A tryst winth death

The land of the Brahmaputra recurrently reels under terrible onslaughts of a scourge

 
Published: Thursday 30 November 1995

-- 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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