Poor's health has been neglected, and its more in remote areas.

By PURUSOTTAM SINGH THAKUR

" When the diarrhea did not stop and my health deteriorated, I decided to call a taxi from Sikarpai ( which is a road side village and only place where some taxis are available ) to go to hospital as there was no hope left behind. Prior to that, my family repeatedly called but neither doctor nor the health worker turned up. First my family took me to Shikarpai health center but when did not get well, so left for a private doctor in Raygada. The doctor took Rs.700. And I too had to spent on hiring taxi. In between my two sons were also affected by diarrhea, than they were too admitted in the hospital. " said Shirpati of Satpai village in Kashipur block in Raygada district.

" I had to spent around Rs.6000 for the treatment of the entire family. Now I am in debt. I have borrowed the money from the " kumti mahajan " ( kumti is a trader community who runs the business of money lending also ) local trader who gives money on high rate of intrest. The rate of interest is 50 paise in a rupee " he added. When asked, " How did you repay the amount ? " he said that, It will took him few years to repay.

But the good thing in this case is that, the lives were saved. Satpai is one of the remote village where the diarrhea has been affected. There is absolutely no communication. If you can you can hire a vehicle. But that requires money, which many people does not have in this part of India. Neither many of the people are so lucky to get the medical facilities what ever the way like Shirpati who is little aware than others.

" Some 2050 people were affected by diarrhea this year, out of them 41 people are died till the last week of the September " according to Dr. Benudhar Naik, CDMO, Raygada. But the unofficial record says it is more than hundred. The epidemic out break in mid July of this year.

" In 2007, some 7800 people were affected by diarrhea and 90 people were lost life " says Benudhar Naik, CDMO, Raygada. " Lack of safe drinking water, connectivity and peoples awareness are the factors responsible for the regular out break of epidemic where health department is helpless " he added.

When this reporter visited the district in the first week of August there were around 7 deaths have been recorded and at that point of time also the CDMO said that, " the situation is under control ".
Six blocks have been affected by the epidemic this year. That are Kashipur, K.Singapur,Bisam-Cuttack, Gudari and Raygada.

But by the last week of August and 1st week of September it goes out of control and when there was hue and cry in the media, government pressed in to action. The Chief Minister asked the Health Minister Prasanna Acharya and the health secretary to go the district to monitor and take stock of the situations.

Prasanna Acharaya was there for 3 days and found two reasons for the spread of epidemic which known to all since many many years. He blamed contaminated water and inaccessibility for the outbreak of epidemic in Raygada among others. Besides that, the report said, the remote areas are worst affected. As the villages are inaccessible, decontamination of water was not possible. Majority of deaths are during night and night patrolling parties were pressed into service to provide medical assistance to the affected, the report said. However, inter-departmental coordination is utmost necessary at this time and a special programmed be launched in Rayagada district to tackle the crisis situation, Acharya proposed in his report.

Perhaps he wanted to say neither of the problems belong to his department and shifted the responsibility but his report also reveals that, the lack of co ordination among departments is very well exist.

Some doctors along with para medical staffs were sent from other places including Bhubaneswar and Cuttack. Temporary health camps were in service in some place where the patients were brought and treated. Many people were treated and live were saved. But there were some instances witnessed by the volunteers which well explained the attitude of the government service and its service holders.

Dr. Biswajit Roy, National Convener, Rashtriya Yuva Sangathan who is now joined there as a bare foot doctor as part of the Sarvodaya relief camp to distribute medicines to the victims says, government servants posted here are not going to remote villages. When he asked one of them sent for this temporary camp, he blasted on Mr.Roy saying, " do you know I am from Cuttack, government has drop us here, where there is no electricity, no net work ! how can one work in this situations ! "

Ravi Das, the 70 years old leader of the Sarvodaya relief camp who is co ordinating the work to arrange medicines and looking after entire operation shared a similar story of Baliguda village of Gudibali panchayat. There are 40/45 house holds in Baliguda village and almost all are very poor. There is tube well but defunct and repaired later when one died recently." When the villagers informed the nearby temporary camp set up by the government about a patient who was serious and requested them to sent the vehicle to transport the patient, the camp in charge a doctor was found missing, the para medical staff who was present there did not respond. When we saw this we also requested them but they said that, why the villagers are not bringing the patient. We told them when the villagers are saying that there was non to bring the old patient as the entire family is affected by diarrhea ! at last when they sent the vehicle it was too late, The 70 years old Binidhar Goud was brought and died in the camp. " said Ravi Das with anguish.

Dr.Roy of Sarvodaya said, he spoke over phone to a senior state level officer of NRHM and complained about the apathy and their attitude, in reply the officer expressed his helplessness and said, the problem is that, our government people are not ready to step down from the pitch road ! They have attitude problem.

when asked why he is not taking action ? he replied, we already lacking staff so we can not just afford it. And you know the reality how it is difficult to suspend or dismiss even a 4th class employee in the government service.

" Now the season has changed. The continues rains has stopped and so the diarrhea cases. " said Ravi Das. He was here in 2007 when the epidemic was broke out and more than 200 people died, he was also done the same work in Kalahandi last year where around 40 people lost their life.

" Its not just the contaminated water and inaccessibility rather its endemic poverty which is prevailed here. They have no access to safe drinking water and the food as well. They are still forced to take contaminated food like mango kernel and seeds of tamarind, roots and poisonous mushrooms " he added.

Although the 25 kg PDS rice at two rupees are of great help to them but villagers says they are getting 5 kg less rice. When they asked the dealers its go unheard.

