Picture of neglect

Print edition : November 11, 2016

A child outside his hut at Palkonda village in Odisha’s Malkangiri district. Despite the State government’s claims about implementing poverty alleviation programmes, severe poverty persists in Malkangiri and other tribal areas. Photo: Biswaranjan Rout

Children affected by Japanese encephalitis at a ward in the Malkangiri district hospital. The district headquarters hospital in Malkangiri town reportedly has only 13 doctors as against a sanctioned strength of 44. Until the end of September, the district had only one paediatrician. Photo: Biswaranjan Rout

Death of children from malnutrition and Japanese encephalitis in the backward Malkangiri district puts the Odisha government in the dock.

The death of 19 Juang tribal children from acute malnutrition in inaccessible hamlets in the Nagada hills in Jajpur district over a period of three months early this year and that of over 60 undernourished children because of acute encephalitis syndrome (AES) caused by the Japanese encephalitis (JE) virus in the tribal-dominated Malkangiri district in less than two months have exposed the Odisha government’s inefficiency in tackling hunger and malnutrition across the State. The toll is likely to increase as many undernourished children are affected by fever.

Malkangiri, a part of the backward KBK (Koraput-Balangir-Kalahandi) region of Odisha, with 1,045 villages in seven blocks, is covered under the Tribal Sub-Plan (TSP), which lays emphasis on the integrated development of tribal areas. It ranks among the few districts with the lowest per capita income in Odisha; its share to the Gross State Domestic Product (GSDP) is one of the lowest. Of the 108 gram panchayats in Malkangiri, only 16 have bank branches, according to the latest Odisha Gazetteers. The 1997 below poverty line (BPL) survey says that 72.69 per cent of the families in the district, most of them belonging to the Scheduled Tribes, fall below the poverty line. This calls for immediate action to build rural infrastructure, conserve natural resources, implement programmes for income generation on a sustainable basis and to restructure the social security system. Though the State government claims to be making a concerted effort to implement a series of poverty alleviation programmes in order to reduce the dimension, deprivation and inequities in poverty, severe poverty persists in Malkangiri and other such inaccessible areas where tribal communities continue to depend upon subsistence agriculture, including shifting cultivation.

The Naveen Patnaik government’s callousness towards the children of Malkangiri is evident from the fact that it did not take up any vaccination drive to prevent the recurrence of JE despite the disease claiming the lives of 38 children in 2012 and 11 children in 2014 in the district. A few deaths because of JE were reported in 2011 and 2013 as well. But no sincere effort was made to procure vaccines from the Central government or make alternative arrangements.

Malkangiri, which has been a stronghold of Maoists for long, is 600 kilometres from the State capital. No government employee, unless belonging to the district, is willing to serve in the district; most of them consider a posting in the faraway district as a punishment.

Although Maoist activity in the district has decreased in recent years, lack of proper roads and communication, even to the district headquarters of Malkangiri town, is a big deterrent to progress. The less said the better about roads, schools, hospitals and telecommunication services in the interior areas.

Together, the government hospitals in the district have only 23 doctors as against a sanctioned strength of 115. This when the death toll from JE had crossed 40 by the first week of October.

The district headquarters hospital in Malkangiri town has only 13 doctors on duty, including two dentists, when the sanctioned strength is 44. Until the end of September, the district had only one paediatrician.

Even the performance of 108 and 102 (emergency telephone) ambulance services in the district was found to be inefficient. Quite often, the District Collector receives complaints about the ambulance not reaching the intended beneficiaries in time for them to reach the nearest health centres. Delayed services have resulted in the death of sick children, according to even official reports.

After getting off on the wrong foot, the State government made postings of more doctors to cope with the JE outbreak. But, according to official records, by then the number of deaths from the vector-borne disease had risen to 50. As many as 99 villages spread over six of the seven blocks in the district have been affected by the disease.

Unofficial estimates put the number of JE deaths at over 100 as many people in remote pockets have not been able to reach hospitals, and some died after they were discharged from hospitals.

Three-year-old Devaki Madhi of Palkonda was discharged from hospital in September, four days after her admission. She died a few days later. The list of victims released by the Chief District Medical Officer (CDMO) of Malkangiri does not have her name.

Sama Madkami of Katanpali village under Padia block lost three of his four children to JE between 2012 and 2014. When his fourth kid showed symptoms of the killer disease, he refused to admit his ward in any government hospital in Odisha and disappeared from the village. Opposition political parties rejected the government statistics on JE deaths. State Congress president Prasad Harichandan, who visited many affected villages, said that JE had claimed some 200 lives. He blamed it on the negligence of the government.

Bharatiya Janata Party (BJP) leader Bhrigu Baxipatra said that field reports had suggested more than 150 child deaths. Questioning the preparedness for tackling a preventable crisis, he said the government had not distributed medicated mosquito nets in Malkangiri in time. Only after the outbreak occurred did the then CDMO, Udaya Shankar Mishra, hurriedly buy 11,000 general mosquito nets locally.

