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Image: Shivani Podiami from Potrel Village. Shivani would’ve turned 7 in another two months. (Source – Dalit Camera)
Up until now, Japenese Encephelitis (JE) has caused more than 120 deaths (Official numbers, real deaths could be much higher) in just two months in Malkangiri – one of the most backward districts in Odisha. Adivasis constitute 59.2% of the total population of the district, with 81% rural population living below poverty line. This Adivasi dominated region also suffers from malnutrition, high maternal and infant mortality rates. Being affected by Naxal violence makes the region even more vulnerable. The ongoing crisis of JE has now also alarmed for its spread in neighboring districts. One would get chills through the spine looking at the list of kids who have suffered death; their age varying from 2 months to 8 years, majority of them are Adivasis and female. While the state government argues that situation is under control and it has been doing everything to fight this epidemic, the statistics and reports from the ground have another story to tell.
Now that the damage has already been done, state government denies that deaths were caused by JE and now has announced for vaccination campaign. A panel constituted by Odisha government has denied that the deaths in last two months in Malkangiri are due to Japenese Encephalitis. The panel argued that children ‘may’ have died of “Encephalopathy”, which is caused due to consumption of a plant ‘bana chakunda’ (cassia occidentalis). State govt is planning to start vaccination campaign, that’d be done in two phases in Malkangiri, Mayurbhanj, Keonjhar and Jajpur districts. First phase will begin from first week of December. However, vaccination in Malkangiri will be taken up in second phase as the disease there is in transmission mode.
“Japanese Encephalitis (JE) is a mosquito borne zoonotic viral disease. The virus is maintained in animals and birds. Pigs & wild birds are reservoirs of infection and are called as amplifier hosts in the transmission cycle, while man and horse are dead end hosts. The virus does not cause any disease among its natural hosts and transmission continues through mosquitoes. Vector mosquito is able to transmit JE virus to a healthy person after biting an infected host with an incubation period ranging from 5 to 14 days. The disease affects the Central Nervous System and can cause severe complications, seizures and even death.
The Case Fatality Rate (CFR) of this disease is very high and those who survive may suffer from various degrees of neurological sequeale. (An estimated 25% of the affected children die, and among those who survive, about 30-40% suffers from physical & mental impairment). The children suffer the highest attack rate because of lack of cumulative immunity due to natural infections. Acute Encephalitis Syndrome (AES) is a general description of the clinical presentation of a disease characterized by high fever altered consciousness etc mostly in children below 15 years of age. Acute Encephalitis Syndrome (AES) has a very complex aetiology and JE virus is only one of the many causative agents of Encephalitis.”
The outbreak of JE is not new to the region and many deaths were reported due to JE virus in 2012, but the district administration turned a blind eye to the situation, taking no measures for its prevention. It also did not prepare itself to deal with any future crisis. As a recent fact-finding report by Right to Food Campaign (RTFC) points out, “the child causalities due to outbreak of Japanese Encephalitis in Malkangiri district were reported in 2011 and 2012. An estimated death of 36 children was reported by District administration in 14 villages of the district within the period of September to 5th December 2012, but the actual scale of causalities was more than that.” The report also highlights the failure of food security, failure of Integrated Child Development Service (ICDS) and Mid Day Meal (MDM) programme; at the same time chronic hunger and loss of immunity capacity was found among children. After two years, in 2014, the deaths reported due to JE were 24.
Regardless of such alarming incidences over the past few years, when outbreak of JE occurred in September 2016, district administration did very little – failing to gauge its strength. While, every year such cases were reported in the region, district administration did not request, or put efforts to equip district hospital to tackle JE. It is not surprising that percentage of vacancies for doctors in Malkangiri remains highest in the state.
According to a Firstpost news report, “the district headquarters’ hospital was the only centre capable of providing treatment for JE. To make matters worse, the hospital only had only one paediatrician available against the sanctioned strength of three… it took two weeks for the government to take action and send its medical expert team to Malkangiri, but by the time 35 children had already died due to JE. Making the case even worse, district administration kept holding first stage patients in ICU, instead of sending them to Berhampur or Cuttack hospitals.”
“The district hospital has 125 beds and 44 sanctioned posts for doctors of which 35 are vacant. Six posts meant for child specialists and intensivists trained in critical care have remained vacant since they were created in 2012. Of the 103 sanctioned posts of doctors in the district, only 37 have been filled. Not just doctors, the district does not have enough nurses, the workers who form the backbone of the healthcare system. Only 43 of the 122 sanctioned positions for nurses are filled” points another news report.
