The Hindu : Front Page : They are a bundle of skin and bones

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Sunday, Jul 25, 2004

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They are a bundle of skin and bones

By Meena Menon

THE FACE OF MALNUTRITION: One-year-old Shravan is one of the seven severely malnourished children in Dab, a village in Maharashtra's Nandurbar district. Poor accessibility, healthcare and the complete failure of the Integrated Child Development Scheme in the district account for the high infant mortality rate. From April to June this year, 434 children in the 0-6 age group have died. — Photo: Vivek Bendre

DAB VILLAGE (Nandurbar district), Maharashtra, July 24. Zaimabai Raut's one-year-old son Shravan is a bundle of skin and bones. Every day, she walks 13 km from Tamnai pada where she lives to the nearest primary health sub-centre to treat her son.

Shravan was in hospital for 19 days but his severely malnourished condition did not improve.

Zaimabai is reluctant to take him to hospital again as she cannot leave her other four children behind.

Severely malnourished

According to Indira Raut, a health worker appointed by the Paryavaran Suraksha Samiti, a local voluntary organisation, seven children were severely malnourished in this hamlet of 40 families. The condition of four of them has improved. Shravan is fed only breast milk and has a bad chest congestion and cough.

"I cannot leave my four children and sit in the hospital. I asked the sister at the rural hospital and she told me I could take away my son eight days ago but his health has not improved," says Zaimabai. To reach the rural hospital at Akkalkuwa, Zaimabai has to walk five km to the main road and then travel in a crowded jeep for 20 km through winding roads.

Even the local anganwadi is far away and only the older children go there.

Last year, 19 children from this hamlet alone were severely malnourished.

Access cut off

The access to Tamnai pada, one of the 30 hamlets in Dab village, is cut off as the road is damaged. It has not been repaired for as long as the villagers can remember.

Lack of access, poor healthcare and complete failure of the Integrated Child Development Services Scheme (ICDS) have worsened the situation in Maharashtra's Nandurbar district where 66 per cent of the population is adivasi. Government records reveal that since 1998-99, between 1,000 and 2,400 children have died every year in this district and the infant mortality rate has been increasing from 37.6 in 1995-96 to 59 in 2003-2004.

No time to grieve

At Rampur village, 27 km from Akkalkuwa, Sumabai Mansingh has no time to grieve the death of her three-year-old daughter Lata on July 13. She is busy working on her field along with her elder daughter, Damayanti.

Sumabai and many other women had met Maharashtra Tribal Development Minister Madhukar Pichad on July 10 and apprised him of the condition of children in this area.

At that time, Government officials got Lata admitted to the civil hospital at Nandurbar. But the severely malnourished child died. "It was the first time I had seen a such a big hospital," says Sumabai. "They did not even feed my child. I prefer to go to private doctors as in the Government PHC they make us wait and give the same medicines for all ailments."

No ration card

Sumabai's second child Hemlata, who is slightly older than six, is severely malnourished too. "I have neglected her health for the sake of the other two children. She cannot even walk to the anganwadi. I have to carry her there. Now they don't accept her as she is over six," she says. Sumabai does not have a ration card and has to bribe the local dealer for grains.

This year, from April to June, 434 children from 0-6 years died, according to district collector Sanjay Khandare.

However, the cause, he maintains, is not always malnutrition. There were cases related to low birth weight, premature delivery, abdominal diseases and other causes [which experts say are related to malnutrition].

He said the IMR for the district was now 57 a 1,000 live births, which was an improvement over last year. The deaths have to be seen in the context of the entire population of 13 lakhs, he adds.

`Not treated properly'

At the 30-bed rural hospital in Akkalkuwa, which is under repairs, Mogi Vasave says her two-year-old daughter Gita has been ill for 10 months. "I took her to the primary health centre but she was not treated properly."

Gita is a highly critical case and needs to be transferred to Nandurbar civil hospital, 60 km away. She is a fourth grade malnourished child and weighs only 4.8 kg when her ideal weight should be over 12 kg, according to the nurse Manisha Acharya. Although she is a severe case with boils all over the body, the mother is refusing to take her to Nandurbar, says Ms. Acharya. The general ward is crammed with malnourished children and their mothers. The Government pays the families of severely malnourished Rs. 40 each so that they stay and look after the children.

From April to July, 52 children were admitted here with severe malnutrition, 22 of them in July alone, two of whom died, says Mangalsingh Pavra.

A paediatrician has just been deputed here, and that too for a month. A gynaecologist was appointed last year in June but she only made one appearance. Two posts for doctors are vacant at this hospital. Dr. Pavri is in charge of the Government-run ashram schools, but he is deputing at the rural hospital as there is none else.

While the Government feels the rise in infant mortality is more to do with improved reporting of cases, the reality is quite different. The Government targets its schemes only at infants, but a more holistic approach is needed if the health situation in this region has to improve.

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