Reaching villages for outsiders is a very dfficult task so is for the people living inside. Outsiders can afford to go inside if they wish because they have the purchasing capacity but in case of villagers its beyond their affordable reach. You requires money in every step you go forward. So people even in distress and in badly need of health care prefer to die or forced to die a silent death but fear to go to hospital as he or she knows even its a government hospital you need money for the treatment.

And this reporter witnessd such an incident when he visited recently along with the Sarvoday team Huder village where a 7 years old boy Karan Majhi was found with a fractured and swelling hand, when asked he said he fell down from a guava tree a week back. The doctor with the team expressed his serious concern and said it may be lead to gangrene inside. When asked to his father Ghenu Majhi, he said he can not afford the treatment in a hospital so have treated with some paste of roots found in the forest. Than the Sarvoday team decided to take the boy and his father to Raygada district hospital. Next day he was treated in Raygada and returned to his village. So god knows if the boy would have brought by these people what would have happened to him.

In the same village we met 75 years old Rupali Majhi. When we were talking to some villagers, she came to us and try to listen to us. Than she told us that, " Please make a road to our village. You see the road is not good so you are too facing problem to reach here, you are not able to come with your vehicle. When we are felling ill who will carry us such a long distance to the hospital. So please do this, we will be grateful to you."

It shows even the older people of the area understood where the problems are lies.

In the meantime the paramedical staffs have been returned to their respective places outside the district from where they were deployed in temporary health centers as the centers are with drawn.

The epidemic has spread to about six more districts including Koraput, Nuapada, Malkangiri, Nabrangpur, Gajpati, Bolangir and parts of Sundergarh. The districts which are known for its poverty and backwardness but, in almost all the districts, 60 percent of the doctors’ posts have been lying vacant for years. There are 128 sanctioned posts of doctors in Raygada but out of it 58 are vacant. Recently after the spread of epidemic the government as appointed 408 doctors on ad hoc in Orissa, out of that 20 doctors have been posted in Raygada but only ................have joined by the end of August.

Its not only diarrhea, Malaria too is known as one of the dreaded killer in this part of Orissa. So far numbers of people have been killed by the malaria.

However, according to CDMO, Raygada, " The district becomes a " malaria endemic zone " during rainy season with about 97 per cent of the patients suffering from falciparum infection which causes brain malaria.

However, according to Nayak the district becomes a “malaria endemic zone” during rainy season with about 97 per cent of the patients suffering from falciparum infection which causes brain malaria.

The tribal couple Rajendra and Solomi Majhi of Panabandha village of Tikri block has lost their two children out of four in a week time. Rajendra, who is a landless narrates the agony he has gone through. " I had no money when my son Bina (13) suffered from malaria. I borrowed Rs.200 and trek down to the Tikri hospital with my son on my shoulder. He died there. 5 days later my another son fell ill but I lost him at home because I could not arrange money."
Villagers said, in last one and half month time 8 villagers have died in malaria.

There are 235 sanctioned health sub-stations for equal number of health workers. At least 166 sub-stations are almost non-existent, without own building that are supposed to be the residence-cum-offices of the health workers. “We cannot stay in our place of work even if we want to. Besides, when there is an outbreak, it becomes difficult to reach the inaccessible villages,” said a woman health worker, requesting anonymity.
Due to inaccessibility, the poor tribals have lost out on many government benefits. Last year, the administration distributed about 50,000 long lasting impregnated nets (LLIN) in the district to ward off mosquitoes. In the four villages that HT visited rarely anybody had one.
A trip to Kadapadar, a hill top village just about 10 km from Tikri, is arduous. Four children below the age of six have died in the village following high fever.
Health workers visited the village twice after almost all of 110 households – all tribals below poverty line – had been affected with high fever.
People are still down with fever, but health workers have not come since the last 15 days.
“It is not that easy to work here. We have distributed medicines in all villages. But the villagers dump them in their house,” said Prasanna Mohanty, a health worker.
CDMO Nayak also corroborated that the villagers rarely come to the hospital. “They rely more on the quacks and people indulging in witchcraft. They come to the hospital as a last resort. Actually, there is lack of awareness,” he said.
It is not that villagers do not come to the hospital. But they cannot afford to. “To be aware means to cough up more money,” said Luki Majhi (29) of Kadapadar, who lost his 2-year-old daughter because he could not hire a vehicle at a cost of Rs.800 to take her to the hospital. “As such, during rainy seasons, vehicles do not come to the village as rain cuts off the road.”
“Going to hospital without taking money is like banging one’s head against a wall,” said Reu Majhi (30), whose 6-year-old daughter died due to malaria.
Poverty is all pervasive across villages. The malnourished people have no work. They do not remember when they worked in a government project last.
As the area gets cut off during the rainy season, gnawing hunger force them to eat on whatever they lay their hands on – mainly dried mushroom and mango kernel, which tend to infected by fungus. “And that leads to several diseases and even death,” said social activist Pabitra Majhi.
In 2007, 99 persons lost their lives to cholera, half of them in Kashipur block. Every year, diarrhea claims several lives in the inaccessible villages. Children have been a major casualty. In the last three years, the infant mortality rate has increased from 78 per to 91 per 1000 children, against the state average of 69.
Orissa health minister Prasanna Acharya said that they were trying to check the spread of malaria. “Of late, malaria cases are being detected successfully because we have used several methods. More vigorous campaign needs to be done to eradicate it completely,” Acharya said.
According to Acharya, vacancy of doctors is a vital problem, not only in Rayagada or KBK area but in the whole of Orissa. “Recently we recruited 408 doctors. All of them have been posted in KBK districts,” he said.