The many tales of death
The interviews conducted by the RTFC fact finding team shows that district hospital miserably failed to provide treatment, nor any efforts were taken to transfer them to a better medical facility. For example – “Manjun Madhi, one year and eight months old was suffering from fever and was taken to Kalimela CHC. The doctor referred her to District Hospital. No proper treatment was made. He brought back her daughter to home on 6.10.16. She got serious next day. While carrying her to District Hospital, She died on the way.” Another incident where, “Bikram Padiami, a 3 years old was admitted in District Hospital. The Doctors could not treat him and he was told to be referred to Berhampur. The doctor asked his father to wait. He waited for one day and his son ultimately died in Hospital.” Similarly, “Deba Kabadi, 4 years old was admitted in district hospital. The doctors neglected in treatment and did not prescribe any medicine. He died in Hospital on 21.9.16.”
(List of deaths due to JE, until October 20 – Right to Food Campaign Fact finding report)
On 15 November, one of the stories reported by Dalit Camera states, “on 29.10.2016 when Irme Padiami and Sudarshan Padiami realized that the fevers their children seemed to have since the day before wasn’t a normal fever. Susila Paddiami and Ramesh Padiami, 2 and 4 respectively hadn’t eaten a morsel for two days now. Their temperature just kept going up and at a point it seemed like their bodies were on fire. When Sudarshan tried calling 108, he realised his phone had network issues. In Daniguda, if you are lucky, your phone will have network during the day. After 8 PM, it was almost impossible to venture out to a spot where your phone would connect. Inspite of desperate attempts, Sudarshan wasn’t able to reach 108. Finally, at day break, he went out till the main road, made a call to 108 and within a couple of hours, his children were admitted at the Malkangiri Govt Hospital. In two days, both of them were dead. Though both the cases were diagnosed as Japanese Encephalitis, the authorities at the Hospital didn’t know how to treat them, nor was their case escalated to higher authorities or to a better facility. Like many other adivasi children from the neighboring villages of Daniguda, both Susila and Ramesh lost their lives due to the State’s historical apathy towards adivasi lives, even before they could hit the age of 5.” These stories speak for themselves showing complete failure on the part of district administration.
Malkangiri- not listed as JE affected region in Centre’s list
Another shocking revelation of RTFC report points that – in 2011, when Ministry of Health and Family Welfare, Govt. of India decided to implement ‘National Programme for Prevention and Control of Japanese Encephalitis/Acute Encephalitis Syndrome.’ The programme is implemented with central government support in 171 JE prone districts of 19 states. Though Malkangiri has been affected since 2011, the state government failed to influence central government to be part of the National programme. The state government did not even try to be linked with National Programme to combat this dreaded disease, despite of its ineffectiveness and incapability to deal with it.
JE and Malnutrition
More than 95% of JE-affected children are Adivasis, and all of them are malnourished; majority of them being girl children – points the RTFC report. The reasons for malnutrition can be attributed to poverty, lack of nutritious food, inefficiency of government programs etc. In some villages, NREGA labourers have not been paid their wages since 7 months. “Seven out of ten children in Malkangiri are underweight, according to the 2014 Annual Health Survey report. The district is ranked third in the country among 100 districts that have the highest prevalence of underweight children under the age of five. About 33.4% of children in Malkangiri have low weight for height, which is classified as wasting and represents acute under nutrition caused by a lack of food” according to the report.
Make in Odisha
The reason for poverty and malnutrition among Adivasis can be attributed to many things. But historically it has been a failure of government and administration to ensure traditional livelihood practices of Adivasi communities. Particularly vulnerable tribal groups in the region, like Bondas still practice Podu- shifting cultivation; while many like Koyas who live in plains are entirely dependent on settled agriculture. In the absence of major river bodies in the region, agriculture is entirely dependent on Monsoon. In my first visit to Malakangiri in 2015, I recall villagers near the Bonda hills telling me that except for monsoon season, most of the year they are unemployed and sit idle in village. They’re not even able to produce for themselves in the absense of any irrigation facilities; and as last resort they’re bound to work in other’s farm lands. Merely few kilometres away is, one of the largest (Chitrakonda) dams in Malkangiri at ‘Balimela’ that was constructed in 1960s for Balimela Hydro Electric Project. Many Adivasi villages were displaced in order to complete the project, but not an iota of water is supplied from the dam for the use of the Adivasi villages.
