Chikungunya spreads its tentacles

Chikungunya, a viral disease borne by the Aedes aegypti mosquito, has assumed epidemic proportions in large swathes of the country, especially Karnataka. One problem with containing it is that the systems in place for monitoring the disease are virtually non-existent, as is the infrastructure for prevention, control and cure. vibha varshney travels through Karnataka to track the disease and its trail of destruction

Published: Saturday 30 September 2006

Chikungunya spreads its tentacles

-- (Credit: Agnimirh Basu/ CSE) Â´??

The scene: late in the afternoon at the directorate of health and family welfare services in Bangalore. Officials, who claimed that no chikungunya case had been registered since August 22, had organised a trip to Bidadi primary health centre (PHC) in Ramanagara taluka in Bangalore rural district. I had no expectations, though I did meet 58-year-old Nagaraja who was already recuperating and could even take care of his utensil shop. Just as we were about to leave, an auto rickshaw entered the compound. A woman was helped off and she painfully hobbled her way towards the clinic. The 50-metre distance took around five minutes to traverse with her husband supporting her. When 38-year-old Nagamma finally made her way to the examination bed, her husband told me she had developed chikungunya symptoms two hours ago. They had travelled 16 km from their village, Kollandanahalli, in neighbouring Kanakapura taluka . Neither was in a state to answer questions. She had a long wait ahead the only doctor in the clinic was attending to another patient.

Karnataka,spreading chikungunya toll which reported the maximum number of suspected cases, is a good illustration of chikungunya's ravages. It first appeared in Gulbarga district in December 2005 and in the next seven months spread to all the districts of the state 

and map  Even though chikungunya is not fatal, its debilitating character deprives people of their livelihoods. The disease incapacitates people for anything between 15 days to three months because one of its main symptoms, excruciating joint pains, persists well after the fever caused by the disease subsides. In Karnataka, the disease came at a time when the land was being readied for the planting season -- work was easy to find.

Word had gone around and people were running scared. The 30 per cent increase in the sales of mosquito nets in the Hariyana Handloom Centre in Kanakapura taluka was testimony to this. And the fears were well-founded, chikungunya did cause ravages and losses of livelihoods.

Throughout Karnataka, the evidence of how the disease impacts livelihoods was overwhelming. Yet, there has been no effort to document this. "Labour was difficult to find during the peak epidemic period," says Hanumantha Reddy of Navodaya Education and Environment Development Services, an ngo based in Ranebennur, Haveri district. His work on a water project was delayed due to labour shortage. M S Patil, a sub-inspector in Ranebennur, gave another example. In the past two months, out of the 46 people working in his department, 12 had contracted chikungunya. Three were out for a month, three were off for 15 days and the others got a week off. They were lucky. Those without regular jobs didn't have the luxury of paid leave and suffered, even in Haveri district, where jobs were aplenty because it is a trading hub and a major seed production centre, with more than 70 companies, including Monsanto, being based there.travelling fast

Loss of wages is the most important, but not the only economic fallout of chikungunya. Madiwalappa Angadi of Garag village in Dharwar district got the disease in the second week of June -- his wife was already suffering. He had just finished planting cotton and, as was normal, started his day tending to his crop. But he was uneasy the whole day and by night he became feverish and his joints started paining. His family of seven depends on the approximately 3.5 hectares (ha) he owns. He could afford to rest only for five days because unless he took immediate steps, the incessant rains would destroy the whole crop. But he had a tough time for it was difficult to sit and even more difficult to get up.

Weeds took over the field -- they were in fact taller than the stunted cotton plants. Angadi finally had to hire labour, which was in short supply in the village -- fortunately, villagers helped out by releasing their workers on a rotational basis. But he had to shell out Rs 50 a day per worker. To meet the cost, he sold his grain reserves and did not have to borrow.

In Gangapur, Haveri, Sridhar Gowda's sister Ratna caught the virus, he had to hire labour to ensure that the work lost was made up. Family members had till then been capable of managing the workload. Working tired Ratna, even though it was a month since she had fallen ill and she could only manage light household work. The family had just under 3.5 ha of irrigated land, which fetched them at least Rs 4,000 per crop, but the family was big and needed more.

People in Mummigatti village in Dharwar blamed the disease for the complete loss of crop this year. Basavgowda Patil said that if people had been healthy, they could have taken steps to remove the excess water from torrential rains and weeded their fields regularly. This would have saved at least part of the crop. The rains destroyed 29-year-old Ravi Pujar's rice crop. An inhabitant of Kotur village, in the same district, he would have earned something around Rs 40,000 from it. He feels if he had not fallen sick at the time, he would have made a profit of at least Rs 20,000. He still cannot work and is waiting to clean up the field and plant a new crop -- which will take at least two months. He has taken a loan of Rs 4,000 since he fell sick in July. Though running the house just needs Rs 1,500, money also had to be borrowed for the Ganpati festival.

In Gudagur village in Ranebennur taluka, 40-year-old Shantamma Asundi was preparing to sleep, tired with housework. She first had fever and joint pains two months ago and still has relapses. In the family of five, she is the only woman and has to continue providing for the family even though the doctor says she should rest. "My sons would feel that I was acting because I did not want to provide food to them so I started working," she says. The disease seems to have the worst effect on women, who can't afford to rest. Doctors say, this could be the reason for repeated relapses.

In Kotur village, Kallava Garagad prefers not to go to defecate in the fields in the morning to avoid the walk and the squat. Doctors say that this is a trend with most patients. Some decide not to eat or drink to avoid tricky movements. Other than the obvious weakness and accumulation of toxins in the body, this also leads to accumulation of fluids in the body and worsens the swelling on the joints.

People in villages that don't have phcs are the worst off. Patients have to travel long distances to go to a doctor or buy medicines. Seventy-year-old Kalamma of Kachuvanahalli village in Bangalore rural district spends Rs 12 as bus fare every time she visits the doctor; she has made seven such visits. Moreover, she can get to the bus stop only if she gets a lift from passing vehicles. On each trip she gets Rs 50 worth of medicines and two injections for Rs 35 each. Three members in her family have suffered and they have spent a total of Rs 7,000 on treatment. Kalamma sold her earrings to meet the cost.

In the absence of adequate state health care, private doctors in Ranebennur taluka have thrived. Proper doctors treat only the better off. Otherwise, local registered medical practitioners (rmps), who work on credit, provide treatment.

Chikungunya might not be a fatal disease in most cases. But it is so debilitating that it prevents people from moving around, forget working

Down to Earth Mahadevamma of Sathanur village in Kanakapura taluka of rural Bangalore had her third bout of fever 15 days ago, after catching chikungunya two months back. She used to earn Rs 35 a day but has not been able to work. Her sister-in-law, Venkatlakshmi, lives with her, but she too has been down with chikungunya and not working. She too earned Rs 35. Mahadevamma's husband rarely gets work. Sathanur has a PHC and provides free medicines. Still, to run the family, a loan of Rs 3,000 has been taken
Down to Earth Bhimappa Durjad, in Gangapur village, Ranebennur taluka, had assured work for at least 10 months a year. While he earned between Rs 30 and Rs 50 a day, his wife Puttawa got Rs 25 to Rs 30. August is the main agricultural season with the rains increasing the weeds, but Bhimappa fell sick in the first week of the month. He had to be hospitalised for 15 days. Puttawa had to stay with him so her earning was also lost. Their daughter Triveni now runs the house on the Rs 25 she earns a day. Rs 2,000 had to be borrowed for treatment

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