Editor's Note: Amarinder Singh was today sworn in as the new Chief Minister of Punjab. Cashing in on the anti-incumbency against the Akali-BJP alliance was not as difficult as the challenges he faces ahead. He needs to keep his promise of sealing drugs supply and acknowledge the problem of public ill-health and groundwater contamination linked to excess use of pesticides. Crumbling health infrastructure and other issues plaguing health sector also need urgent intervention.
In the autumn of 2015, Down To Earth travelled to one of India's most thriving and prosperous states. What we saw is a state that has metamorphosed into the country's second-highest disease burdened state.
Punjab usually evokes an imagery of prosperity: tall and robust farmers tilling vast green fields on tractors, women milking cows and buffaloes, children enjoying glasses of lassi, rich cuisines prepared with huge dollops of pure ghee and butter, ancestral homes surrounded by yellow mustard fields and courtyards… A rosy picture, isn’t it? But you may need a lens to find out the stark contrast. Walking through the lanes in rural Punjab, one witnesses diseases and disappointment, instead of prosperity and affluence.
Teja Ruhela in Fazilka district looks like any other village. Comprising about 200 households, the village mostly has kuchcha houses. Some of them hardly have any ventilation. But people do not care. At least one-tenth of the households in Teja Ruhela have a mentally challenged kid, according to Baba Farid Centre for Special Children (BFCSC), a non-profit working in the area. “Cerebral palsy has been afflicting children in the village for almost two decades now,” says Krishn Singh, a local doctor. The truth in his words is reflected in the wide age group of cerebral palsy patients. The village residents have accepted their dilapidated existence, just like they have accepted the prevalence of cerebral palsy among their children.
Four-year-old Dilkhurshaid Varval, or Dilkhush as he is fondly called, suffers from cerebral palsy. He lies cross-legged and motionless on a cot in the courtyard. He has never walked, eaten or bathed on his own. He occasionally rolls his eyes, for that is all he can do. His father, Swarn Singh, is unmoved as he speaks about his son. He says Dilkhush has been in a state of paralysis since he was five months old.
In another household in the next lane, 15-year-old Poonam and her younger sister, Renu, also suffer from the neurological disease. Their father works in the revenue department and the family is better off than the Singhs. But the fate of these two young girls is not very different from Dilkhush. Only in this case, Poonam and Renu can walk, but with the help of both legs and hands.
One of the lucky few among cerebral palsy patients is eight-year-old Gulshan, another resident of the village. He attended physiotherapy sessions organised by BFCSC in his village from 2009-13. With regular treatment, he can walk holding a walker. He still cannot speak. If he wants to greet someone with a namaste, he can partially raise his hands, but cannot join them.
Pritpal Singh, who runs BFCSC, says that his organisation has not been able to provide physiotherapy to children in the village since 2013 due to lack of funds. As a result, young patients like Dilkhush never got the opportunity to get a long-term treatment, unlike Gulshan.
Reproductive disorders, too, are emerging as a major health concern. Many couples in Fazilka and Faridkot districts are childless. If some women have not been able to conceive, others have had miscarriages. And the problem is not only with women. Forty-five-year-old Satnam Singh and his wife Simro Bai live in the lane next to Dilkhush’s home. Singh has erectile dysfunction and Bai’s uterus is small in size. Their visits to doctors for treatment proved futile. Since they never had a child of their own, they adopted the daughter of Bai’s brother.
Thirty-five-year-old Bir Pal Kaur, a resident of Ramuwala village in Faridkot district, has had 10-12 miscarriages, an astoundingly high number. “I have had so many of them that I lost count,” she says with a blank look. “In the past 15 years, I have been to various government and private health facilities in Gidarvaha, Faridkot, Bathinda and Muktsar districts. I started with the government hospital in Faridkot, but shifted to private clinics because the government hospitals did not have the necessary equipment to treat my case. And the doctors could not explain what the problem was.” Krishn Singh says most people refuse to talk about reproductive health problems as they are shy. “I know at least 24 couples in Teja Ruhela who suffer from reproductive disorders and are childless. There could be more,” he adds.
A state of maladies
About an hour’s drive from Faridkot is Muktsar district, known as the “cancer capital” of Punjab (see ‘What ails Punjab’). Almost every village here has a cancer story. Kotkapura is one such village. Nearly all households have had at least one cancer patient. Many have seen the death of their loved ones.
Nistar Singh lost his 27-year-old wife, Amarjeet Kaur, to brain cancer last year. He had sold off all his possessions—land and jewellery—to save her. Once a farmer, Singh today works as a bus conductor. His wife’s death has shattered him, and he avoids talking to neighbours or mixing in society.
