In Odisha, Tribal Communities Are Languishing Without Access to Basic Healthcare

03 October, 2016

Late at night on 23 August 2016, while the nation debated whether the Congress member and Kannada actor Divya Spandana, popularly known as Ramya, had committed a seditious act by saying, “Pakistan is not hell,” a tribal man in Odisha beseeched the staff at Kalahandi district headquarters hospital for an ambulance that could take his wife’s dead body home. Dana Majhi, a middle-aged labourer, lived in Melghar village at Kalahandi district’s Thuamul Rampur block, close to sixty kilometres away from the hospital. His wife, Amang Dei, who had been suffering from malaria and tuberculosis, had passed away sometime between 11 pm and 1 am that night. When the authorities at the hospital did not relent, Majhi quietly walked into the Malaria Ward. He asked his twelve-year-old daughter to collect their belongings in a gunny bag while he wrapped his wife’s body with old sheets from the hospital. Without waiting for a discharge receipt, Majhi hoisted the body on his shoulder and began the journey towards his house. His daughter walked beside her father, sobbing.

At around 5.30 am on 24 August, Ajit Singh, a reporter with Odisha TV, a local news channel, received a call from some of the residents of Sagada village who had seen Majhi and his daughter walking. Singh immediately left for the spot with his friend, Bikaash Sarangi, on a motorcycle. He reached the village, where he met Majhi, at 6.30 am.  By then, Majhi and his daughter had covered close to 12 kilometres on foot. “I requested everyone in the hospital, but no one listened. What option did I have other than carrying her,” Majhi told Singh. Singh called Brunda D, the district collector of Kalahandi, to ask her if she could arrange for an ambulance. Brunda told Singh to reach out to the chief medical officer instead. According to Singh, when he called the chief medical officer, he was told that the matter was being forwarded to the assistant district medical officer. Finally, Singh called a representative from a local trust called the Balaji Mandira Surakshya Samiti, who sent an ambulance at once. Pramod Khamari, the owner of a restaurant in Bhawanipatna, provided the funds for the vehicle’s fuel. Meanwhile, a video clip of Majhi and his daughter’s journey was broadcast on Odisha TV. Within hours, it was circulated widely, leading to outraged and incensed conversations across the country.

Majhi’s plight is not an exception in Odisha. On 18 September, according to a report in The Indian Express, the family members of Pana Tirika—a 65-year-old tribal woman who died at Jajpur district hospital—had to carry her body in a trolley-rickshaw. In March, a woman who was suffering from labour pains was carried from her village, Kalyansinghpur, to the hospital in the neighbouring Rayagada district on a charpoy because an ambulance did not reach her in time. A month later, in April, another patient from Kalyansinghpur was taken to the district hospital on a sling. In May, two young men carried the body of their relative from the Jharigan community health centre to Bharuamunda village, around 30 kilometres away, on a bike. They did not have enough money to arrange a vehicle. Sanjib Joshi, a reporter who works with Dharitri, a local daily, said, “It’s not uncommon to see tribal people carrying patients or dead bodies of their relatives in sling here because most of the time it’s not about money but unavailability of ambulance and the inaccessibility of the terrains.”

Melghar, the village Majhi is from, is in the Thuamul Rampur block. This block also consists of 16 other villages  that form a part of the 97 villages that were affected by the construction of the Indravati dam in 1999. Of the 97 villages, 65 were completely submerged and 32 remained partially affected after the dam was constructed.

The dam has reportedly displaced close to 17, 000 people, most of whom belong to Scheduled Castes and Scheduled Tribes. The 16 villages in Thuamul Rampur block are extremely vulnerable to floods, diseases and malnutrition as they are located within the Indravati reservoir. According to a report in the Times of India, around 1,860 people of the 340 families here live without electricity. The villagers, the report stated, “have to cross the river for salt and reach Talngangi gram panchayat, 15 km away.”

Regional publications have reported that Thuamul Rampur block has witnessed thedeaths of 21 tribal people, including four children, between 25 July and 12 August this year. All of those who died were suffering from preventable diseases such as tuberculosis, diarrhea and pnemonia. Kurukhetra Rout, a local journalist who works with Odisha TV told me that several deaths in the villages of Thuamul Rampur block often go unreported. “Many of the deaths occur in the anonymity and isolation of the forest, so there is no record with the district hospital. Melghar is one of the villages whose settlers still depend on the river stream for drinking water,” Rout said. Although several national newspapers claimed that 21 people have died so far, Rout told me that the records he had accessed indicated that there have been 17 deaths.

According to a story that was published in The New Indian Express on 8 August 2016, the National Vector-borne Disease Control Programme Unit of Bhawanipatna released a report which stated that 42,000 people had been tested for malaria at different hospitals in Kalahandi, the district under which Thuamul Rampar block falls, in July. Around 7,000 people were found to be suffering from the disease. Bhakta Charan Das, a former Congress MP from Kalahandi, told me that the ruling Biju Janata Dal government has failed to provide basic facilities such as water, electricity, education and health systems to the isolated villages in the district. He said, “CM Naveen Patnaik trusts a few bureaucrats close to him to deal with such crisis than on party workers or local politicians who could tell him the ground reality.”

