the scourge of hunger and tuberculosis

Raja Baiga is 9 years old and weighs 10.8 kg. That is the normal weight of a two year old child. He has tuberculosis, as do both of his parents. His father has completed treatment, the mother was only recently diagnosed to have sputum positive TB, and weighs 27 kgs herself.

A passive and sad looking child, Raja spent three weeks at Ganiyari with us. At discharge he weighed 12.4 kg, his appetite had improved, and he was more active and cheerful.

He and his mother will not go back immediately to their village Kurdar which is on top a mountain and inaccessible, but will stay at the foothills in the village of Karhikachar where his grandmother lives. There he will be enrolled in a day-care centre run by JSS (normally only for children between 6 months and 3 years of age). His diet at home will be supplemented by daily eggs and khitchdi with oil, as well as sattu.

We hope that the anti-TB medicines and the improved diet will help him overcome this infection. Is there some treatment for his chronic hunger as well?

hungama over hunger

the recently released hungama report tells us what we already know: almost 50% of children are underweight, which means that nearly half our children go to bed hungry every night. a national shame, if there was one.

seen here is shiva of chaparwa village, grinding garlic to make a gruel to give his younger brother vishnu who was crying with hunger. there is nothing else edible at home, and both parents have gone out to work. shiva, 5, is confident he can wait till the parents earn, buy some food, and come home in the evening. he hopes the garlic and water gruel will help vishnu, 2 years old, to stave off his hunger pangs for a while.

Bahoud

naresh baiga, 10 years old, with tuberculosis of the foot and leg bones, was unable to stand when he first was brought to our clinic at bamhni. fortunately he has responded well to treatment.
when we visited bahoud last week, i went to his house to see how he was doing. we found him in the street, playing in the dirt with his friends.

choitram baiga, 38, however, has not been so lucky. he has multi-drug resistant tuberculosis, and continues to be unwell in spite of over a year of treatment. he is being provided with what are called second-line anti-TB drugs, which are expensive, and need to be given for a longer period of time than the usual course of medication.
earlier this year he had sold his few his goats and pigs to raise Rs. 6000 in order to hire a tractor to help till the 5 acres of land he has been given here at new bahoud. in spite of that, the rice yield has been poor, and will last his family of 8 for three months. the BPL rice does not last the entire month for the family. the oldest son, 18, works and keeps enough money aside to buy a kilo of arhar daal every fortnight for his father.
choitram's main worry now is how his family will survive this coming year. he is now unable to walk and drags himself around on the ground once someone helps him off the bed.

tuberculosis continues to be a serious and widespread problem in rural india. this small village of bahoud has three patients with severe forms of tuberculosis. the risk of death due to TB increases as the body mass index of the patient reduces. that means that a malnourished person is more likely to die of tuberculosis than a well-nourished patient is.

Resettlement, two years on.

Bahoud village, relocated from within what is now the Achanakmar tiger reserve, to a place several kilometres away. It sits in plain view of the road from Bamhni to Khudia, neat rows of whitewashed buildings, complete with electricity poles along the street and wide cemented roads. This is the village that has been showcased as an example of the Government's resettlement and rehabilitation policy - surely these neatly laid out concrete houses and broad streets are far better than the inaccessible village the Baigas inhabited earlier?
Two years on, most houses have a fence of twigs around them; now in December, several houses have the rice harvest in, ready for threshing.
I visited the village on Friday, to follow up some patients we had seen in our clinic.
What struck me was the solar powered street lights at the corner of each street: why this in addition to electricity, I wondered. Each house has a ceiling fan fitted, as well as a CFL in two of the four rooms. Each house also had a small solar lamp they had purchased at a discount from our NGO, and this was their only source of light at night.

