The land of the Brahmaputra recurrently reels under terrible onslaughts of a scourge
THE threat of malaria has been an omnipresent phenomenon
in Assam and the Northeast, but the disease struck in the
region with particular virulence early this year. Epidemic-hit
Sonitpur witnessed a typical government response to the barrage of critical reports in the press: the chopping block was
readied; the health commissioner issued sheafs of suspension
orders to his derelict doctors; the minister paid the customary
visit and relief teams were mobilised.
In spite of the fact that malaria claims hundreds of lives
every year in the region, an adequate surveillance Uetwork to
work as an early warning system is sadly lacking. Usually,
when the epidemic breaks, it is the media which arrives on the
scene first.
The situation was more critical this time. The Junior
Doctors' Association had gone on strike, protesting the -beating up of one of its members by SULFAS (Surrendered ULFAS).
Besides, preparations for the members'post graduate entrance
examinations, held after two years,
blocked any possibility of their participation in the relief efforts. "We
would have loved to have helped",
said Aroopjyoti Kalita, the president
of the Association, "but you know
how it is; we're tied up with this agitation, and then there are the
exams."
In Goalpara's Agiya public
health centre (PHC), doctors
demonstrated an engaging nonchalance in refusing to aamit patients
because they did not have any
means of feeding them. Lakhipur
presented a similar sorry picture. A
resident said that people were dying
cveryday, unable even to reach the
mc. The doctor's contention that
Gaurinagar was "under control"
proved to be inaccurate, as spot checks in the region revealed a
desperate scenario, with deaths continuing unabated.
Volunteers for the Gaurinagar relief camp were sumnoned, and a strategy to manage the problem was worked out
bkmlly. Every village in Assam has some 'social organisations'
- youth clubs, mahila samitis; it was the Navjyot Club of
Gmuinagar that took the lead in organising relief. Volunteers
,qpreed to go around spraying DDT. The supplies were requisi161M from the government, while the local young men provided voluntary labour. Two volunteers went around in a
iducle fitted with a loudspeaker, announcing the venue and
ammg, of the camp, as well as carrying out an advance reccee
of the situation; the vehicle was also used to transport very sick
patients to the camp and from there to the civil hospital at
Goalpara.
A team from the Malaria Research Centre, Sonapur, which
had been stationed at Gaurinagar, provided a desperatelyneeded support to the entire operation. Although its mandate
was research, the members of rolled up their sleeves and were
in the thick of thp relief efforts.
The problem was more complex in this particular area
because of several factors typical to the region. Firstly, the
worst affected areas were the interior reserve forests, areas that
had been 'encroached' upon by illegal settlers. These settlers
are non-citizens, who do not exist in official records, except if
they die; then they have to be accounted for, but that too only
if they make it out of their jungle hideouts to a revenue village,
where they have to encounter the hostility of the locals as well
as the authorities. They are also extremely poor, unable to
afford the luxury of treatment in a Ystem which for all practical purposes is already privatised.
The outbieak had provided an
opportunity to the doctors and
pharmacies to make money, and
that is what they did with a
vengeanee - putting people on
drips, charging between Rs 300400 per patient. It was partly the
fear Of exploitation by medical
practiondrs that kept people away
from seeking immediate relief.
The second complication was
rampant lawlessness and terrorism.
Many interior areas were, and still
are, in control of the underground
movements. In Tripura, a team of
doctors had to be sent under armed
escort to Mandai, which is just 20
km away from the state capital,
Agartala.
The nature of the vector posed
the third problem. Anopheles minimus is the species that transmits malaria in these parts. Unlike its other cousins, it does not
breed in stagnant water, but in slow flowing streams of fresh
water, which are found in abundance in the jungles of the
region. Although the mosquitoes are susceptible to DDT, houses are distant and spread out, making full coverage difficult.
Many areas reported resistance to chloroquine, making it
imperative for doctors to treat the disease with second-line
drugs which were more expensive, had Worse side effects and
were not easily available. Some of them could be administered
only under medical supervision, making the logistics of reaching the vast affected population very difficult.
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