"Between dish TV and death :"

 

The Indian Express :
12/05/2013
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Between dish TV and death :
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Shaju Philip
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 Sun May 12 2013, 00:20 hrs

With D2H antennas rising above the tiled roofs of its houses, its mobile supermarket, its electrical lines, its concrete road to the panchayat headquarters and its incessant mobile phone chatter, Kadambara South in Kerala's Attappadi is unlike any other tribal-dominated colony in India. But the death of a child last month from malnutrition—taking the count to 33 for the Attappadi region since January 2012—makes it, tragically, like any other.
Between these two narratives lies the story of Kerala's lopsided model of development, and of people who fall through the cracks of its famed human development, inclusive growth, and revolutionary decentralisation of planning.

In Attappadi, a change of livelihood has destroyed lives, leaving in its wake poverty and alcoholism. Combined with hereditary illnesses, it has left a community struggling to keep its numbers. The Health Department recently screened 23,597 people in 7,565 houses in the three panchayats of Attappadi. Of them, 496 adults, 70 pregnant women and 283 children below the age of 12 were found to be anaemic. In 1999, a government survey held in 2,051 houses in 51 colonies had found 437 people to be anaemic. In those 14 years in between, the tribal population of Attappadi has been slowly dying—disappearing at both ends, among the infants and the elderly.

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Kadambara South is one of the 187 tribal colonies in Attappadi. The child death here blamed on poor food intake was that of a six-month-old, born to Selvan (25) and Veramma (26). Similar deaths in the region since January 2012 have resulted from pre-term deliveries, 'malabsorption syndrome' (inability to absorb nutrients from food), genetic disorders and anaemia.

Vellakulam colony in Sholayur panchayat saw five child deaths last year and has lost four children this year already. At Nellippathy colony, six children have died in 2013. A 28-year-old at Nellippathy has lost three children over the years due to a low haemoglobin count. There are less than two dozen children below the age of 10 among the 120 families of

Vellakulam colony.

According to Rajendra Prasad, president of Thambu, a tribal welfare outfit that brought out the number of deaths, the actual number of dead children could be higher as many cases go unnoticed, with tribal families in eastern Attappadi mainly dependent on hospitals in Tamil Nadu.

Palakkad District Medical Officer Dr K Venugopalan admits malnutrition is prevalent in the Attappadi region, 42 per cent of whose population comprises tribals, but says not all deaths can be attributed to it. "Malnutrition deaths per se were only two this year. But feeding mothers and pregnant women face serious health problems," he says.

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One of the reasons for this is alcoholism. Dr A J Rajesh, the chief medical officer with a tribal speciality hospital at Attappadi, says, "In many houses, women go to work to meet the family expenses as the men are liquor addicts. This leaves little children without proper care and food. But on the other hand, if mothers do not earn, the children would starve." Anganwadis in the region function only when health camps are held, the doctor admits.

"Many young men are alcohol addicts. Since Indian-made-foreign-liquor is prohibited in the region, they consume deadly concoctions of chemicals. Besides, they do not eat quality food. How can you expect them to have healthy children then? We have pregnant women consuming liquor too, leading to several health problems, including miscarriages. There weren't so many deaths due to malnourishment among tribals even during the famine," says M N Shivarajan, a member of the Irula tribe and a Railway employee in Salem. Born and brought up in Attappadi, Shivarajan says he has seen tribal life change drastically before his eyes.

Ranki Raman of Vellakulam lost her first child, who weighed 550 gm at birth, four days after delivery in 2012. Her second, born pre-term and without any health workers present, died in March this year. Admits Raman: "Our food is rice sold at ration shops and a piece of pickle, two times a day. I did not eat any nutritional food during pregnancy." Her second child weighed 2 kg at the time of birth, but came down to less than 1 kg within six months.

Vanchi Vellinkiri's child died a week after delivery on March 19. Many Vellakulam residents suffer from sickle cell disease and her child was born underweight. She has not got any medical care since delivery.