Studies on JE prevalence

The deadly JE virus, which originates from pigs, spreads to humans, mostly children, through culex mosquitoes that live near a pigsty. JE is a public health problem in the South East Asian region and India. Its outbreak was reported for the first time in Odisha from Rourkela city in Sundargarh district in 1989.

According to a study of the prevalence of JE in Odisha by the Regional Medical Research Centre (RMRC) of the Indian Council of Medical Research in Bhubaneswar, sporadic cases of the disease had been diagnosed from hospitalised children between 1992 and 1995. During September-November 2012, following reports of AES and deaths among children in Malkangiri, an epidemiological investigation was carried out by the RMRC to support public health measures taken by the State Health Department. The report says that in 2012, as many as 24 deaths were reported from four villages under two tehsils of the district within a distance of around 18 km. But the current outbreak has covered almost the entire district.

“This report of Japanese encephalitis from this non-endemic area indicated a need for public health vigilance in areas having environmental risk for acquiring JE infection. This can prevent morbidity and mortality by early suspicion and investigation,” said the RMRC’s scientific paper.

Though it is public knowledge that undernourished children aged up to 10 years are particularly vulnerable to JE, the government did not take any concrete steps to vaccinate the children. Only now has the government made an announcement to take up vaccination in phases.

Apart from vaccination, cleanliness measures, distribution of medicated mosquito nets, and an awareness drive before the onset of the monsoon to keep the pigs away from homes could have helped in preventing such an emergency situation, said senior administration officials.

It was only after hospitals started overflowing with affected children that the administration woke up from its deep slumber. Fogging machines were procured to control mosquitoes and distribution of mosquito nets was undertaken on a war footing. Measures were also taken to isolate pigs.

Opposition speaks up

When opposition parties started criticising the government, Health and Family Welfare Minister Atanu Sabyasachi Nayak visited Malkangiri to take stock of the situation. Even then the administration was found struggling to cope with the situation because of the shortage of health professionals.

After the Minister left Malkangiri, former Congress MP from the area Pradeep Majhi undertook a walk from the hospital to the District Collector’s Office carrying the bodies of two children to make the administration aware of the gravity of the situation. He alleged that although cases of JE deaths had been a recurring feature in the district since 2011, there was no effort by the government to prevent the outbreak of the disease. “Since 2011, JE has claimed at least 160 lives in the district, but the government has failed to vaccinate the children against the disease. The government could afford to sit idle in Bhubaneswar, since tribal people are peace-loving and hardly question it,” said Majhi.

Nayak, who did not resign in the wake of the death of children in Malkangiri, however, resigned from his post in the wake of a major fire mishap in Bhubaneswar-based SUM hospital. The fire, which broke out on October 17 evening, claimed the lives of 26 patients. Meanwhile, as poverty-stricken children were getting admitted in hospitals in Malkangiri, at least one of the affected was dying almost every day for lack of medicine available. Some children suffering from cold and fever were being discharged after basic treatment for a few days. Encephalitis caused the death of 90 to 95 per cent of the affected, said a doctor in Malkangiri. Meanwhile, Malkangiri CDMO suspended two health workers, Subal Charan Mistry and Biswanath Patra, who were working at Palkonda and Badli nodal centres, for dereliction of duty. No action was, however, initiated against any other government employee holding any key post in different departments.

In the presence of opposition leaders, several parents from Koimetla village lodged written complaints with the police against Chief Minister Naveen Patnaik and some of his Ministers, holding the government responsible for the death of their children.

As the Congress and the BJP continue to blame the Chief Minister for not visiting Malkangiri, the district remains a picture of utter neglect. Local people alleged that many corrupt government officials and leaders of the ruling Biju Janata Dal were swindling the funds meant for various welfare schemes.

In 2014, Malkangiri ranked 15th in the list of 100 districts in the country with the highest prevalence of child wasting, stunting and underweight. According to the latest Annual Health Survey (AHS) data, 33.4 per cent of the children below five years of age in Malkangiri suffered from wasting, stunting and underweight primarily because of undernutrition. It “can be termed as a deficiency of calories or several vital nutrients essential for growth and survival. Undernutrition develops largely when people fail to obtain or prepare food, suffer from a disorder that makes eating or absorbing food difficult, or have a greatly increased need for calories.”

In the AHS list of 100 districts with the highest prevalence of under- and over-nutrition among children, Malkangiri stands 10th with 35 per cent undernutrition. The infant mortality rate (IMR) for Malkangiri is reported to be 48 as against the State average of 56, and the maternal mortality rate (MMR) stands at 245 as against the State average of 230. The worst that has happened to Malkangiri’s poor population in the wake of the outbreak of JE is the fear of losing pigs, a major source of livelihood. Panicky villagers killed hundreds of pigs after the administration identified the animal as the repository of the virus. Those that have survived are being kept in enclosures away from the hamlets.

Regions like Malkangiri have failed to gain their share of development in an equitable manner in the State. Until the powers that be act decisively and sincerely to strengthen the healthcare infrastructure and enable the tribal and other poor people to take care of the nutritional requirements of their children in every region of Odisha, epidemics like JE will continue to take their toll.