Greeshma Aruna Rai | Courtesy Dalit Camera
Rama Podiami explains in the above video that his son, Biju Podiami, came down with high fever after which he was taken to the Block Community Health Care Center. Here he was told that treatment isn’t possible at the Center and that he should take the child to the District Hospital. Since he couldn’t afford to do this himself and the CHCC failed to provide the services which they should’ve, he took his child back home. The child eventually died.
After more than 90 children, majority Adivasi, died in the month of October and most samples tested positive for Japanese Encephalitis, the District Administration centralized referrals from various Primary Health Care Centers and Community Health Care Centers to the Malkangiri District Hospital. A separate JE Ward was set up at the Hospital. This happened after continued reporting by the media in October. Before that, if a sick child were to be taken to a PHC or referred to the Block CHCC, they would often be met with no doctors or sent away with available medicines, without any additional testing or investigation. Eventually if a child would die, the reason would never be known.
Were these deaths by JE new? So was there a sudden surge in deaths which led to these referrals? Mark that as Question No. 1.
On one hand, samples tested in 2012 at Regional Medical Research Centre in Bhubaneswar had previously established that the outbreak which killed 38 children was due to Japanese Encephalitis, informs ADMO from Puri, Amarender Mahanth. On the other, a government employee at the office of ADMO – Hospital Administration, Malkangiri who didn’t want to disclose his identity informed us that in the monthly block meetings, reports of more than 100-120 deaths would surface. These deaths are nothing new, children have been dying for years, he seemed to suggest. In an interview with the District Collector K. Sudarshan, he seemed to stress on the same aspect, “Why is there a sudden upsurge of interest in Malkangiri now? I request you to check the deaths from 2000, you’ll know for yourself that this is nothing recent.” To supplement this, a fact finding report furnishes data obtained from CDMO, Malkangiri which in addition to referring to the 2012 JE deaths, also puts the number of death of children from 2008 to 2012 at 7400, reasons for these deaths being Epilepsy, ATI, LBW, Diarrhea, Ashtma, Fits, Burning, UND, Septicemia, Birth Asphyxia, Fever related ailments and more such minor ailments. That answers Question No. 1 in the negative. No, deaths by JE isn’t new. No, there was no sudden surge in deaths, children have been dying in Malkangiri for quite a while.
If children have been dying for a while and if lack of nutrition is one of the factors, the failure of the ICDS and the MDM programs as established is only going to further aggravate matters.
“A child who has access to basic nutritional food and minimal health care is still in a better state to fight a disease like Japanese Encephalitis which though has no cure, can still be tackled with early detection, diagnosis and aggressive medical intervention. Pointing to ineffectiveness of health officials at this point may be redundant when in fact two episodes of Japanese Encephalitis must’ve led to immediate immunisation”, explains Dr. Sylvia Karpagam. The real question one needs to be asking is why didn’t immunisation happen? This didn’t happen, we can go into the reasons for this later but when children fell sick, were systems in place to facilitate early detection, diagnosis and aggressive treatment? And in addition, if children have been dying for a while and if lack of nutrition is one of the factors, the failure of the ICDS and the MDM programs as established is only going to further aggravate matters. Then, at least due to these existent state of health of children in Malkangiri, were these programs strengthened? Mark that as Question No. 2 and 3.
While District Collector did centralize referrals and attempted to strengthen the ICU and other facilities at the Malkangiri District Hospital, the Hospital is still severely understaffed. The doctors on duty vary from 9 to 11. How is that sufficient for a population of 6.12 Lakh? As explained by Rama Podiami in the video above and other’s interviewed by DalitCamera, Japanese Encephalitis deaths in Malkangiri, any child who isn’t well first is given medicines by the village Anganwadi worker or ASHA worker. After this, the child is taken to the Primary Health Care Center and next, Community Health Care Center. DalitCamera has further established through interviews and through local enquiry that these PHC’s/CHCC’s are either unmanned or the one doctor who is incharge is usually unavailable or are spending most of their time in private clinics. The PHC’s/CHCC’s further do not do anything more than prescribe medication after making the patients wait forever, based not on testing and diagnosis but what they infer without such testing. Many a time, this is done by the staff without the presence of a medical doctor. These medicines do not help and usually the parents end up taking their child to the traditional healer of the village. The traditional healer ties an amulet, chants a mantra or two and the advises bedrest. It is common knowledge that in the case of a viral infection, if the body’s immunity is even marginally good, with just sufficient rest and food, it might cure itself. The child at times eventually gets better, the parent distrusts western medicine and prefers the traditional healer or no healer.
