It was only when the midwife announced that the second child was on its way that Rashmi* and her family realised that she was carrying twins. The Semadoh public health centre was a mere 3 km away, and an ambulance could be called. But the delivery took place in one of the inner rooms of the hut. A few minutes after the first child was born she slipped out of consciousness, never to wake up. The twins - boys - were given up to relatives and were dead soon too. Just like that, three more of the Korku tribe joined the long list of infant and maternal deaths in Maharashtra’s Melghat region.
The room where Rashmi gave birth to her twins.
An RTI activist’s query revealed in September 2016 that nearly 6,000 children and women in the Melghat region died in the noose of malnutrition in the past six years. Of these, deaths inside the womb were 2,958, infants were 1,528, child deaths were 1,365 and mothers were 134. Malnutrition makes a person susceptible to diseases, which could ultimately cause death. It also affects a child’s physical growth, and cognitive and motor development.
It is interesting to note that the government’s, judiciary’s and media’s attention was drawn to this region in the early 90s when 5,000 children were reported to have died between 1992 and 1997. Since then, the state and judiciary have appointed committees which have produced reports; international organisations have given their verdicts and solutions; political parties too have petitioned for the cause. There are over 300 registered NGOs for the 320-odd villages of Melghat. Crores of rupees have been poured into this region to fight malnutrition.
Despite all this, during the pregnancy Rashmi hadn’t had a single sonography done. A primary reason for this was a lack of machine operators and a large distance from the machine. The sonography machine operator comes irregularly to each centre and by the time news reaches patients, the operator will have finished and left. This dearth of specialists extends far beyond operators - there are no specialists like gynaecologists and paediatricians in most of malnutrition-riddled Melghat.
Gangay Chote Bethekar, 75, is a midwife in Melghat. Here she fries fish to sell.
Dr Ravi Kolhe, one of the first doctors to come to Melghat in the early 80s, knows that doctors are not ready to stay and work in the interiors. “People here don’t have paying capacity but they badly need doctors,” he said. He has a solution to the lack of doctors - hefty packages to attract expertise. This money can come from CSR funds. “If this happens, the changes in the situation will be miraculous,” Dr Kolhe asserts.
The other option for Rashmi was the monthly health camp conducted in the village. But the fast she was following, as recommended by their bhumka (traditional healer), forbade her from leaving the house. It also restricted her food and medicine intake. Semadoh PHC helper Shivdas, a local resident, knows that people here still prefer going to the bhumka because he treats them well. If not tea, he will at least offer water. Why would they come to the hospital if they are not treated well?
There are specific illnesses, like fits, for which the people choose the bhumka. The bhumka knows his limits. He redirects people to the hospital when he doesn’t know the treatment. He only gives herbal medicines and mantra-fortified water. The bhumka Chotelal Bhilawekar, however, believes that sookhi bimari (malnutrition) can be cured if a specific herb is tied to the baby’s waist. He claims to annually see an average of 50-60 children with sookhi bimari from his and nearby villages.
To add to their woes, Rashmi’s tribe and other tribal communities here lost access to forest produce after Melghat was declared a reserve forest. The produce was a source of nutrition and medicines, and also income. Her family now depends on a small roadside shop, rain-fed farming, and work as daily wage labourers to keep afloat. Each member of the family has to participate in the physically arduous tasks.
Dr T.D. Shinde, who works with MAHAN trust in Melghat, feels the priorities in tribal areas are home, farm, animals and at last child and mother. He doesn’t think anything will change till these priorities don’t change. “But there is no will in the administration to change these priorities,” he rues. “Even though there is no problem of food availability, malnutrition is a problem in all of India. It’s simply spoken about more in Melghat because there are more activists here,” he said.
NGO Khoj’s director Bandu Sane believes that health in Melghat has been affected because the economic problems of the people have not yet been addressed. He goes on to recount how several state and central ministers, top state bureaucrats, chief justices, as well as politicians have visited the region. The current state health minister too has promised to bring down child deaths here and in other tribal areas. Despite the publicity, the problem of malnutrition persists. He thinks the main solution to malnutrition is coordinated work of all the departments - tribal, health, women and child, infrastructure.
The doctor of the Semadoh PHC Mahesh Kurtkoti sees the lack of infrastructure - roads - as the most basic problem in Melghat. The reserve forest region has monotonous forests of teak where scores of tourists come to spot tigers, but the roads to the interior villages remain disconnected for five months from June to October. Melghat region in Amravati district is made of Dharni and Chikhaldhara blocks. Seventy five per cent of the 300,000-strong population in Melghat is tribal, mainly Korku.
He believes the “unhygienic” lifestyle of the tribals is another problem. Lalita, a Korku tribal and karyakarta in Khoj, pointed out that the tribals have to walk 2-3 km through dusty kaccha roads to take a bus and come to the PHC, between manual labour jobs. There are no running taps, which limits washing and cleaning. How can they be “hygienic” on arrival at the PHC?
Some, like Lalita’s grandfather, believe that it is the recklessness of the people that causes malnutrition and related deaths because “the government has given everything to the people – hospitals, anganwadi and education”. A farmer in Rethya Kheda, in Chikhaldhara, Babu identified the tough lives of the tribals as the reason behind malnutrition. “The mother goes out in the morning and returns only in the evening, the child remains hungry the whole day. If children are not fed on time, they are bound to fall ill,” he said.
One angnwadi worker clips a child’s nails while another watches the children eat lunch.
Dr Kurtkoti stressed that the difference in mentalities is the biggest cause behind malnutrition. “We are doing everything we can, but tribals are not convinced about our treatment and prefer visiting the bhumka,” he said. He believes mass awareness is the key to change the situation.
The Korku tribe’s belief is that talking about pain will only amplify it. So till the moment she gave birth, Rashmi did not mention any discomfort from contractions. Gangay Chote Bethekar, a 75-year-old midwife in a village near Semadoh, added to the list of cultural deterrents - the Korku tribal women are reluctant to let male doctors examine them or carry out the delivery. Doctors put their hands inside to check where the baby is; women don’t like that. “I use a simple method – I can tell how the baby is positioned by the way a drop of oil travels down from the navel. Then I can shift the baby so that it comes out head first,” she said.
This difference exists on the part of government staff too. A nurse in Raipur, who had taken up the posting just 10 days back, was very unhappy. The location was far from her daughters and husband and remote. She did not even understand the language. She was appalled by the way the people lived. Clearly, she was unprepared and untrained for the place.
Sane is dismayed by the treatment being meted out to the tribals. “Cities are dependent on rural India for basics of life like food, water, electricity. There is only a flow of resources out of places like Melghat. Urban folks wouldn’t survive if the tribals blocked the river or stopped growing food. The tribes are an important part of the system. What then is the reason for this callous attitude to a people who are dying?”
* Name changed
Shatakshi Gawade is an independent journalist with ‘EkatraBol: Stories about culture, rights and environment’.