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Sickle cell is a common disease among the tribals, says Dr Rajesh. Patients suffering from the condition have red blood cells shaped like sickles that obstruct blood flow and lead to health complications. Children born to Attappadi tribals are also known to suffer from Type 1 diabetes and Vitamin A deficiency.

"Type 1 diabetes is not seen among children belonging to the general population. Although we do not have an exact figure of tribal children with this illness, the past six months saw six persons being admitted to the speciality hospital in a serious condition," says Dr Rajesh.

Dr K Venugopalan claims the government has made available food supplements, but many tribals refuse to take these as they don't like the flavour.

A factor contributing to the death of newborns, says Dr Prabhu Das, is that they are delivered at home, including those falling in high-risk categories. "Of the deliveries, 40 per cent still happen in houses in remote areas. Some of the women are reluctant to seek medical care during pregnancy. Our health workers do not take the pain to bring them under the ambit of care," says Dr Das, who has worked in Attappadi for 14 years.

On paper, the Attappadi region has a tribal speciality hospital, one community health centre, three public health centres, 28 public health sub-centres, three mobile clinics and two clinics. The health department consists of 85 ASHA (accredited social health workers), 172 Integrated Child Development Services (ICDS) workers, 140 Scheduled Tribe promoters and a total of 84 health inspectors. These apart, there are two private hospitals.

Health Department officials admit many centres function only when special camps are held and that staff do not go for field visits to colonies.

At the tribal speciality hospital, there is no surgeon or anaesthetist. The reason cited for the lack of a regular woman gynaecologist is want of family quarters. Since there is no gynaecologist at most times, tribal women do not come to the hospital for delivery.

A hospital official points out another glaring fact: that while anaemia and sickle cell are common among tribals, the speciality hospital does not have a blood bank. "For a bag of blood, an ambulance has to run to the district headquarters at Palakkad, 85 km away," said the official.

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If tribal children with a high mortality rate paint a grim demographic picture, there are fewer and fewer people above the age of 60 among the Irula, Kurumba and Muduka tribal communities too. A survey conducted by the Kerala Institute for Research, Training and Development Studies of Scheduled Castes and Tribes (KIRTADS) back in 2006 in Wayanad, another district with a significant tribal population, talked of a steady decline in the tribal population with age. It talked of men dying in greater numbers between the ages of 40 and 50.

In many tribal colonies of Attappadi, the number of people aged 60 and above is alarmingly low, in stark contrast to the rest of Kerala.

According to tribal activist K A Ramu, a cursory look at the 776 deaths recorded in the three village panchayats of Agali, Puthur and Sholayur in Attappadi, between January 2011 and June 2012, reveals a major chunk to be tribal men. Many of them were below the age of 60.

In Puthur, the most backward region among the three panchayats, of the 64 deaths reported in 2012, 38 were of ST.

Among the 120 families at Vellakulam colony, only 10 people are above the age of 60. At Kalkundi colony in Agali, colony chief Makkulan is 42. "I am the head of the colony for the past 12 years as there are no senior members. We have only three 60-plus people in my colony."

Again alcoholism is blamed for these falling numbers. "If the present trend of boozing and tobacco use continues, the primitive groups would vanish within the next 20 years," says M N Shivarajan.

According to Shivarajan, his Mulli colony on the Kerala-Tamil Nadu border has less than a dozen 60-plus survivors among 80 families.

"In colonies such as Chazhayoor, Paloor and Mulli, one meets an unusual number of young widows," says Manish Sadashivan, a public health inspector at Puthur panchayat.

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At one level, the problems are on account of poor government planning. Until two decades ago, the tribals grew their own cereals and grains, ensuring a balanced and healthy diet.

In 1996, the state government launched a major 'ecological restoration' programme in Attappadi, with aid from the Japan International Agency for Cooperation. The Rs 210 crore project, executed by the Attappadi Hill Area Development Society (AHADS), was envisaged to improve infrastructure in the region apart from developing watershed development and afforestation programmes.

Thousands of check dams were constructed and 18 lakh saplings were planted on 12,000 acres to revive the green cover of Attappadi. Concrete houses were constructed for tribals, depending on the size of the family. Men and women were employed as daily farm workers under AHADS, with 100-odd given jobs in offices as sweepers or guards.

