The tragedy of survivors

Ranjana and Ananta Mere with their three-and-a-half-year-old twins Rina and Sunny, who were diagnosed with Grade 4 malnutrition when they were 11 months old. Although they have recovered, they have only just started walking. Ranjana holds a picture of the children taken three years ago. - ANIL SHINDE

BEYOND the statistics on the affected, there is the hidden and often painful story of children who recover from severe malnutrition. Recovery, even from severe malnutrition, is not uncommon nowadays. Intensive medical intervention and a nutritious diet can help a child to be declared normal. But what is normal for a child whose physically, emotionally and intellectually formative years have been spent in a life-and-death struggle?

In August 2002, Frontline met Ranjana Mere, a Katkari tribal woman who lived in Uprale village in Thane district. Ranjana's twin children, Sunny and Rina, were 11 months old at the time and diagnosed with Grade 4 malnutrition, a condition that can be life-threatening. They were receiving treatment at the local primary health care centre. After intensive treatment for two years, the children were declared normal.

Three years later, in August 2005 Frontline revisited the Mere family and found that the children had survived, but just about. At three and a half years of age, Sunny and Rina are unlike their peers running around the schoolyard cheerfully. Shy and withdrawn, with prolonged bouts of attention-seeking in between, the twins live in a world of their own. They have just started to walk, but they tire easily. Their parents carry them most of the time, especially if they are going to the fields, a distance that other children manage effortlessly and frequently throughout the day.

Communication, too, is a recent achievement on their part. Their parents understand them instinctively, but the twins make little effort to interact with other children. Slow development is not uncommon in children who have suffered malnutrition at some stage, said paediatrician Dr. Abhay Bang, adding: "The child may survive the early years of malnutrition but unless there is special intervention it could lag behind in its development."

The three years of treatment have taken their toll on another hidden area - the health of the parents. The compulsion to earn prevented Ananta, the father, from sharing the responsibility of making frequent visits to the hospital for the twins. Ananta owns a tiny plot of land, which feeds his and his brother's families - a total of 11 people. In the stony fields of Vikramgadh taluk, the yield of paddy is barely enough for the family and there is nothing left over for a commercial profit. Inevitably, he must work as an agricultural labourer for part of the year, or on road building projects under the Employment Guarantee Scheme if it is a poor agricultural year.

In eight years of marriage, Ananta and Ranjana have had four children. While the first two had no problems, the birth of the twins and their subsequent ill health caused great setbacks to the health of the mother. Even now, Ranjana complains of a constant abdominal pain and tiredness. Medication eases the pain, but only for a while. She says the doctors tell her it will go away, but conventional medical opinion on the health of mothers of malnourished children suggests otherwise.

Given the condition of tribal mothers, it is more than likely that Ranjana herself was an undernourished child (if not malnourished). Early marriage, frequent childbirths and the need for caring for sick children often take their toll on tribal mothers. Dr. Bharat Mahale, gynaecologist at the Jawar Cottage Hospital, says that in the tribal regions 80 per cent of the first-time mothers are underweight. "Their weight in an advanced stage of pregnancy is usually 40 kgs, whereas it should be about 60. Usually the baby is also born underweight." He added that babies on breast milk normally doubled their birth weight in the first five months but this almost never happened in the case of tribal babies.

Doctors say Ranjana could be the victim of what is called "hidden hunger" - vitamin and mineral deficiencies, which do not necessarily make a person look underweight. Its classic symptoms are inability to function efficiently and a general sense of malaise. Ranjana displays both.