By Srinibash Das and Ranjit K Sahu

 Tribals and indigenous people comprise about 22% of the population of Odisha and inhabit the forest and hilly tracts of the state. Though several decades have passed since independence their health and living standards has not seen any change in spite of rapid industrialization as well as advent of modern technologies into these once unexplored and avoided tracts. Their backwardness in terms of development stems not only from their intrinsic cultural practices but also from the negligent and indifferent attitude of organizations that have the responsibility of catering to their needs. While various agencies and individuals are quick to harp on the untimely deaths occurring in these regions to meet their own goals of hogging limelight or pushing their political agenda, little happens in terms of improving the situation on the ground. Each incident of epidemic proportion that would have had heads rolling in any other developed nation ends up being a headline for a few days in some local, regional or national newspaper of media. Similarly the area of tragedy becomes a political hotspot and vote bank politics takes precedence over the welfare of the voters. Places that were neglected on a daily basis become the focus due to deaths that are in scores and there is a flood of personnel. It is a paradox that people who need attention while alive get limelight after death! The sociopolitical ramification of each incident that occurs are many, yet none of these have ever benefitted the tribals. Their situation remains dire especially with regards to health and sanitation.

 Incidents like the death of  Dana Majhi’s wife where he carried her body for cremation himself due to non-availability of  an ambulance, the deaths due to consumption of mango kernels in kashipur or large scale infant mortality due to  Japanese encephalitis  are becoming common and frequent events. While these become the focus once in awhile, they are quickly lost in the din of other activities which the media thinks will gain it increased TRP. However the basic facilities are never upgraded. The case pointer is the death of five people in Mushukuta Village of Kalahandi district affected by a cholera epidemic due to consumption of contaminated water from defective bore wells. While an emergency measurement  was taken and an ambulance and a four day camp was  to treat the patients, the basic problem of repairing and/or digging new bore wells to prevent further incidents are overlooked.  The problem thus haunts the 200 odd families in the village and it is just a matter of time before the scene unfolds again.

 The tragedy of contaminated water is not limited to just humans. In one incident that affected Gopinathpur village of Thuamul Rampur block (Presently the mines are being operated by Utkal Alumina), consumption of the contaminated water by cattle and goats had led to loss of over 100 animals. While government agents related to the compensation as well the company dilly dally with the formalities for payback, the people who lost their animals have no respite and have no means to overcome their loss which also puts their livelihood in jeopardy.

 Critical facilities like clean water and sanitation apart from a provision for rapid diagnosis and control of diseases that can progress to epidemics need to be restored or installed in these villages wherever possible. Awareness about the actual cause of the disease and their prevention needs to be spread through the communities being continuously affected as a first step. Knee jerk reactions like mass slaughtering of pigs to prevent Japanese encephalitis needs to be curbed. Rather people need to be educated how to deal with such situations that the epidemic is not blown out of proportion by emphasizing on personal and public hygiene and environmental modifications to contain the spread of the disease.  The primary health care centre staff maybe trained to deal with these cases at their initial emergence to prevent and control the problem on site as many times the immediate response time is critical to control such menace. Apart from this there is a need for establishment of a direct liaison between central and state health agencies with the primary for continuous monitoring of the situation where a re-emergence of the disease is anticipated. In remote tribal villages the minimum health services is due to poor functioning of health care institution and  it is the time to involve local PRIs functionaries, Youth mass, non-government organizations(NGOs) and Self-help groups (SHGs) to manage  and monitor  the services available. Another recurrent problem encountered in these areas is the unwillingness of doctors to be posted here. The employee or doctor who are posted in this area aren’t willing to stay due to poor road connection, lack of proper infrastructure and other facilities, there is an urgent need to provide them all the necessary support by the health dept.

 In addition to this, often the public ire is directed against the doctors when a calamity strikes as he/she is held responsible whether or not he/she has a role to play in the situation. While corruption has found its way into the health care system like many others, yet these types of public reactions discourage even the genuine and selfless doctors from getting interested in serving the rural poor. The recent incident in Kashipur, where a young girl suffering from malaria and admitted in the hospital, died after she was taken back home without being discharged is a case for analysis. The villagers threatened the doctor that due to poor treatment the girl died and kept the doctor locked for 3-4 hours. Such public responses also demoralize health workers and hamper effective health care in tribal areas in the opinion of the in-Charge of Kashipur Hospital.

In tribal area many Anaganwadi worker and ASHA(Accredited Social Health Activist)  worker are illiterate or aware of only the basics three ‘Rs’ (namely reading, writing and arithmetic) and in spite of having the minimum knowledge and lacking adequate training they are made to perform tests for  malaria and other blood borne diseases in their area of operation. This creates a major problem as well and a system to impart required training to such workers along with their own protection during this type of work should be undertaken by concerned agencies.  The perennial challenge in these areas has been high infant and maternal mortality. To reduce the IMR (Infant Mortality Rate) &MMR (Maternal Mortality Ratio) organization of massive campaigns among the tribal community about the evils of child marriage needs to be undertaken. They need to be educated under special health literacy education, to encourage the women and adolescent girls to take iron, and other medicines regularly supplied by the health worker using the platforms of different traditional media and folk dance. While domestic animals can serve as the host of many pathogens, their eradication may not be the solution as they are a vital source of   the rural nutrition in terms of animal products. Their relocation (e.g. the piggeries) or rearing the animals in isolation away from vulnerable population with proper management under the guidance of trained professionals maybe the key to mitigating the ill effects of inadequate sanitation. It is high time the rural health scenario is seen as a part of the complex socioeconomic and cultural dynamics of rural India (Odisha) rather than just a disease prevention and cure issue. Without such extensive and urgent remedial steps these areas would be in the grip of health problems and the inhabitants of these villages would live the life of gamblers, taking their chance with diseases, death and destruction every single day.

About the Authors:

Srinibash Das is a development professional based in Odisha and works as a District Coordinator of Agragamee. His thematic areas of works are right based advocacy, education, women empowerment and strengthening community based organizations. He has also a keen interest in environment protection and health care in rural/tribal areas and has been witness to the sufferings of the people in the hinterlands for several years.

Dr. Ranjit K. Sahu is a Research professional and freelance writer with over a decade of experience in biomedical research , currently located in Virginia, USA. His interests include education, environment, sustainability and health care in the underprivileged regions of the world.