Deathly inaction

The Orissa governments apathy in providing health care makes cholera deaths a recurring phenomenon.

in Kashipur &DasmantpurBhagirathi Behera of

Young Ruai Majhi, a resident of Kucheipadar village in Kashipur block of Orissas Rayagada district, was eight months pregnant when her dreams of motherhood came tumbling down. She got seriously ill with cholera and was initially taken to the nearby primary health centre for treatment. But owing to the lack of adequate facilities there, she was rushed to the hospital at Tikiri. Doctors saved her but not her baby; she gave birth to a stillborn baby at the hospital the next day.

Ruai and her husband, Tankadhar Majhi, are happy that she survived cholera but are aggrieved that the absence of proper health care claimed their first child. The doctor told me that I should be worried about my wife but not about the child that she was carrying, Tankadhar said.

Subai Majhi of Ruais village met with the same fate. She survived cholera but lost her unborn baby. In the last week of August alone, the deadly disease claimed four lives, including that of a 35-year-old, in Kucheipadar, where tribal people form the majority.

The Kucheipadar health centre speaks volumes about the administrative neglect that leads to many diarrhoea and cholera deaths every year in this mineral-rich region during the monsoons. Established seven years ago, the health centre does not have a toilet, water or electricity. Ironically, there are power supply lines just a few metres away.

The lone post of doctor has also been lying vacant for the past one year. A doctor was posted and electricity provided after activists of the Prakrutika Sampad Suraksha Parishad and residents of Kucheipadar and nearby hamlets staged a roadblock on August 22 demanding help for the cholera-hit population. The authorities, who had been sleeping over peoples problems for years together, suddenly swung into action and got work started on a new tubewell in front of the health centre.

The Naveen Patnaik government makes frequent announcements about filling up of vacant posts of doctors in the backward Kalahandi-Bolangir-Koraput region of the State. But the Kucheipadar health centre had a doctor for just two years in the past seven years.

Against the sanctioned strength of 12 doctors in Kashipur, there are only three doctors at work. Similar is the situation in the Dasmantpur block in the neighbouring Koraput district. This place has three doctors against the required 11.

Although appointments are made, no doctor reports for duty and even the rare ones who join are keen to leave the area as early as possible. The prime reason for this is lack of basic amenities. Many health centres do not have residential accommodation for doctors. Or the houses do not have electricity and water.

In some areas, it is the fear of extremists that keeps the doctors away. Despite the government announcing incentives for them, doctors are not willing to work in the Kalahandi-Bolangir-Koraput region.

Early this year, the primary health centre at the block headquarters of Dasmantpur was upgraded to a community health centre. But it does not have a doctor on permanent posting. Two doctors drawn from two other primary health centres in the block are on duty here, leaving no one to attend to patients in their actual places of posting.

collecting water from

The Kashipur and Dasmantpur blocks did not have enough doctors even two full months after diarrhoea and cholera started claiming the lives of tribal people in the area. Cholera-related deaths in the two worst-hit blocks were first reported in the first week of July. The local administration and the State government reacted to the situation only in the third week of August. By then at least 100 people had died.

The district authorities, who were caught napping when reports started appearing in the media on the deaths, were clueless about the death toll. As correct information was not coming through official channels on the deaths occurring in distant hamlets, officials found it convenient to suppress the actual toll.

The State government claimed that only 178 persons succumbed to diarrhoea and cholera in Rayagada, Koraput, Kalahandi and Gajapati districts by September 4, but unofficial reports put the death toll at over 300. Bhagban Majhi, convener of the Prakrutika Sampad Suraksha Parishad, said that at least 180 persons had died in Kashipur block by the end of August. Majhi, who himself survived cholera, alleged that the authorities were deliberately keeping the figures low to save the government from embarrassment.

In Dasmantpur, leaders of both the Congress and the ruling Biju Janata Dal (BJD) said that as many as 130 people died of cholera and diarrhoea by September 1. They said the health department, which was suppressing the exact number of deaths, would have a tough time issuing death certificates to the kin of those who died in the epidemic.

Squarely blaming the BJD-Bharatiya Janata Party coalition government for its failure to cope with the epidemic, Taraprasad Bahinipati, the Congress legislator representing Koraput, said the authorities had ignored his repeated requests to fill up the vacant posts of doctors in Dasmantpur. Only a permanent solution to the problems ailing the health sector in the region can prevent deaths in the coming years, he said. The prime reasons for so many diarrhoea deaths in the region are a weak health care system, absence of safe drinking water and non-availability of employment opportunities. When 20 people died of cholera in Kashipur block in August 2001, the Naveen Patnaik government announced that it would improve the health infrastructure in the region. But it still remains a promise.

Contaminated water and total absence of health care in the region are the reasons for the large number of deaths of tribal people during the monsoons every year. The rural water supply scheme has failed to meet the peoples needs. Hundreds of tubewells are defunct in the Kalahandi-Bolangir-Koraput region.

The latest report of the Comptroller and Auditor General of India (CAG) makes the governments apathy clear. It says: Out of 74,020 wells targeted during the period 2001-06, 65,680 wells were constructed. Of these, 27,316 tubewells (42 per cent) were found to be discharging water with high iron/fluoride/chloride contents, rendering them unfit for drinking. Several piped water supply schemes remained incomplete for one to 14 years due to failure of water sources, deviations during execution, constraints of funds, etc. There was a general disregard to the governments instructions regarding testing the quality of water through trial bores before installation of tubewells.

Water is not tested and monitored periodically. Water quality of 0.40 lakh sources in 0.28 lakh habitations was found unsafe for drinking. Around six lakh people were affected by water borne diseases during 2002-05, the CAG report says.

This is not all. Many tubewells have water only during the rainy seasons. Local people alleged that though the authorities claim that the tubewells are sunk 100 feet (30 metres) or below, the real depth was around 70 ft (20 m). This is the main reason for water scarcity and contamination, they said.

tribal women attending

The less said the better about the employment generating schemes. In Rayagada and Koraput, there are signboards announcing developmental works being carried out under the Sampoorna Grameen Rozgar Yojana (SGRY) and the National Rural Employment Guarantee Scheme (NREGS). But the schemes have made no substantive difference to the lives of the people.

Hundreds of hamlets do not have roads. The roads laid in interior areas are in bad shape and the water harvesting structures are not maintained well.

The CAG report also clearly outlines the faulty implementation of employment generation schemesReview of implementation of Sampoorna Grameen Rozgar Yojana (SGRY) in the State during the period 2001-06 showed serious deficiencies in implementation of the programme. The Government failed in adhering to the scheme guidelines for efficient financial and food grains management, leading to loss of Central assistance, misutilisation of scheme funds, shortage and pilferage of food grains. Contractors were extensively used in the guise of Village Labour Leaders (VLL) and prohibited works/non-durable assets/idle assets were created. Man-days generation was hypothetically arrived at without linking to the actual generation as per the muster rolls. Serious irregularities existed in payment of wages. There was no dedicated monitoring mechanism at the State level to review and evaluate the implementation of the scheme.

The Centre for Environment and Food Security (CEFS), a Delhi-based organisation that had conducted a survey of 100 villages to assess the implementation of the NREGS, said that it was not the epidemic of cholera but the cancer of corruption that was killing hundreds of poor tribal people and crippling millions of them.

Alleging that government officials had misappropriated Rs.500 crore of NREGS funds, the CEFS said this amount would have given about 90 days of employment to 10 lakh poor families in Orissa.It is not just another financial scam. Callous officials of Orissa have robbed 10 lakh hungry families of one meal a day for a whole year or two meals for six months, it said.