Tugur Baiga sits outside his house warming himself in the sun. I ask him about the solar panels and the electricity poles and wires. There is no provision for electricity supply to our village, I am told. None of the villages nearby have power either.
He has been given five acres of land in this new location, but it is on a slope and does not retain water. So the rice he has harvested is the same quantity as he would get on his 1.5 acres within the forest. After the harvest, we used to supplement our income with forest produce like sal seeds, but now there is nothing, he says. Given the choice would he like to return to his original village? I ask him.
Choice? When do we ever have a choice? he answers. We were bundled here in trucks and left under a few trees, and had to live through the summer and the rains while the houses were built. Now our house has a number.
Do you own your house? Do you have any papers for it? No, he says, nothing.
What about the patta for the five acres? No, there is no talk of giving us a patta, he says. I dont know anything about it.
Why don't you ask for it through your Gram Sabha? He thinks for a while. When our Gram Sabha met, we raised the issue of another drinking water source - this large settlement has only one borewell at one end of the village. The Government had also promised to help with tractor facilities for five years to clear our land of stones, and we have asked that they be reminded of that. But it is two years now, and they have not done it, I wonder if they ever will. Tugur sounds discouraged and resigned.
It is the same story in every household I visit.
I visit the anganwadi centre in some anticipation: one of our staff had reported on CGNet Swara earlier this year that the centre was not receiving rice for the children's meal, and that they had to make do with chana and murra. This had received quite a bit of publicity, and when he visited the village three weeks later, he found the children being given cooked food to eat. We felt encouraged - our report had made the difference, we thought.
The centre is run in one room of the house belonging to the helper. It was brightly decorated with charts on the wall and a mat on the floor, and scattered about it were grains of murra. I asked the helper how many children she had cooked food for that day. There are 30 children who attend, she replied, but I don't cook, since there is no rice supplied. I asked about the rice that was served in April when my colleague visited. Oh, that was the time of the Gram Suraj Abhiyan, when all the officials come to every village, she replied. Before their visit a 50kg sack of rice was provided. But after that, there has been nothing. Indeed, when I look at one of the registers kept there (no growth register or immunization register was available), the last three entries are a flurry of visits in April, with recommendations and remarks: made, no doubt before the bureaucrats and politicians descended on Bahoud for a day to listen to the problems of the aam aadmi.

Development with a human face.

learning BLS

this is a picture of some of our staff learning to administer cardiac massage on a dummy. we plan to train a few people in each village in this life-saving technique.

The Kodekasa Kanyashram

The village is set in a valley, green and verdant now at the end of the monsoon, and as you look down from the top of the road, the houses are to the left, and the various institutions to the right – first is the middle school set in a large ground, then the sub-centre, the panchayat office, and the primary school with the anganwadi in the same compound. Kodekasa is a panchayat headquarters village and the road that runs through it is in a good state of repair.

We had come to meet the ANM who lives at the subcentre here, but she is away to visit her mother who is unwell. We met the Mitanin there, a cheerful woman who has been working as a mitanin for the past ten years. We are now headed back to Dalli and I stop for a last look at the village.

I am standing outside a building surrounded by a wall, with nothing outside to indicate what it is. Only the numerous clothes drying on the wall tells me that it may be a hostel of some sort. Dr Prathap who is with me in the jeep says he would like to see if anyone there has fever (this being the start of the malaria season), and he and the driver set off inside while Temin the nurse and I wait on the roadside enjoying the sun.

They are back in a couple of minutes: it is a girls’ hostel, they say. Temin and I go inside to meet the staff and students. We are able to walk right in, through the gate, through the front door, into the dormitory, into another large room with a water cooler installed (there is no running water in the hostel), and I glimpse more rooms beyond.

The entrance to the dormitory has pictures of Gandhi and Ambedkar on it. To the right is a small board stating this is the Kodekasa Kanyashram (Girls’ Hostel), with an intake capacity of 50 boarders. To its left is a large board giving details of the number of students there. At present there are 30 of them. No other details of whom to contact, who is in charge, no name of the warden, nothing.

My knocking on the door brings three girls out from somewhere inside, and they are soon joined by some of their friends. Today being a holiday, they are not in the middle school fifty yards away.

