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Hunger & games




Every year, Khalwa in MP hits the headlines for malnutrition deaths. Bagish K Jha and Rashmi Chouhan visit the block and find that with both food and water scarce, villagers are struggling to survive. Can an administration in denial wake up in time?

Sleepy Khalwa has this uncanny knack of hogging national headlines almost every year. Its claim to fame is hunger, the kind that leaves desperate men and women on the edge of survival and kills over a hundred children every year, if field-level state officials, who spoke on condition of anonymity, are to be believed.

Government records say 125 children died there last year and 148, the year before. But the records also state that they died of either tuberculosis or kidney failure. Starvation or malnutrition deaths are evidently a political issue, but TB and kidney failure are medical causes that can be ignored.

Doctors fault this logic. "Malnutrition weakens the immune system of children and they then easily fall prey to infections like TB and die. When a child is hungry for long, the kidneys can also give away. So the deaths goes into records as due to kidney failure and/or TB, " says a local doctor. "I would say 95 per cent of child deaths in Khalwa are from malnutrition. But it is never, ever, mentioned as the cause for death. "

There is another reason Khalwa does not report precise numbers. In critical cases, says Manish Jaiswal, the president of a local NGO, Jeevan Dhara Seva Samiti, children are referred to the Khandwa district hospital or to Indore hospitals. If death occurs at these centres, they are not entered in Khalwa records.

With so much morbidity and hunger, and too little money to sustain a viable medical practice, quacks thrive here. Khalwa has some 300 "jhola chhaap doctors" (quacks), many of who may be even contributing to the appalling mortality figures. "They administer injections and give high doses of antibiotics to malnourished children that often prove fatal. Deaths at their clinics are not recorded anywhere, " says Jaiswal.

Block health officer (BHO) Dr Shailendra Kataria claims the sarkari health campaigns have helped create some awareness, but admits "a lot more needs to be done". The BHO accepts that children do die of malnutrition in his block but insists that their numbers have been coming down of late. "A few months ago we surveyed and identified 1, 737 malnourished children in a block, of whom 477 were critically malnourished and were on the verge of death. They were immediately admitted to the Nutritional Rehabilitation Centre (NRC). Most of them were saved, " says the doctor.

The district collector of Khandwa, Kavindra Kiyawat, admits that malnutrition does exist but hastens to add that conditions have been improving. "People are very orthodox and not very willing to bring their children to the NRC. We are conducting campaigns and programmes (to create awareness), but it will take time before things change, " says Kiyawat.

Welfare and employment generation schemes, including the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), have done little for Khalwa. Most villagers go off to Gujarat and Maharashtra, leaving behind hungry relatives and cattle. It makes sense for the villagers to migrate - they get Rs 200-300 for working in fields or as labourers whereas MGNERGA gets them only Rs 120. Old men and women, who cannot join their migrating kin, sit around in quiet groups, awaiting the return of a son or grandson.

The local zilla panchayat member Bhiayalal Palbi says their return usually takes months. "People start migrating after Holi and come back just before the monsoon when they can't find any work there. "

Mangulal, of the local Kurku tribe, is angry that few have been getting work under MGNREGA for months now. Those who did were not paid, he alleges. "So we just have to move elsewhere in order to survive. I am going to Maharashtra soon, " he says.
The mass migration also adds to the worryingly high malnutrition levels. "People take their children with them but cannot look after them while they work. The children are not properly fed and they end up getting even more dangerously malnourished, " says Palbi.

"The number of children admitted to the NRC goes up significantly after each monsoon, especially from July to October, " says Samita Rajkar of NRC, adding that from April to July, the numbers are generally low, simply because most of the children will have left the villages with their parents.

Kamleshwari Bai of Aangarwadi said that in many cases parents leave small kids at the mercy of their older children, who are just not able to take care of them. "People are too poor to afford two meals a day. So how will they ensure nourishing food for the children?" she asks.

The migration season has just begun. In the remote village of Karwani in Khelwa block there is a deathly quiet of hopelessness. Holi gulal is yet to fade from a few sunken cheeks but there are no smiles. Almost all families have just sent off a member or two to bordering districts of Maharashtra or to the Hoshangabad side of MP.

Forget food, even water is a tough call in Karwani, Karwanimal and Khadi villages of the Khalwa block. Since drinking water is itself scarce, a bath is a huge luxury. Around 225 families of three villages, comprising close to 1, 000 people, have only a single creaky hand pump, to drink from.

At least two to three members of every family here need to bring water for their household use. Women trudge under the searing sun for 2-4 km, to fetch each pitcher of precious water. This has not only affected their daily life, but their incomes as well.

"Two people in each family are engaged in bringing water in pitchers balanced on their heads, everyday. They cannot work, and can earn nothing, " says Rajal Bai of Karwani village. Rukmani, a 14-year-old who fetches water for her family everyday, says she avoids repeated trips to the pump by balancing three pots on her head.

Sajjulal Fatu Patil of Karwanimal village said the water level in the area has dropped and only one hand pump is in working order. "We pleaded with the panchayat and the administration, but nothing has been done, " says Patil. Mechanical deep drilling is too expensive for these villagers.

Collector Kiyawat said he will soon send a team to those villages to find a solution. But most of the villagers are resigned to their fate. Kusum, who is eight-months pregnant, is busy rustling up some "chawal aur sabzi" for dinner and is worried about what lies ahead.

"We have no water to grow vegetables in the backyard and prices are soaring. Even the lowest quality of rice costs Rs 12 per kg, " she mutters. This year, her family had even tried to cultivate some paddy but the erratic rains killed their crop.

The public distribution system is ineffective here. Despite a BPL card, Kusum's family gets only kerosene at the ration shop. But they have no complaints, since they don't know what to expect. Kusum had not even heard of MGNREGA, or about state-supported medicare. "Ghar par hi hoga (I will deliver at home), " says Kusum, who is to give birth to her fourth child and the ninth member of the family.

There are now only 26 children admitted at the NRC in Khalwa block;where there would have been hundreds otherwise. As one-year-old Siksha playfully loiters in the vicinity, weaker children lie mute and exhausted on their mothers' lap. Thanks to the aanganwadi staff, Shiksha managed to get back on her feet after being fed nutritional supplements for 14 days.

Quite often, superstitious tribals resort to black magic and sorcery to "cure" themselves. Then there are the quacks locally called "Bengali babus".

So frequent are infant deaths in this region that they have even stopped causing emotional distress. Local NGO workers quip darkly that having many children is the only insurance against losing them to malnutrition. The Kurku tribe, with the highest incidence of malnutrition, has an average of six to seven children per couple.

Dr Kataria says that the death of a child in this area treated with callousness. "Only vasectomy can check the number of children in a family so that they can be fed properly, " he says. "In the last three years we had vasectomied 7, 500 couples, which probably saved the lives of hundreds of children. " This year, the number so far is 2, 551 couples.

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