The government of Odisha has failed to check deaths of children due to an outbreak of Japanese Encephalitis (JE) in the district of Malkangiri. A total of 136 children have succumbed to JE over the past three months but the government’s response has been pathetic. This is not for the first time that we have been witness to gross governmental neglect.What is new this time is that the government, instead of acknowledging its carelessness and inability to effectively address the tragedy, has even started blaming the tribals for the deaths!Government functionaries are asserting that the deaths are occurring because the adivasis raise pigs and eat BanaChakunda. (A wild grass whose bean-like seeds contain anthroquinone, a toxin).
The GanatantrikAdhikarSurakshaSangathan (GASS), Odisha is a human rights organisation, whose activists have conducted fact-findings on various issues in respect of human rights violations over the past two decades.A 2-member GASS team visited 7 villages of Korkunda, Kalimela and Sadar blocks of Malkangiri on December 2 and 3 and met family members of children who succumbed to Japanese Encephalitis. The team also met panchayat members, Anganwadi members, ANMs, health workers and tribal leaders of the area. The following is a brief report of its findings:
In the second week of November, ShibaniPadiami (4years), daughter of Soma Padiami of Potrel village in Korkunda block came down with high fever, nausea and convulsions. Her father rushed the girl to the Korkunda MedicalHospital where the doctor referred her to the District Hospital at Malkangiri. She died there on November 15, 2016 at 11.45 pm after undergoing treatment for fourdays. The team also met family members of Jhansi Tagri (5years), SubhadraSadi (2), BikramPadiam (3), BapiPadiami (4), AnanyaMadi (2), BasantiMadakami (4), BiswajitMadi(2), Ramesh Padiami (4) and SushilaPadiami (2). All of them died at the Malkangiri District Hospital. While ChumkiPadiami died enroute the hospital, BijuPadiami died in his house. According to their family members, all children had high fever and were vomiting frequently. A few of them also were biting their own body due to the high fever. Some said that at the time of death thick blood came out through the nose and mouth.
In what can be termed as an exceptional case, Shanti Padiami(5) of Daniguda village of Malkangiri Block survived.Her father SudershanPadiami, was not inclined to get her admitted to hospital after she developed symptoms of JE. This was because he had lost two of his children to the disease at the MalkangiriHospital. His youngest child SushilaPadiami (2) died on 29/10/2016 and Ramesh Padiami (4) succumbed on 1/11/2016. As luck would have it, the District Collector came to know of this and he visited the village and got Shanti admitted to the district hospital with the help of the Anganwadiworker. The Collector took personal interest in the matter and enquired about Shanti’s condition regularly. After six days of “proper” care Shanti came back to the village. When our team visited her home she was in fear thinking she would have to go back to the hospital. Her aunt, who had accompanied Shanti to the hospital said: “She was fortunate to get good care and treatment at the hospital. This was not available to other children in the same ward”.We feel, had same care been available to rest of the children then number of child deaths in the district would have been much less.
Families alleged neglect, improper treatment and non-seriousness of medical staffs. According to ManguliPadiami of Koimetala village in Kalimela block, his nephew Bikram died before her in the Malkangiri Government Hospital because of medical neglect. She said her son Bapi, who was also suffering from JE fever and undergoing treatment in the same hospital was referred to the Berhampur Medical College, a distance of more than 400 km from Malkangiri. By the time it was too late and the boy died one day after admission in that hospital. Manguli and her husband Shukra brought the boy’s body back after spending Rs22,000 towards a vehicle. For the money, they had to mortgage half an acre of their land.
The health infrastructure in Malkangiriis woefully inadequate. There are only 37 doctors and 43 nurses for a population of 6.5 lakh. That is one doctor for 17,000 people and one nurse for 14,500, which is way below the all India average of one doctor for 1700 people. As per the World Health Organisation, the ideal ratio of doctor-population should be 1:1000. Thereis only one big government hospital in the district where only 9 doctors are working with none of them being a child specialist. The hospital has 44 sanctioned posts of doctors!