Although AHADS undertook several infrastructure projects, it failed as a sustainable, income-generating programme. So, in 2010, when AHADS was wound up, the tribals were left in the lurch.

According to former KIRTADS director P G R Mathur, a major drawback of AHADS was that 90 per cent of the funds were spent on eco-restoration schemes. Only 10 per cent were used for tribal empowerment.

Palakkad additional district magistrate K V Vasudevan says a special health package will be implemented for the Attappadi tribals. "We have identified 88 children with malnutrition. Special health camps will be held for them next week. The field staff of the health department has been asked to increase the frequency of their visits to identify health issues. We will also start campaigning against excessive alcoholism," says Vasudevan.

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Almost all tribal families in Attappadi have a reasonable amount of agricultural land. But for want of money to take up farming, some of them travel up to 30 km daily to work in estates for daily wages of around Rs 290.

Ponnuswami of Moolangal colony is the owner of five acres of land. Nearby, settlers who have encroached on tribal land are cultivating their plots, having fenced it and ensured proper irrigation. Ponnuswami points at these plots and shrugs his shoulders: "From where will I get money for irrigation and solar fencing of the property to protect it from wild animals?"

Instead, he and several other tribal men of the colony walk 2-3 km into the forest to fetch grass to make brooms. "Daily earnings are less than Rs 200," Ponnuswami says.

Vellinkiri, 37, is another tribal whose family has five acres of land at Vellakulam colony, but little money to make the initial investment in farming.

Attappadi block panchayat president Usha Raju says illegal settlers take advantage of the fact that 90 per cent of tribals do not have proper land documents. "The agriculture department demands land documents and tax receipts to sanction any subsidy. Tribals' applications are rejected. Same is the case with banks which they approach for loans," says Raju.

Lack of papers means tribals cannot get MNREGS help either. "If a tribal wants to get his land tilled under the rural employment guarantee scheme, he has to submit land tax receipts. Many tribals do not have such receipts,'' says Prasad of Thambu.

As a result, the tribals in Attappadi often end up working on farm land owned by non-tribals and settlers.

A Sukumaran, convener of the Attappadi Protection Samithi, says tribals should be helped to cultivate their own land to tide over their food crisis.

Besides, even after AHADS exhausted Rs 210 crore and the three village panchayats continue to spend money year after year on tribal welfare, the 187 colonies are yet to get basic infrastructure. Many tribal colonies have no drinking water. At Paloor colony in Puthur panchayat, people have to walk 7 km to a nearby river to get water.

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Forgotten by the government, many tribals have turned to Christian evangelist groups. The Pentecostal Church groups offer biryani, rice and fish curry to tribals largely surviving on an inferior quality of rice and crushed chillies or a piece of pickle. At Sholayur panchayat, the Pentecostal Church has established a tribal mission with a prayer hall.

To those who see a conversion effort in the whole exercise, Maruthan, a tribal of Vechapathy in Sholayur, has a simple question: "When we can't give our children a single meal of tasty food, how can we resist the offer of biryani and fish curry?"

Tribals in Numbers

* They constitute 1.14% of Kerala's population.

* As per state economic review 2012, 55% of the tribal population in the state depends on agriculture for livelihood (compared to 20% of the rest).

* The development draft of the Attappadi block panchayat in 2012 shows it is still to get adequate drinking water supply, power, roads, toilets and other basic amenities.

* However, ST households in Kerala have much greater access to banking service, television, computer with internet, landline and car than an average tribal household in India.

* Palakkad district, under which Attappadi falls, has 11 per cent of Kerala's tribal population. It has 28,000-plus tribals in 8,271 households and almost 4,800 scheduled caste members.

* While in 1951, tribals comprised 90.26% of the total population in Attappadi, in 2001, that was down to 42%.

* Tribal literacy in Kerala is 64%, compared to 94% among the general population.

* They enjoy 2% reservation in state government jobs, a target that is yet to be achieved.