson the baseball star and a champion of the under privileged youth whose confession of being HIV positive helped a great deal in increasing the awareness of the disease and removing the associated social stigma.
If we look back, practices such as quarantine can be traced back to Biblical times when individuals with leprosy (Myond in Kashmiri) were deemed as social outcasts. Lepers were expected to carry a bell to inform others to be careful and move away. Lepro stigma is a part of history of humanity despite the fact that its communicability is very low. Lepers used to be quarantined for life in leprosaria’s or leper colonies. Some of them with physical deformities are still seen begging on roads being carried in carts.
COVID and Stigma:
The most recent disease to be stigmatized is COVID19. Its precursor influenzas were being accepted quite well. The media hype internationally and very large numbers getting infected all over with a definite mortality up to 10% in high risk patients has contributed to it largely. It has resulted in a generalized scare and a person labelled as positive is often stigmatized by his neighbourhood. Asymptomatic patients need only self-isolation at home, especially when even patients with symptoms needing oxygen or ventilation face scarcity of beds in hospitals. The health care systems of USA, Spain and Italy also crumbled despite having a solid machinery in this regard. Fortunately, the morality in this part of the world especially in J&K is much lower.
Most of us in the valley have a house to stay with more than a few rooms. Asymptomatic persons just need isolation, nutritious food and empathy. The conditions in the so-called centres for isolation from the authorities are far from satisfactory. The neighbours should realize this and not get scared. Maintaining the preventive measures of distancing and general measures of hygiene are adequate to avoid getting infected.
However, the facts are on the contrary. Having personally seen discrimination from close quarters and also numerous news reports in the media where not only the patients but also their families are being treated as out casts. Dead bodies are being disowned sometimes by their families. Qabaristans abandoning them for their last rites. All out of fear. Are we converting COVID into a sort of disease like leprosy where the stigma has been transferred? We by now know the preventive methods of containing the spread. This stigma urgently needs to be curbed by public education and also in extreme cases punishing the defaulters legally. At the current rate of spread with around 5050 cases testing positive and 60 deaths in our UT with numbers still increasing, who knows you may be the next person in line to become infected and then ostracized.
Author is a cardiologist and Past president of the Cardiological Society of India and SAARC Cardiac Society. Recipient of Padmashiri and DR B C Roy Award.