Criminal neglect takes toll on Attappady tribes

30 infants die in five months as result of malnutrition; rural development minister announces Rs 125 crore package

By M Suchitra
Published: Monday 08 July 2013

The infants in Attappady died within few hours to few days of their birth. Most were newborns with birth weight between 550 gram to 1.5 kg (Photograph:  K A Ramu , Thampu, Attappady)

Attappady, the only tribal block panchayat in Kerala, hit the headlines following a series of infant deaths caused by malnutrition. According to the latest figures available with the Integrated Tribal Development Project office at Agali, the headquarters of the block, 30 infants have died this year till May 31, while data shows that 52 have died over the past 18 months.

Attappady is a part of the Nilgiri Biosphere Reserve in the Western Ghats region of Palakkad district. In 1975, the state planning board assessed Attappady as the most backward block in Kerala and the next year the Integrated Tribal Development Project (ITDP) was launched here—the first in the state. Since then a number of projects have been implemented in Attappady in the name of tribal development. But the lives of the tribes in this large block, spread over 745 sq km, remains a synonym for poverty and social backwardness. 

Traditional food missing from plate
There are a number of causes for malnutrition among tribals in Attappady. These are a combined effect of poverty, lack of employment, land alienation, failure to provide forest rights, loss of traditional agriculture, loss of indigenous food and lack of alternative nutritious food. “We used to cultivate ragi, chama (bajra), thomara (horse gram), maize, millets and pulses and vegetables,” says K Kaali from Naickerpady settlement, an activist with Thayikula Sangham. Tribals also used to get a variety of wild greens, tubers, and meat of small animals from forests. A well balanced diet consisting of iron, carbohydrates and proteins were available to them. “We used to save this for the monsoon months,” she says.

“Over the years, many of us lost our fertile land and traditional cultivation,” says K A Ramu from Karara settlement, convener of Thampu. “Now most tribes are living on barren hill slopes. The Forest Rights Act, 2006, has not been properly implemented in Attappady, points out Ramu. Tribes who have land are cultivating bananas, sugar cane and other cash crops which they do not traditionally grow.

Tribals are forced to depend on the public distribution system (PDS). “But we are yet to adjust to this system. We generally don’t like rice provided from the ration shops,” points out Kaali. “Most families cook rice and one curry once in a day and eat the same thing two or three times. There is no variety or nutrition in diet.” Interestingly, out of the 10,160 ration card holders, about 2,000 were above poverty line (APL) category. They were brought into Antyodaya Anna Yojna (AAY) category after infant deaths. To make matters worse, the supplementary nutrition programme in Attappady was very poor. There are 172 anganwadis here but they were almost non-functional.
Most of the infants in the tribal block who died over five months since January this year were newborns with birth weight between 550 gram to 1.5 kg, much less than the normal weight of 2.5-3.3 kg. They died within hours or a few days of their birth.  With exception of a few, most were premature deliveries that took place in the sixth to eighth months of pregnancy.

Dwindling population

The block has about 10,000 tribal families belonging to Irula, Muduga and Kurumba communities, living in 192 oorus (settlements) scattered in three gram panchayats—Agali, Pudur and Sholayur.

The tribes who comprised more than 90 per cent of the population in 1951, has dwindled to a minority over the years due to the influx of settlers from the plains of Kerala and Tamil Nadu.

Of the 70,000 people living here at present, tribes are only about 40 per cent. Deaths occurred in all three gram panchayats.

At Nellipathy, an Irula tribal settlement in Agali gram panchayat, twins born to twenty-five year-old Ponnamma on March 23 died within a week of their birth. Ponnamma had just entered the seventh month of her pregnancy when she delivered her babies in the community health centre (CHC) at Agali.

One of them, weighing only 640 grams, died immediately. The other was slightly more than one kilogram. “It died on the seventh day,” says a visibly weak Ponnamma. As per the medical report, the reasons for the deaths were the babies’ low birth weight and growth retardation. Including Ponnamma’s twins, four babies died in this settlement this year.
In Vellakulam settlement in Sholayur panchayat, too, four babies died: three of them in March alone. They include the twins born to 28-year-old Chelli, wife of Velan. One of them was a still-born while the other died after three days. She could not go to the hospital since her settlement was remote. The delivery happened late in the night and there was no transportation facility.

She was in the eighth month of her pregnancy. “There are wild elephants here so jeeps won’t come in the night,” says Chelli.  A doctor from the primary health centre came only two days after the delivery after he was informed by the ASHA worker (accredited social health activists). Chelli was anaemic and the second baby weighed just 750 gram.

Silent genocide

What caused the infant deaths is the combined effect of marginalisation and impoverishment of adivasi communities, lack of food and nutritional security, poor healthcare and supplementary nutrition services.