There have been reports of child deathsfrom JE from the year of 2011-12 and before. Over 45 children died that year in Potrel village of Korkunda block. This year the toll is six from the same village. In 2011, the villagers killed or sold all pigs of the village following an appeal by the then District Collector. Since then, there has not been a single pig in the village. How then does one explain the death of 6 children this year? This year the District Collector has again given oral instructions through his subordinates to all tribal villages either to kill pigs or to keep pigs far away from the village. This has broken the back of many tribal families since pigs are an essential part of their economy. A tribal who could have got some money from selling a pig for meeting medical expenses of his sick child is now unable to do so.About 3 months back, the district administration had assured theadivasisof compensation, but so far no money has been given to the pig-owners.
Significantly, the worst sufferers of JE are the adivasis. In some villages, though both tribals and non-tribals reside, the non-tribal children are relatively untouched. The low socio-economic status of adivasis and widespread malnutrition levels, particularly among children, is therefore an important reason for the large scale deaths of tribal children in the district. Apart from non-tribal exploitation on many fronts, depletion of forest resources and absence of traditional food and agriculture are other reasons for the poor health condition of tribals. To cite an example:About 130 families of Koya and Halbiadivasis reside in Namakonda village of Kalimela block .None of them have forest land patta and many do not even possess ration cards. They have forgotten when NREGS work was last done in their village. Many of the young are migrating to Andhra Pradesh seasonally. In times of serious sickness, the Malkangiri Government Hospital is their only hope. When Dinesh and Sarita, two children of the village came down with JE, government-ambulance drivers charged their families Rs 500 and Rs 1,500 respectively to transport them to the Malkangiri hospital.The two kids died in hospital. JagaPadiami, a resident of the same village,who was not happy with the killing drive of pigs by the government, lost his nephew Asit in the same hospital. He was looking after Asit in the absence of the boy’s father who had gone to AP in search of work.
The health expert of Vellore Hospital Dr. T. Jakob John who was invited by the government of Odisha to determine reasons behind the large number of deaths in the district, said the non-JE deaths were the result of consumption of the seeds of a wild grass BanaChakunda. This is a ridiculous assertion. It is true that the adivasisofKalimela and Podia blocks have started collecting BanaChakunda seeds from last year only because a few traders had offered money in return. These seeds look like moong dal (green gram). It is quite possible that the traders are using such seeds for adulteration. The tribal women engaged in collection of the seeds, are unaware of its use. What they do know is that BanaChakunda is uneatable. The regular diet of tribals in the district is rice with tamarind curry and they consume vegetables and meat only on rare occasions. The children largely depend on Anganwadi centers and the mid-day meal scheme for food.
Malkangiri is a district teeming with para-military forces engaged in fighting Naxalites. There is no limit to the resources that the government, both the State government and the Centre, will pump in to get the better of left-wing extremism. Security camps manned by the BSF, CRPF and other forces dot the area with almost one camp every 20 km. And news of police raids on tribal villages, beating up of civilians, illegal arrests, torture in custody and extra-judicial killings are almost a daily feature in the district. Yet, the government has shown scant concern for improving the health, education and employment status of adivasis. Time and again we have brought to the notice of the government the ill-effects of neglect, the increasing misery of tribals because of non-tribal encroachment onto forest lands, land grabbing and naked exploitation by traders. Institutional response to tribal predicament and misery has been abysmal.
We demand that the government provide comprehensive treatment free of cost to all JE-affected patients. It should pay compensation to all families who have lost their child/children.Compensation must be paid without further delay to all families who have lost their pigs. The government should fill up all vacant posts of both doctors, nurses and other staff immediately in all hospitals including the District Hospital at Malkangiri. Adequate number of child specialists should be appointed immediately and they should be sent with mobile health vans to all affected villages.