While Malkangiri is going through an epidemic, Odisha government is preparing itself for Make in Odisha project. Goverment of Odisha in collaboration with Department of Industrial Policy and Promotion (DIPP), Government of India is organizing the Make in Odisha Conclave at Bhubaneswar from November 30 and December 02, 2016. “The Conclave will showcase the policy & regulatory environment, investment opportunities across focus sectors and the manufacturing prowess of the State.” Odisha has been listed in one of the top states in the ease of doing business in India. Odisha Industries (Facilitation) Act was passed in 2004 and is one of the first legislations for window business clearance systems in the country. Over 300 industries from across the country and outside are going to participate in the conclave. The State Government has already organised pre-conclave investor reach out events including road shows at Delhi, Kolkata, Pune and Hyderabad; and a budget of around 20 crore has been proposed for the conclave.
These two events in a way also reflect priorities of state. Make in Odisha project is surely going to further marginalize Adivasi communities, with more investment, new projects to extract resources and industrialize the region. While the state could not even ensure filling vacancies of doctors in Malkangiri or allocate special arragements to curb the epidemic; the upcoming 20 crore conclave seems to symbolize a celebration of these deaths.
‘Caste-less’ state officials?
In order to identify what went wrong in Malkangiri, one should not only look at administrative loopholes. But also try to understand that most administrative posts in Adivasi regions including PVTG development authorities, ITDAs etc are entirely dominated by upper castes. It’s naive to assume that administrative officers’ caste does not have anything to do with their insensitivity and irresponsibility towards Adivasi communities. The reality is that most of these upper caste officials scorn Adivasis, they remain ‘primitives’, uncivilized people in their minds. Regardless of being outside Hindu varna system, Adivasis are considered lowest in social hierarchy of rural as well as urban areas. So it’s not merely an administrative ‘error’ but the Brahminical mindset of administration that doesn’t value Adivasi lives.
In this year itself we have seen multiple cases of reported deaths due to malnutrition. E.g. the case of malnutrition related deaths in Attapadi, Kerala, where this year (November) death of infants due to malnutrition has risen to seven now. This Attappady region has witnessed 58 malnutrition-related deaths in 2013, 30 deaths in 2014 and 14 deaths in 2015, as per the State Health Department. At least 19 children of Juang tribe died of malnutrition between March and June 2016 in Jajpur district of Odisha. Another report by Maharashtra government’s tribal development department report stated that, over 740 tribal students died in last 10 years due to malnutrition in Maharashtra. The fact finding report of RTFC highlights that according to a RTI filed at Chief District Medical Officer, Malakangiri – on 3.11.12, from 2007-08 to 2011-12, around 7400 children have died due to contraction of various diseases like Epilepsy, ATI, LBW, Diarrhea, Ashthma, Fits, Burning, UND, Septicemia, Birth Asphyxia, Fever related ailments and Boll cancer etc. While we do not have data from the year 2012-16, available statistics show that in normal period, thousands of children mostly Adivasi children died of minor ailments. Merely adding up these numbers would tell that in less than a decade, a large Adivasi population (probably population equal to many PVTG communities) has been consciously wiped out. Isn’t that an ethnic genocide?
In a country, that despises its original inhabitants and has been attempting to eliminate them to take control over resources, it is evident why Adivasi lives don’t matter, why even 120 deaths of Adivasi children don’t make front page headlines or create a public uproar. The deaths of Adivasis are so normalized in people’s psyche, that their lives remain mere ‘numbers’. On one hand we see visible forms of violence, like in Bastar – where Salwa Judum, Green Hunt operation, multiple cases of rape and now ongoing massacre through fake encounters are being carried out, resulting into thousands of Adivasi deaths. On the other hand, we have more covert forms of violence, such as this case of JE epidemic, where insensitive and indifferent response of state administration towards a particular group of people isn’t a ‘minor mistake’ but a conscious act. It is symbolic violence, where ‘caste-less’ government officials, remain inconsiderate and apathetic towards Adivasi children and show Brahminical nature of the state.
Fact Finding report of Right to Food Campaign, Odisha 2016, http://odishasoochana.blogspot.in/2016/10/report-of-fact-finding-visit-on-infant.html
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