A PhD dissertation published under the University Grants Commission, which studied the displacement of people because of the Indravati dam, stated, “Despite the large scale displacement of people from various state sponsored projects, no uniform and concrete state level resettlement and rehabilitation policy has been formulated by the Government of Orissa till 1994.” The report noted that the water resources department of the government of Odisha released a detailed resettlement and rehabilitation policy only in 1994, after “tremendous pressure from the World Bank, which is a major funding agency of various ongoing projects in Orissa.”  “In Upper Indravati Project,” the dissertation concluded, “resettlement and rehabilitation policy was formulated without proper database and sufficient investigation.”

Prafulla Samantray, an environment activist who works in Odisha, echoed these findings. He told me that none of the 16 villages in Thuamul Rampur block were offered a proposal for rehabilitation by the government. Members from the civil society, Samantray said, are still demanding that a commission be instituted by the Supreme Court to look into the displacement of forest dwellers.

In July 2016, The New Indian Express reported that asmany as 19 children from the Juang community had died of malnutrition in a span of four months at Nagada, a hilly village that is located in the Sukinda valley of Jajpur district, around 400 kilometres north-east of Rampur block.

Following the incident, the state Women and Child Welfare Minister Usha Devi reportedly blamed the community for the tragedy. “On the very first day,” she said, “had they come down from the hills, things would have been better for us.”  Going a step further when she spoke to the media on 20 July in Bhubaneswar, Devi said, “There is nothing called family planning” among tribal communities. She continued, “In some families, there are about eight-nine children. Even before a child completes one year, there is another child in the family.”

Shortly after the incident, the state administration sent anganwadi workers to the hills to mitigate the crisis. On 2 August, a five-member fact-finding team from the Union Ministry of Tribal Affairs (MoTA) visited the village. Arun Singh, a member of the team, said, “First of all, the state government has responded positively towards the problem in the region, which is clearly visible. There are some problems which are perennial to the whole country and some problems are acute. So I don’t think there will be a solution for everything in one capsule.” Meanwhile the government of Odisha is planning to implement development programmes such as creation of a market for forest products as a solution that would improve the standard of living for the community.  When I spoke to Biswanath Patra, a local activist and a stringer for Dharitri, on 30 August, he told me that the government had not initiated any immunisation programmes in the region.

The chromite-rich Sukinda valley is mined by Tata Steel along with several other mining companies. By 1990, Tata steel had been mining the entire area, spanning around 1,261 hectares of land—for forty years. In 1993, other companies such as Indian Metals and Ferro Alloys (IMFA), Jindal Strips and Ispat Alloys claimed their stake and dragged the government into the Odisha High Court to protest the repeated renewal of Tata’s mining lease. The court, in 1995, limited the area on which Tata Steel could conduct its mining operations from around 1,261 hectares to 406 hectares, which included 106 hectares of forest land.

According to Patra, the forest-dwellers in Sukinda valley are confronting a situation not unlike the one that the villagers in Thuamul Rampur block have been facing. The government has no rehabilitation policy for them, Patra said, even though one ostensibly exists on paper.

Around five years ago, Patra said, the government announced that it would rehabilitate the tribal people from Sukinda valley under the Indira Awas Yojna (IAY), now known as the Pradhan Mantri Awas Yojna. According to Amlendu Behera, a local Congress leader, soon after the scheme was implemented, “We got to know that money was released under the IAY to seven beneficiaries on paper, but not a single Nagada resident ever got it.” “In reality, not a single tribal person got a home, although on paper, the government shows three names at least,” Patra said.

Meanwhile, in Kalahandi, BK Brahma, the chief medical officer, blamed Majhi for embarrassing the state government by his actions. “Majhi disappeared from the hospital without intimating to anyone. The patient was neither discharged nor declared dead by the ward in-charge doctor,” Sharma claimed.

Late in August 2016, after Brunda D, the district collector, did not respond to any of my calls, I sent her a text message soliciting her reaction to the incident. “I was busy in urgent meeting,” she said, “And from morning I was answering all the channels of the phone calls but evn [sic] I was busy.” She continued, “When the incident came to knowledge, we have arranged ambulance and financial assistance.” Brunda’s version does not tally with that of Singh’s, the reporter from OdishaTV, who claimed that no official had arranged a vehicle for Majhi.

In February 2016, a picture of an unknown dead body that was being transported in a cart from the city hospital in Bhubneswar to a crematorium had created a similar furor after it was published in regional newspapers. Consequently, in February, the chief minister announced a scheme called Mahaparayan, under which mortuary vans would be provided for the deceased. The scheme was formally launched in August, after publications reported the plight of Majhi as he carried the dead body of his wife.

Under Mahaparayan, the state is supposed to have 40 hearse vans at 30 government hospitals across the state. According to Singh, a van under the scheme was allotted to Kalahandi district hospital as well. In fact, he said, there was a van at the hospital on the day Amang Dei died. But, Singh added, although vans had been dispatched after the scheme was announced in February, the procedure to procure one was unclear until August. Even when some clarity emerged, he said, the process was extremely cumbersome. The relative of the person who had died would have to first approach the additional district medical officer with a death certificate. If the officer approved, the application would then be sent to the chief medical officer and then to the district collector, who would decide whether or not a vehicle would be made available.

The government of Odisha has notified 119 blocks across 13 of its 30 districts as being occupied by tribal people. Most of these blocks are located deep in the jungles or on the hills, cut-off from not just the mainland, but also the healthcare facilities that they have long been promised.