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Millennium Post

India’s ‘hunger’ shame

Attappady, the only tribal block panchayat in Kerala, hit the headlines following a series of infant deaths caused by malnutrition. According to the latest figures available with the Integrated Tribal Development Project office at Agali, the headquarters of the block, 30 infants have died this year till 31 May, while data shows that 52 have died over the past 18 months.

Attappady is a part of the Nilgiri Biosphere Reserve in the Western Ghats region of Palakkad district. In 1975, the state planning board assessed Attappady as the most backward block in Kerala and the next year the Integrated Tribal Development Project (ITDP) was launched here – the first in the state. Since then a number of projects have been implemented in Attappady in the name of tribal development. But the lives of the tribes in this large block, spread over 745 sq km, remains a synonym for poverty and social backwardness.  Most of the infants in the tribal block who died over five months since January this year were newborns with birth weight between 550 gram to 1.5 kg, much less than the normal weight of 2.5-3.3 kg. They died within hours or a few days of their birth.  With exception of a few, most were premature deliveries that took place in the sixth to eighth months of pregnancy.

Dwindling population
The block has about 10,000 tribal families belonging to Irula, Muduga and Kurumba communities, living in 192 oorus (settlements) scattered in three gram panchayats – Agali, Pudur and Sholayur. The tribes who comprised more than 90 per cent of the population in 1951, has dwindled to a minority over the years due to the influx of settlers from the plains of Kerala and Tamil Nadu.
Of the 70,000 people living here at present, tribes are only about 40 per cent. Deaths occurred in all three gram panchayats. At Nellipathy, an Irula tribal settlement in Agali gram panchayat, twins born to twenty-five year-old Ponnamma on 23 March died within a week of their birth. Ponnamma had just entered the seventh month of her pregnancy when she delivered her babies in the community health centre (CHC) at Agali. One of them, weighing only 640 grams, died immediately. The other was slightly more than one kilogram. ‘It died on the seventh day,’ says a visibly weak Ponnamma. As per the medical report, the reasons for the deaths were the babies’ low birth weight and growth retardation. Including Ponnamma’s twins, four babies died in this settlement this year. In Vellakulam settlement in Sholayur panchayat, too, four babies died: three of them in March alone. They include the twins born to 28-year-old Chelli, wife of Velan. One of them was a still-born while the other died after three days. She could not go to the hospital since her settlement was remote. The delivery happened late in the night and there was no transportation facility. She was in the eighth month of her pregnancy. ‘There are wild elephants here so jeeps won’t come in the night,’ says Chelli. A doctor from the primary health centre came only two days after the delivery after he was informed by the ASHA worker (accredited social health activists). Chelli was anaemic and the second baby weighed just 750 gram.

Silent genocide
What caused the infant deaths is the combined effect of marginalisation and impoverishment of adivasi communities, lack of food and nutritional security, poor healthcare and supplementary nutrition services. ‘The present crisis in Attappady happened not because of any reasons,’ says Rajendra Prasad, president of Thampu, an organisation working among the tribes in Kerala. ‘There had been a systematic failure of governance, neglect and corruption for the last several years in this region.’ In Attappady, 25 starvation deaths were reported in 1996 and 32 in 1999, he points out. ‘In fact, what has been happening in Attappady is a genocide without any exaggeration,’ says B Ekbal, neurosurgeon and former convener of Jan Swasthya Abhiyan, a national-level people’s health movement, who led a six-member medical team that assessed the situation in Attappady in May.

Malnutrition & anaemia
Malnutrition and anaemia are prevalent among the tribals in Attappady. ‘Almost all tribal women, including adolescent girls, are anaemic, and it’s acute among the pregnant and lactating mothers,’ says Prabhudas, a committed government doctor, who has served in Attappady for about 20 years. He had been transferred out of Attappady two years ago, but after the infant deaths, he has been appointed as the district nodal officer to coordinate health services for adivasis. While it is dangerous for a pregnant woman to have a haemoglobin count below 10 gram, most pregnant adivasi women in Attappady have counts of seven or eight, points out Prabhudas, and it even goes down to five or six.  According to him, the tribals suffer from calorie as well as protein deficiency. There are at present 536 pregnant Adivasi women in Attappady, and 90 per cent of them are anaemic and are facing serious health problems.

After many infant deaths were reported, the state health department conducted a mega health survey in April this year, screening 23,597 persons in Attappady. A total of 536 cases of malnutrition and anaemia were identified – of them 69 were severely malnourished while 463 were anemic. These 536 include children below six years, pregnant women, lactating mothers and adolescent girls. A mega medical camp found 536 of the 836 people from adivasis who participated in the camp suffered from malnutrition and anaemia – 125 of them were children below five years.
The report of the six-member medical team led by Ekbal observes eclampsia (high blood pressure and seizures) is common among tribal women of Attappady in the third trimester of pregnancy. One of the major reasons for high blood pressure during pregnancy is lack of nutritious food, says Ekbal. This leads to growth retardation of babies before birth (intra uterine growth retardation).

Poor health risk management
The death toll of infants would not have been this high had the health centres worked efficiently, points out A Laxmiah, public health nutrition specialist with the Hyderabad-based National Institute of Nutrition, who led an experts’ team that conducted a nutrition survey in Attappady’s adivasi settlements in May. ‘Undernourishment is there but more than that the risk management by healthcare centre was very poor,’ says he. In Attappady, there are 36 healthcare centres – one tribal speciality hospital, one community centre, three primary health centres, 28 sub centres and three mobile medical units, all managed by the state health department.  Besides, there are two outpatient clinics (OP) under the ITDP and 85 Accredited Social Health Activists (ASHA) under the National Rural Health Mission.

‘But none of the healthcare facilities were working effectively and efficiently for the past two years,’ points out P V Radhakrishnan, the  ITDP project officer who took charge in March this year. It was he who first confirmed deaths due to malnutrition in a report sent on 4 April to the state tribal development department. The state government was literally caught in a bind when the media continuously highlighted the ITDP officer’s report.
On arrangement with Down to Earth magazine
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