The 2011 Population Census establishes that out of the 6.12 Lakh population of Malkangiri, 93% is rural. 93% of Malkangiri is subject to the medical attention explained above, which translates to no medical attention at all. Out of the total population, 58% is Adivasi, 23% is Dalit. Almost all of the children who’ve died are from the villages of Malkangiri, mostly from Korukonda, Kalimela, Podia, Maithili Blocks where the state of the PHC’s and CHCC’s are like explained above. Putting two and two together, one can say with confidence that the state of healthcare in the villages of Malkangiri presently, which is the epicenter of the deaths, is far from abysmal, it is worse than horrible. That answers Question No. 2 also in the negative.
More than 80% of the district is Adivasi-Dalit and therefore the brahminical government is hell bent upon wiping out a whole generation in Malkangiri by simply denying public health care.
As far as Question No. 3 is concerned, the answer is still in the negative. Some videos of DalitCamera (https://youtu.be/926YD_ulSbU, https://youtu.be/z5dD6ohZqks) capture the state of the Anganwadi’s of Malkangiri. The state of infrastructure and hygiene is horrible, food being served is sub standard, two-three children share one plate of rice and there are no checks and balances in place to ensure compliance. An Anganwadi worker gets paid Rs. 4000 and is expected to take care of 100+ children in the age group of 0-6, is expected to first go from house to house at daybreak, get all the children to the Anganwadi, keep them occupied for half a day, serve them lunch, check them for ailments and treat them herself if necessary, check every household for sick children through the day, else refer them to the District Hospital and in the process also fight with the parents who are reluctant to send their children to the Hospital, keep a tab on the pregnant and lactating women in the village, serve them food and supplements too, the list goes on. In almost all cases, the Anganwadi workers in Malkangiri are Bengali or Oriya and hence there is an existent linguistic and cultural difference which doesn’t make things better for the children. Now every time a child returned from the Hospital dead, the parents land up at the residence of the underpaid Anganwadi worker and blame her for the death. One worker from Kalimela Block even got beaten up. The District Administration also holds the Anganwadi worker responsible for an unreported death at the village. Why would they do otherwise? Who doesn’t resort to the easiest way out which is to blame the lowest paid worker in the hierarchy? Now if the Collector had instead raised his fingers at the systemic exclusion of Adivasis by the brahminical BJD year after year and asked why didn’t an immunisation drive for JE happen in 2012 after samples tested positive, the Naveen Patnaik government would’ve taken the easy way out too. Transferred him immediately.
Malkangiri is one of the least populated districts of Odisha, a fraction of the more highly and densely populated yet developed districts in the state. But, more than 80% of the district is Adivasi-Dalit and therefore the brahminical government is hell bent upon wiping out a whole generation in Malkangiri by simply denying public health care. The district’s hospital & health care centres are majorly understaffed with a staggering 50% vacancy in posts for Doctors. The criminal and intentional negligence of Adivasi-Dalit children is evident across the state of Odisha. Earlier this year, at least 19 children died from severe malnutrition in Nagada village in Jajpur district, where more than a dozen steel factories and massive chromite mines exist. The Expert Medical Committee that was meant to investigate the deaths in Malkangiri resorted to blaming Adivasi food habits, a sinister attempt to whitewash the blood on the hands of the Brahminical Govt., and further reinforced the fact that the Odisha Govt. would rather have Adivasi Dalit children die than spoil its image. The truth is that the Orissa government has more than one reasons to keep Adivasis and Dalits in Orissa in the state they are. Wiping out generation after generation in addition to keeping them malnourished will make it easier for the ruling government to keep their uppercaste vote bank happy. Divesting all funds in the name of ‘development’, occupying the lands of Adivasis, grabbing their resources will just become a step easier. ‘Resistance managed’.