Environment
While overall, hospitals remain functional, doctors and medical staff have chipped in at Belrampatti to ensure that patient care isn’t affected.

At first glance, there is something extremely welcoming about the environment at the Belrampatti Primary Health Centre (PHC) in Tamil Nadu’s Dharmapuri. There is an array of public health awareness posters and bulletins stuck down on compound walls on both sides of the dirt path leading to the entrance of the building. Several posters boasting of public health campaigns, splashed with colours and even the smiling faces of a celebrity or two, greeted anyone who walked into the hospital premises. Behind that facade, however, the PHC has been struggling in the face of a water crisis.

“Today we are fine, but our doctor had a lot to do with that. He went out of his way to find some way to get water for at least the most basic needs,” one staff member told TNM.

While Dharmapuri district has been facing a water crisis for a few years now, this year in particular has recorded extremely low levels of rain as well as a low level of groundwater. These factors combined have left residents in the lurch, without water for even the most basic necessities.

Of 24 districts in the state which have been battling the drought, it was earlier reported that 17 districts recorded a rainfall deficit of anywhere between negative 59% and negative 19%. In the remaining seven districts, while the monsoon rains were normal, the overall annual rainfall had gone down.

With Dharmapuri among several districts in the state of Tamil Nadu reeling from a severe drought, leaving residents scrounging for water wherever and whenever they can, how have the hospitals in the region managed to stay functional? TNM visited two hospitals in the area to find out.

Belrampatti PHC

While the water scarcity has certainly affected the hospital, staff members have found ways to keep the centre running. Multiple staff members spoke of the doctors who pitched in money from their own pockets putting together thousands of rupees to pay for private water companies to supply the hospital to keep it running.

“We did what we could to keep the hospital functioning. It wasn’t just me alone, it was others in the hospital who contributed as well. That is what has helped us to be able to function without any hindrance for our patients,” says the duty doctor at the PHC. “We did what we had to do, and will make sure our hospital is supplied with water,” he adds.

While the residents in the vicinity are struggling to find water for basic day-to-day needs, doctors at the PHC have gone out of their way to ensure that the hospital remains functional and that no patient suffers.

“Can you imagine our situation today if our doctor hadn’t personally arranged for us to get water?” the elderly staff nurse asked another hospital staffer at the PHC. A young pregnant woman watches on as the discussion continues. “Now we don’t have to worry about bringing at least one litre of water from home,” adds the other staff member, chuckling with relief.

“We spend most of our day here, a significant number of the patients we see here are mostly for deliveries. Forget drinking water, can you imagine how difficult it would be without any water for the patients?” she says.

A few days earlier, the hospital faced a shortage as there was no water to prepare the oral rehydration solution (ORS) given to patients. 

ORS is a fairly common necessity in every hospital, no matter how small or big. At the corner of the lobby in the hospital, atop a small green stool is a steel container with a plastic spout covered with a steel plate, labelled ‘ORS’. “ORS-Zinc corner for the treatment of diarrhoea,” reads a sign amidst another poster written in Tamil explaining the benefits of ORS.

In government hospitals, there is always a staple of ORS, as a result of the large numbers of young children and infants (and adults on occasion) who present with dehydration requiring the solution to help correct the chemical imbalance of salts in the body. According to reports, the National Family Health Survey has stated that up to 8 percent of infant deaths in India occur due to diarrhoea which causes drastic loss and imbalance in salts.

Loss of fluids from the body can result in dehydration. It has been noted that diarrhoea and vomiting can cause people to lose a large amount of electrolytes which results in severe dehydration. The best treatment is to replace lost fluids through supplementary ORS, and a lack of ORS at a hospital like Belrampatti PHC would severely hamper its ability to care for patients who present these symptoms.

The PHC tends to cater to a much smaller group of people, unlike the Palacode government hospital, about 20 kilometers away, which is managing the crisis in their own way.

Palacode Government Hospital

A pungent scent of the phenyl cleaner used to sanitise the hospital premises lingers in the air inside the outpatient building of the Palacode Government Hospital. It is one of the centrally-located hospitals in Dharmapuri district’s Palacode taluk, with hundreds of residents from nearby villages coming in daily.

“It hasn’t been easy, there were some instances when we got a little worried, but for the most part we have managed to keep going because we have a borewell supply for water,” says head nurse Rani.

There are currently two main buildings which are functional at the hospital -- the outpatient and inpatient departments. Down the path from the inpatient building, a borewell pump has been set up inside a shed. “We are lucky that we have the borewell supply of water, because of that we have been able to manage,” adds Rani.

The borewell is connected to an underground system which draws water into the overhead tank located in between the outpatient and inpatient buildings. Construction of another building is currently underway.

“A few years ago, we did face some problems because we were largely dependent on an external source for water, whether for drinking or anything else in the hospital. However sometime back, the hospital was allocated funds by the government, using that we were able to get the borewell installed,” she says.

Rani is one of a handful of full-time staff members working at the hospital. She is privy to the dire plight faced by those living in the nearby villages, and is well aware of the situation which plagues the district.

Sitting at the entrance to the outpatient department are three women from the village of Nallur, a few kilometers away from Palacode. “We sometimes get Cauvery water, but that also once every two days or so,” says one 65-year-old resident of Nallur village. Others say that they get the Hogenakkal water supply from the government, but the quality of the water brought in the tankers is questionable.

“I know in some places, the situation is extremely dire, people are having a hard time getting any water to drink, much less clean water. But we have been really fortunate, there had been some renovations taking place here for the past few years. At the time, they installed a borewell at the back of the main building which is connected to a tank and thereby we are able to manage the hospital functions well,” Rani says.

Depleted groundwater sources and lack of rains

The state of Tamil Nadu has been plagued by drought in recent years, which has been drastically more evident this year. Dharmapuri recorded a deficit of 50% rainfall in the northeast monsoon, which had failed in 2018. This failed monsoon combined with depleting groundwater levels has left most people without a reliable source of water for drinking and other necessities. According to the Indian Meteorological Department, between the period of March 1 to May 31, 2019, Dharmapuri recorded 24 percent deficit in rainfall. Some reports suggest that despite the district receiving average or above average rainfall since 2004 (apart from 2016), the area is prone to drought. Dharmapuri was also the centre of the state’s worst drought in 140 years in 2016.

Earlier in May, the Cauvery Water Management Authority had ordered the state of Karnataka to release 9.19tmcft to Tamil Nady for June. However in the first 10 days of the month, it was reported that only 1.16tmcft of water had been released. While this has impacted some people in Dharmapuri district, who are dependent on the Cauvery as a primary source of water, it is not the sole factor alone.

The Hogenakkal Water Supply and Fluorosis Mitigation Project was introduced to the region in the 1960s by then state Chief Minister K Kamaraj, to ensure that people living in the districts of Dharmapuri and Krishnagiri were supplied with clean drinking water. It went into effect properly 50 years after it was introduced in 2013 and was funded in party by the Japan International Cooperation Agency (JICA), which provided around Rs 1,928 crores for the project.

It remains one of the predominant sources of drinking water for those living in Dharmapuri. But the continuing drought poses the looming question no one seems to have an answer for, what happens when this no longer proves to be a sustainable source of water?

Also read: Ground report: In Dharmapuri, residents forced to travel up to 7km in search of water