“The present crisis in Attappady happened not because of any immediate reasons,” says Rajendra Prasad, president of Thampu, an organisation working among the tribes in Kerala. “ There had been a systematic failure of governance, neglect and corruption for the last several years in this region.” In Attappady, 25 starvation deaths were reported in 1996 and 32 in 1999, he points out.
“In fact, what has been happening in Attappady is a genocide without any exaggeration,” says B Ekbal, neurosurgeon and former convener of Jan Swasthya Abhiyan, a national-level people’s health movement, who led a six-member medical team that assessed the situation in Attappady in May.

A mega medical camp in April found 536 of the 836 tribals who participated suffered from malnutrition and anaemia—125 of them were children below five years (Photograph: M Suchitra)

Malnutrition and anaemia

Malnutrition and anaemia are prevalent among the tribals in Attappady. “Almost all tribal women, including adolescent girls, are anaemic, and it’s acute among the pregnant and lactating mothers,” says Prabhudas, a committed government doctor, who has served in Attappady for about 20 years. He had been transferred out of Attappady two years ago, but after the infant deaths, he has been appointed as the district nodal officer to coordinate health services for adivasis.
While it is dangerous for a pregnant woman to have a haemoglobin count below 10 gram, most pregnant adivasi women in Attappady have counts of seven or eight, points out Prabhudas, and it even goes down to five or six.  According to him, the tribals suffer from calorie as well as protein deficiency.  There are at present 536 pregnant Adivasi women in Attappady, and 90 per cent of them are anaemic and are facing serious health problems.

After many infant deaths were reported, the state health department conducted a mega health survey in April this year, screening 23,597 persons in Attappady. A total of 536 cases of malnutrition and anaemia were identified—of them 69 were severely malnourished while 463 were anemic. These 536 include children below six years, pregnant women, lactating mothers and adolescent girls. A mega medical camp found 536 of the 836 people from adivasis who participated in the camp suffered from malnutrition and anaemia—125 of them were children below five years.
The report of the six-member medical team led by Ekbal observes eclampsia (high blood pressure and seizures) is common among tribal women of Attappady in the third trimester of pregnancy. One of the major reasons for high blood pressure during pregnancy is lack of nutritious food, says Ekbal. This leads to growth retardation of babies before birth (intra uterine growth retardation).

Poor health risk management

The death toll of infants would not have been this high had the health centres worked efficiently, points out A Laxmiah, public health nutrition specialist with the Hyderabad-based National Institute of Nutrition, who led an experts’ team that conducted a nutrition survey in Attappady’s adivasi settlements in May. “Undernourishment is there but more than that the risk management by healthcare centre was very poor,” says he.

In Attappady, there are 36 healthcare centres—one tribal speciality hospital, one community centre, three primary health centres, 28 sub centres and three mobile medical units, all managed by the state health department.  Besides, there are two outpatient clinics (OP) under the ITDP and 85 Accredited Social Health Activists (ASHA) under the National Rural Health Mission.

“But none of the healthcare facilities were working effectively and efficiently for the past two years,” points out P V Radhakrishnan, the  ITDP project officer who took charge in March this year. It was he who first confirmed deaths due to malnutrition in a report sent on April 4 to the state tribal development department. The state government was literally caught in a bind when the media continuously highlighted the ITDP officer’s report.

Radhakrishnan’s report had clearly pointed out that the functioning of the health care centres and anganwadis in the block was not satisfactory. It had also pointed out that there was no coordination among ITDP, health, social justice, local administration, agriculture and forest departments in Attappady. The report had sought immediate intervention.
“But even after that, the state government did not take any preventive measures to control deaths by giving special attention to pregnant mothers and infants,” says Rajendra Prasad. Fifteen more babies died—six in April and nine in May.

Tribal activists are extremely bitter about the whole episode. A health convention organised by the tribal organisations in December last year had highlighted the dismal health scenario in Attappady. “We had given submissions to chief minister and ministers of health, social justice and tribal development departments and had requested urgent actions,” says K Kaali, from Naickerpady settlement, an activist of Thayikula Sangham, a group formed by tribal women in Attappady to fight against spreading alcoholism. “But only when the national attention turned to Attappady did the state government take infant deaths seriously,” says B Udayakumar, an activist with Thampu. They are more disgusted to see the flow of ministers, officials and politicians and media persons after the deaths. “Now women have to remain in oorus and are unable to go for wage work. They stay back to narrate their stories to the visitors,” says Kaali.

Packages and promises

The state government has started a 11-bed nutritional rehabilitation centre in Attappady apart from a series of other actions. It distributed free rice and announced four months free ration of 10 kg ragi and 2 kg green gram.  It has also filled up the vacant posts in the health centres and anganwadis. Union Minister for Rural Development Jairam Ramesh has announced a Rs 125 crore package. A special task force to implement the package has also been constituted.

Part of the package includes government help for adivasis to develop vegetable cultivation and grow traditional food crops in Attappady. “But where is the land for that?” asks Kaali. “The state government does not address the basic issues of our land alienation which is the root cause of our poverty, malnourishment all major issues we face now,” she says.


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