The heat of poverty

Poverty is the underlying reason for the large number of heat-related deaths reported from Andhra Pradesh this summer; the heatwave is just the proximate cause.

Yes, `n' how many deaths will it take till he knows That too many people have died?

Bob Dylan in "Blowin' in the wind"

THE onset of the southwest monsoon has reduced dramatically the rate of heat-related deaths across the country, particularly in Andhra Pradesh, where the heatwave reportedly claimed over 1,300 lives this summer. However, the actual number must be much higher. For every heat-related death that is reported, there could be at least five cases of complications owing to renal problems, especially in regions where the temperature exceeded 44C.

While several parts of the country witnessed spells of intense heatwave conditions, 90 per cent of the deaths were reported from Andhra Pradesh. Most of the deaths could have been prevented if the state machinery was geared to meet the situation. In places such as Arizia in Libya, temperatures as high as 58C are recorded; in California's Death Valley, temperatures soar to 57C; and in parts of Spain, summer temperatures shoot up to 50C. However, none of these places has reported large-scale deaths of human beings.

In technical terms, a heatwave condition is said to prevail when the maximum day-time temperature exceeds 40C and it is 5C higher than the average temperature recorded in the place during the same period over the past 30 years.

The four clinical syndromes associated with high environmental temperatures include cramps, exhaustion, exertional heat injury and heatstrokes. Although these symptoms are distinct in clinical terms, medical science places them in a single spectrum. Harrisson's Principles of Internal Medicine, a standard text for medical practitioners, refers to the summer of 1984 when a heatwave in New York City resulted in a 35 per cent increase in mortality almost exclusively because of a rise in the number of deaths of elderly persons living at home. The book further states that among the elderly, those affected by mental illnesses or alcoholism or those receiving anti-psychotic drugs, diuretics or those residing in poorly ventilated places, were more vulnerable. According to the book, a heatstroke might result in death either within a few hours or in due course of time from complications such as acute renal failure. Death could occur also after several weeks, usually owing to myocardial infarction (heart attack), bronchopneumonia or other causes arising out of damage to the vital organs.

In order to prevent renal failure, the most common complication resulting from a heatstroke, doctors emphasise the need to augment fluid intake, take frequent cold baths, remain in a cool environment and avoid strenuous physical activity.

Indeed, in this respect, the Government of Andhra Pradesh did not fail in doing its duty. Chief Minister N. Chandrababu Naidu took it upon himself to instruct the people to stay indoors, apart from sanctioning monetary compensation to the next of kin of those who died of heatstroke. But there is hardly any infrastructure available in most places of the State to conduct the medico-legal formalities, including post-mortem. Therefore, it remains to be seen how the dependents of many of those who died will receive the compensation.

The most tragic aspect of the heatwave deaths is that those who died did not expose themselves to the scorching heat by choice. They had to stir out of their hamlets in search of work, work that would save themselves and their families from starvation. Most of the victims were landless agricultural workers who were thrown out of employment because farming activities had come to a halt because of the drought in the region for the second consecutive year. The only way they could keep themselves alive was by working in the stone quarries. The choice, therefore, was between a rock and a hard place.

Thanks to the liberalisation-globalisation agenda of the Chandrababu Naidu government, the construction industry in Andhra Pradesh seems to be thriving in and around Hyderabad. The rural masses are forced either to migrate to the towns in search of manual labour or to work in stone quarries. It is not a mere coincidence that a large number of the deaths were reported from Nalagonda, where landless agricultural labourers are driven to find work as stone crushers. There is no sign of the drought relief measures announced by the State government; even if they do exist, the quantum of funds and foodgrains is inadequate to feed the starving poor.

Thus, while the heatwave is touted as the cause of the deaths in Andhra Pradesh, the fact remains that as many people did not die in other parts of the country, including Alwar in Rajastan where the mercury is reported to have soared to levels considerably higher than in Nalagonda. In fact, the Hanakonda observatory recorded a maximum temperature of 47C for several days continuously from May 15, against the normal seasonal temperature of 40C.

Heatwave conditions are caused by the earth's orientation to the sun. When the sun's rays fall vertically on the earth's surface, as it happens in the northern hemisphere between April and July, temperatures soar. While coastal areas experience a cooling effect owing to the sea breeze, those lying farther than 40 kilometres from the shore experience higher levels of temperature in summer. In India, the wind flow from the northwestern direction leads to a further increase in temperature and that is why several parts of peninsular India, including Andhra Pradesh and northern Tamil Nadu, experience heatwave conditions.

The heatwave conditions could have been anticipated at least a couple of months before May and adequate steps taken to prevent deaths. All that the government needed to do was to ensure the supply of adequate drinking water and sachets containing biochemic salts to the vulnerable masses.

The fact is that the government did not take any measures to augment the supply of drinking water. The lack of government aid was compounded by the odious caste structure that prevails in most parts of Andhra Pradesh, which prevents the poor, who in most cases belong to the marginalised castes, from drawing water from sources located in upper-caste localities.

According to Harrisson's Principles of Internal Medicine, a simple procedure can save a person suffering from a heatstroke. The patient has to be stripped, wheeled into a shower on a gurney, given a vigorous massage and then administered body salt fluids through a drip. However, according to medical practitioners, such measures are effective only where the patient is young and previously healthy. Most often the poor, the ill and the elderly do not respond to the treatment.

Hence, poverty is the underlying reason for the large number of deaths in Andhra Pradesh this summer; the heatwave is just the proximate cause.