Mandar Singh, another resident of the village, too had to give up his possessions to bear the cost of treatment of his wife, Harjinder Kaur, who died of brain cancer in 2010. He spent Rs 6.5 lakh on her treatment. This excludes the cost of travel and food. “I sold one hectare of my ancestral land for Rs 4.5 lakh and gold for Rs 60,000. The rest were from my savings,” he says.
As this correspondent was passing through Jagat Singh Wala, another village in Muktsar, she struck a conversation with 37-year-old Surpal Singh, one of the residents. He suffers from Hepatitis C, a liver disease. “Some households have two to three cases,” he says. What was striking was his calm and composed demeanour. He showed no sign of fear or worry of a man suffering from a chronic illness.
Forty-six per cent of Jagat Singh Wala’s population has Hepatitis C. This was found in a survey conducted earlier this year by multiple non-profits and led by Amar Singh Azad, a retired government doctor. In fact, more than 30 per cent of people in three villages in Muktsar, Faridkot and Bathinda districts tested positive for Hepatitis C. Jagat Singh Wala is the worst-affected.
As one hops from district to district, village to village, new stories of deaths and diseases emerge. But the people appear unperturbed. If some have embraced their sickness, others have left it to fate. Some are reeling under heavy debt to bear the cost of treatment. Jagtar Singh, 38, of Jaitu village in Faridkot, had persistent cough for almost a year. Medication from a local registered medical practitioner did not help. When he started to get frequent bouts of chest pain and breathlessness, he went to the civil hospital near his village, where doctors diagnosed him for lung cancer in 2013. He then went to the government hospital in Faridkot. When his condition did not improve, he went to the Acharya Tulsi Regional Cancer Institute in Bikaner, Rajasthan.
“Families who have had cancer patients told us to go there,” says Manjeet Kaur, Singh’s wife. Coming from a family of construction labourers, they could not afford the cost of treatment and took the first loan of Rs 50,000 from a moneylender in the village. “The burden of debt has increased to Rs 3.5 lakh,” says a lean and visibly weak Singh. Out of this, Rs 1 lakh was given by a zamindar. “Three members of my family work on his fields without wages. That is how we are expected to pay back the loan with interest,” Singh says, his voice heavy with helplessness.
Troubled youth, depressed elderly
In the Malwa region of the state, many people are reporting high levels of uric acid in their blood, which can cause arthritis, and other bone and kidney problems. Sukhpreet Kaur of Ramuwala village has 7.8 mg/dl uric acid in her blood, while the normal range is 4 mg/dl. “I know many people in my neighbourhood with this problem,” she says. Karamjeet, 23, is one of them. She has had arthritis for the past four years. Laboratory tests show excess uric acid in her blood. “I have severe pain in my joints, and I am unable to get up from my bed without someone’s help,” she says.
Davinder Singh, who runs the only pathological laboratory in the village, says that in the last week of July this year, he received 20 patients for uric acid test, out of which 17 had levels higher than normal. “A lot of patients who have excess uric acid in blood are in their 20s,” he adds.
About 190 km away in Patiala, there is a queue of men and women outside the clinic of Dharamveer Gandhi, a cardiologist and member of Parliament from Patiala. A chat with the doctor reveals that most of the patients above the age of 50 complain of depression and loneliness (see ‘Elderly depression’).
“Most mornings I wake up with thoughts of committing suicide. It is scary,” says Swami Barnala, 62, a heart patient from Nabha village in Patiala. He says he has been facing this problem for over five years. “I feel fine when I take medicine, but feel suicidal again when I stop taking it,” he adds. Barnala goes to a private clinical psychiatrist in Patiala and spends Rs 1,500 each month on consultation and medicines. A retired schoolteacher, he avoids visiting the doctor when some major expense crops up in the family.
Besides chronic diseases, Punjab is dealing with another major health crisis: drug abuse. Over the years, Malwa region has emerged as the state’s hub of drug abuse patients. According to a study by Madhu Bala, a researcher in Patiala’s Punjabi University, 12,994 patients were admitted in 18 drug rehabilitation centres surveyed in six districts of the region in 2009. By 2012, the number had increased to 18,770, the study says. The state government recently conducted a survey in 12 districts to estimate the number of drug addicts.
The results are expected in September.
Baljeet Singh (name changed) took to drugs at the age of 15. He started going to a government drug rehabilitation centre in Amritsar in 2011 and showed remarkable improvement. But in November 2013, the police put him behind bars for addiction. His therapy was discontinued. While in jail, he went back to injecting drugs, sharing needles with other inmates. He was released a year later. When he went back to the rehab centre, he tested positive for HIV/AIDS.