The dormitory is large and airy, but poorly maintained, and has twelve neatly made beds in two rows. At the far end of the hall is a row of tables with six computers on them. I am impressed and ask whether they know how to use them. No, they say, the computers are out of order. Since when? I ask. The oldest resident there has been in the hostel for three years, and the computers were already there and not functioning at that time, she replies. I ask for their warden – there is no one here, they reply. Has she gone home as it is a holiday? No, there is no warden.

Who takes care of you?

There is Ahilyabai the cook, they reply. Temin goes in search of Ahilyabai, fails to find any adult in the place.

Meanwhile, I try to start the computers – none of the UPS units are functioning, nor are the computers. Understandably, the tables are left alone and everything is coated with dust and cobwebs. There is electricity though.

Some of the computers at the kanyashram.

There are 30 of us girls here, they reply to my question. I ask if there is another dormitory as I count only 12 beds here.

No, they say, all of us sleep here, the smaller ones are 2 or 3 to a bed. We join the beds together at night so that no one falls off.

The dormitory - 12 beds for 30 girls

They attend the middle school that is next to the hostel.

What happens when you fall sick?We go to the village and call our parents and then we go home, they reply.

Don’t you see the ANM who lives here?No.

Don’t you ask the Mitanin to give you some medicines?No, we just go home.

How far is home? Quite far. If we are very sick, our parents come and get us, otherwise we go by ourselves.

Who do I have to ask if I want to get someone to repair the computers?Thakur sir.

Where does he live?In Lohara.

Lohara is at least 10 km from here. No,they don't have his phone number.

The girls are happy that someone has visited, but are shy to talk. I am wary of asking probing questions in case they get into trouble for talking to a stranger. They want a picture taken with the nurse. Temin and I then leave, with all the girls crowded at the gate and waving to us. Just past the bend in the road after the hostel, barely 50 feet away, is a small shop: cycle-repair and petty shop in one, and at this moment there are five young men sitting there and talking.

I leave with many questions in my mind. Who is supposed to be in charge here? Surely there cannot be a residential school for young girls with only the cook who may and may not be there all the time? What about security – all four of us in the jeep could walk in unchallenged. What if some men decide to walk in and harass the girls or worse? Who do they turn to for help? What if one of them has an accident or falls ill – no first aid or simple medication available there? And what about the budget – if the stated capacity is for 50 boarders, surely there must be a provision to purchase 50 cots and mattresses for them? Who purchased the computers, or was it a donation of used ones? Who set it up and why did no one come to check that they have not been working for at least three years? Obviously their parents would like them to study beyond primary school – after all, that is what many of us say is the basic requirement for empowerment of women. Is this what the state offers them?

kakna

i was conducting a training for nurses in sarguja district last week at a place called kakna, 18 km from ambikapur. the night train between durg and ambikapur takes about eight hours from usalapur (near bilaspur) to get there, but the journey was comfortable.

my brief glimspe of ambikapur left me wide-eyed: a huge bustling market, good roads (no significant potholes at least in the market areas and the centre of town, unlike in bilaspur which is one endless series of potholes of varying dimensions all over the city), and large showrooms with branded products. when i worked here, first in 1987 for a year, then in 1992-93, it was much smaller, without a rail-head. traveling to ambikapur meant an eight hour bumpy bus-ride from bilaspur, with at least two punctures guaranteed on the way. both towns were still part of madhya pradesh at that time.

kakna is a silent haven, a lush green valley ringed by hills with no internet access, and poor cellphone connectivity. a perfect place for training. the only downside was the prolonged powercuts but an inverter ensured that the projector and laptop could be used without interruption. keeping the 25 nuns and myself company on the campus were kajal and kalloo the dogs, and changoo the kitten. it rained practically incessantly, with occasional spectacular thunder and lightning thrown it for good measure.

the RAHA centre at kakna is a perfect place for a retreat or for solitude if one wants to write a book. unfortunately i do not have any photographs to share.