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Sunday, Aug 01, 2004

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Hardly hospitals

Government hospitals in rural areas struggle to serve the target population. Meena Menon details the problems in Maharashtra's Nandurbar district.

THE ONLY rural hospital for 168 villages in the Dhadgaon taluka of Nandurbar district in Maharashtra is bursting at its seams. Its corridors are packed with women and children and the general ward is full of malnourished babies and their mothers, sitting on the bed or the floor. Twenty-five children are in grade four of the malnutrition scale while seven are in grade three — both severe malnutrition categories.

The hospital is under repair and the air is full of dust. There is no electricity and the generator is not working. The general ward is cramped and there is no toilet. For the women who stay in the ward, life is hell. The floor is covered with urine and children suffering from diarrhoea relieve themselves on the floor. There does not seem to be any disinfectant or cloth for the women to wipe their children clean.

Waiting for cots

Bijra Khamla sits on the floor hugging her malnourished son, Ganesh. She is still waiting for a spare cot. "I came five days ago, I will stay till my son gets well. My elder daughter looks after my six other children," she says.

The paediatrician is on deputation. The day we visited the hospital, he was out on a camp in the villages. The sole medical officer on duty has to handle at least 100 patients and the drunken hospital staff members do not take orders from her.

Since June, two children have died in the hospital. There is no gynaecologist and a medical officer post is vacant. The newly-appointed medical superintendent came for a few days in July.

At Son village, 10 km from Dhadgaon, a spanking new pink-coloured primary health centre (PHC) was built three years ago but is not yet in use. Bhattesing Supa says the PHC has no electricity or water connection.

Villagers have to trudge to the old decrepit PHC, a km away, where often there is no doctor. In one room in the PHC, medicine bottles are dumped in a corner and rats abound in the storeroom. Twenty-five villages are served by this PHC, covering a population of 13,600.

Many of the villages are in the submergence zone of the Sardar Sarovar Project (SSP) and have no healthcare facilities. About 26 children are severely malnourished and two have died since April under this PHC.

Doctors on contract

The Government has appointed doctors on contract since June for four months to visit these remote villages. Geetanjali Chavan of the Narmada Bachao Andolan (NBA) says that except a few, doctors rarely pay visits. There is no immunisation other than polio vaccines and medicines are not distributed properly.

Revati Joshi, a doctor on contract, mapped the health situation in 14 villages in the Dhadgaon taluka affected by submergence last year. She found a high incidence of scabies, malaria, dysentery and fever mainly among children.

This month, Dr. Joshi and Dr. Ujwala Dakre examined children in Nimgavhan village on the banks of the Narmada, a three-hour walk from Dhadgaon, and found that of the 19 children surveyed, 14 were malnourished.

Spurt in activity

Now that the Government has made ICDS officials responsible for child deaths, there is a spurt of activity in villages with anganwadi sevikas bringing even slight cases of malnutrition to the nearest PHCs. In Akkalkuwa taluka, the PHC at Moramba is crowded with women and children.

Savita Bai who has come with her daughter, Nirguna, says that there was no doctor here for two days. Khushibai walks to the PHC everyday with her child from Talamba village, which is five to six km away. Her son, Roshan, is only eight months old and weighs about four kg. He is severely malnourished.

"Everyday I walk for an hour to bring my child here. We have to stay till the evening and then go home," she says.

Some incentive

The Health supervisor, Ratnaprabha Paliwal, says the women are asked to come to the PHC till the condition of the children improves and they gain weight. "These women are daily wagers, so we pay them Rs. 40 as incentive."

Further down from Moramba, the PHC at Khapar is located in a large ground full of stagnant water and scavenging pigs. B.L. Patil, medical officer, says seven children have been admitted to the PHC since July 13.

There are 24 villages under the PHC with a population of 27,000 and only 930 of the 2,915 children below the age of five are normal. About 32 are severely malnourished, while the remaining 1,271 are in grade one and 684 are in grade two of malnutrition. All the women walk five to six km to the PHC everyday with their malnourished children.

No jobs

The problem is not of malnutrition alone. There is a massive failure of the Government to provide employment as well. Sanjay Mahajan of Punarvasan Sangharsh Samiti (PSS) based in Taloda says, "Earlier people cultivated forest land but after the Forest Conservation Act 1980, their rights were taken away and now if they till the land, the Forest Department cuts their standing crop. Loss of land and extensive deforestation in the mountains have meant that people migrate to Surat and other places for four to six months, usually in the summer months."

By targeting children alone, the Government is missing the point. In an area that is remote, Government schemes have failed and medical services are provided on a fire-fighting basis.

Unless the livelihood problems of the population are addressed, there can be no headway.

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