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Twenty-six-year-old Meenakshi, a resident of Edavani ooru, one of the 19 settlements of Kurumbas, a particularly vulnerable tribal group (PVTG) in Attappady block, lost her baby in the seventh month of pregnancy. Doctors at the primary health centre, which is 16 km from her house, had advised her to be taken to the Tribal Speciality Hospital because she was very anaemic and her condition was serious. The speciality hospital, which is 25 km from her house, refused to admit her despite repeated requests, says Nagan, Meenakshi’s husband. She developed labour pain while returning home and was rushed back to the hospital. She gave birth to a stillborn.
Her baby was among the 32 tribal infants who died this year in Attappady. While babies were dying before or soon after their birth, the one and only gynaecologist in the speciality hospital was on long leave. The posts of surgeon, anaesthetic and pharmacist were vacant.
Speciality hospital sans staff
The 52-bed Tribal Speciality Hospital at Kottathara village started in 2007 with Rs 8 crore from the Tribal Sub Plan and funds from the National Rural Health Mission to provide good healthcare to tribals. When this correspondent visited the hospital, its operation theatres, labour room, intensive care unit (ICU), neonatal ICU, X-ray and ECG facilities and laboratories were not working in the absence of adequate doctors and other staff. The operation theatre did not even have electricity connection. The hospital did not have the required permission under the Pre-Natal Diagnostic Techniques Act to use the ultrasound machine in the absence of a gynaecologist. The blood storage unit was awaiting licence from the district drugs controller because a visit by the assistant drug controller was due.
Apart from the Tribal Speciality Hospital, there are 35 more healthcare centres at Attappady—a community health centre, three primary health centres, 28 sub-centres and three mobile medical units. Besides, there are two outpatient clinics under the Integrated Tribal Development Project (ITDP) and 85 Accredited Social Health Activists (ASHAs) under the National Rural Health Mission. Had these medical centres functioned efficiently, death toll would not have been so high.
In the past two years, none of the healthcare centres appointed a senior doctor. Because of this, complicated cases have to be referred to Kozhikode Medical College or Thrissur Medical College, both about 140 km from Agali, the headquarters of Attappady. The taluk hospital is 35 km away and the district hospital is 95 km away. The office of the ITDP spent about Rs 30 lakh last year to run its ambulance to different destinations.
This apart, pregnant tribal women have not even received iron and folic acid tablets in the past two years because the district health department did not supply it to them, says Prabhudas, a government doctor, who has served in Attappady for about 20 years. He is the newly-appointed nodal medical officer for coordinating health services to tribals in Palakkad district. His appointment followed in the wake of the infant deaths.
Attappady is a big block spreading over 745 sq km. Proper functioning of sub-centres here is important because most of the tribal hamlets are located far from the main healthcare centres. “Junior public health nurses (JPHNs) were supposed to stay in the sub-centres but they did not do so,” says Prabhudas. After the furore over the infant deaths, the health department has issued a strict order asking JPHNs to stay in the sub-centres.
Under ITDP, healthcare is one of the responsibilities of tribal promoters. There are 132 of them, “but they lack proper training in health services,” says P V Radhakrishnan, ITDP project officer in Attappady. Besides, ASHA workers were not provided with medical kits, and they as well as the ITDP promoters failed to do make house visits, he says.
“In the last two years, we held many protests to make the speciality hospital function properly, but the authorities did not care,” says tribal activist Maruthi P from Pettikkallu settlement. The hospital does not even have a proper drinking water facility. Water is directly pumped from the nearby Siruvani river.
Infant deaths prompt action
When deaths of tribal babies became a big controversy, the health department was forced to admit its lapses. A report prepared by the department has noted that even the immunisation level among tribal children below five years is poor. The state government, on its part, took a slew of actions. It started a nutritional rehabilitation centre, created 75 new posts in health centres, filled all vacant posts, gave medical kits to ASHA workers, supplied iron and folic acid tablets to health centres. This apart, it announced Rs 20,000 extra allowance to doctors working in Attappady and increased the basic pay of other staff by 20 per cent.
But the increase in salary will not help much, says Prabhudas. “Doctors and other staff in adivasi region need to have empathy towards tribals and knowledge about their beliefs and customs,” he says. Therefore, it would have been better to first prepare a list of doctors and nurses ready to serve in tribal areas, he adds.