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Tragic cocktail of bad health care, superstition for MP’s tribals

By, Shahdol
Feb 14, 2024 03:06 AM IST

In 2023, the women and child development department identified 11,774 vulnerable families which had considered branding their children as a medical practice

This could not be happening again. It was the middle of November, and in 22-year-old Ganeshiya Baiga’s arms, her three-month old Ragini daughter was shivering — breath drawn sharply, eyes fluttering, body fading. Ganeshiya’s mind flashed back to another baby who was once motionless in her arms; her six-month-old son had died after he fell into the village well. This could not be happening again.

A slogan warning people against branding written across a house in Shahdol. (HT PHOTO) PREMIUM
A slogan warning people against branding written across a house in Shahdol. (HT PHOTO)

She looked for help, but there was none. It was early afternoon, and her husband, like every other male member of the tribal Patasi village in Madhya Pradesh’s Shahdol, had left home early to earn his daily wage. She glanced around her thatched home for something that could alleviate her daughter’s pain. The floor was bare, the kitchen sparse; and no possibility of any medicines.

She thought briefly of the sub-health centre (SHC) at Kotma, 9km away, but experience told her that was rarely useful. There was the medical college in Shahdol — the district headquarters —15km away, but there was no money for transport. Travelling to the city without her husband was out of the question anyway; the village would not allow it.

Ragini had pneumonia, not uncommon among young children. And as her condition deteriorated, Baiga decided on an option often exercised in tribal Madhya Pradesh because of a potent cocktail of superstition and inaccessible primary health care an option that may not always cause death itself, but can delay proper medical attention until it is far too late.

Ganeshiya took her daughter to be branded.

The young child clutched tightly, she ran, arriving at the home of her 67-year-old grandmother, Tirji, in Kotma. Tirji is a “vaidya”, the local word for an unregistered medical practitioner. Tirji did what she had done many times before. She brought out an old sickle, and set it next to a flame. Then, 50 times over, as the child cried out, she branded Ragini, the tell-tale scar from burnt skin spreading its tentacles across her stomach.

Ironically, on a wall next to the house, are two sentences in scraggly government graffiti in Hindi: “Pet dagna hai abhishap, kabhi na karen aesa paap”(branding stomachs is a crime, never commit such an evil).

Ganeshiya lived with her grandmother for a few days, watching over her daughter. But Ragini did not get better. On December 3, they rushed her to the sub-health centre, which sent them to the Shahdol medical college. It was too late — she died two days later.

That day, Ragini became one of the seven young children to die after branding in Shahdol in two months. In 2023, the women and child development department identified 11,774 vulnerable families which had in responses to a government survey, considered branding their children as an accepted medical practice. They were all asked to sign a resolution that they would refrain from doing so, and would go to a registered doctor instead. One of those signatories was Ganeshiya.

Dagna, Shahdol and the failing health infrastructure

A district on Madhya Pradesh’s eastern tip bordering Chhattisgarh, Shahdol is racked by poverty. The Madhya Pradesh state planning commission characterises it as a district which has more than 50% of the population above the state average in terms of poverty. 44.7% of its population is tribal, and according to NFHS-5, 44% children of its children are stunted and 57.3% anaemic.

This data illustrates a lived reality, for in tribal blocks that have Baiga and Kol populations, both tribes classified as particularly vulnerable tribal groups (PVTG), “dagna” — or branding — is rampant. In village after village, there are vaidyas who profess to have the ability to cure a range of illnesses from diarrhoea to pneumonia, from jaundice to typhoid.

Shad Ahmed, a local activist who works with the state health department said that the problem isn’t just limited to branding. “Two years ago, I saw a case where a child afflicted with tuberculosis was being treated with blood extracted from an earthworm. The principle reason behind these practices is rampant superstition that exists in the vacuum left behind in the absence of government health care,” he said.

At Hardi village in Sohagpur, for instance, 72-year-old Booti Baiga, the lines on her face drawn with age, speaks with a sense of pride. Over the years, she has branded scores of infants, and she refuses to believe that the practice could be harmful. “Dagna makes the children strong. People come to us because our treatment is free, quick and successful. We have always acted this way, but they call us criminals,” Baiga said.

At 1pm on January 5, 22-year-old Amasiya Baiga from Kathar village stood outside the Paediatric Intensive Care Unit (PICU) at the Shahdol medical college, her one-and-a-half-year old daughter Ahana battling for life inside. She was beside herself with worry and anger, facing a volley of questions from medical staff who told her she had come far too late. Amasiya told them that she had spent months attempting to get Ahana treatment at the community health centre in Manpur, close to her village. “Both my husband Deepu and I work as labourers but I stopped working after Ahana was born because she was so weak. I kept taking her to Manpur but there was no improvement. The doctor told me they didn’t have the medical facilities to treat her for pneumonia. On January 1, my family called the vaidya who branded her. She got even worse so we brought her here,” Amasiya said.

The village is 56km away from Shahdol, so even if treatment is free, travel is an out-of-pocket expenditure that pinches the poorest. “We came here in an ambulance, but if we want to go home, we have to hire an auto-rickshaw which is 200 either way. We only earn 300 per day we get on our construction sites, so every day we come here we lose the wage that feeds the rest of our family,” Rinki said.

Five days later, Ahana was dead.

Overall, senior district officials admit that the district has 263 health centres at the primary level, that should have a total of 657 staff. “Against these vacancies, all we have is 391 people and that affects our services,” a senior official said.

Kotma, for instance, is a large village that has a population of over 6,000, and has an SHC. But when HT visited the SHC on January 5 at 10am, auxiliary nurse midwife (ANM) Kiran Singh Paraste was the only one there. Inside were two small rooms that only had stray antibiotics, paracetamol and iron tablets, and a rarely used blood-pressure machine.

Paraste said that since ANM’s are meant to be stationed at the SHC, this doubles up as her home. Asked about the death of Ganeshiya’s daughter, she said: “She was not registered here, so we didn’t have information. The only thing we can do is regular check-ups of pregnant women and vaccination programs. We can’t treat anyone and refer them to the district hospital or medical college.”

But the tribal community has a name for the Shahdol medical college, the largest government health facility in the district. They call it “juta-chappal hospital”.

“Whenever we are sent there, they send us from one room to another. Someone asks for a slip, and then someone else takes that slip and asks for another. They don’t care about treating us. They only keep shouting at us to remove our slippers,” said 47-year-old Rajani, who’s two month old grandson was branded in Hardi, but has thus far survived.

Dr Milind Shirilkar, head of the medical college, said that their processes were far from complicated, but admitted that tribal villagers who arrive do struggle to find their way around. “They lack faith in us but that is also because families come to us after the condition of their children has already deteriorated. We do not have a help desk yet, but are working on measures to improve things,” he said.

Government intervention and path forward

Between February 2018 and February 2022, the Shahdol divisional commissioner formed district task forces in Shahdol, Umaria and Anuppur to identify children who had been branded; task forces which found that in the four-year period, over 2,000 infants had undergone the practice, and of them, 55 had died. Shubham Singh, a journalist based in Shahdol, and a member of the district’s six member task force said, “We went door to door and documented these 2,000 cases. In the absence of this, the health and WCD departments had no true picture of the scale of the problem. In 2022, there was some fall in the numbers to 30 but in 2023 they have risen again to at least 50 cases.”

A senior women & child development (WCD) department official said that the problem was persistent because behavioural change was a challenge and required focused multi-agency initiatives, which have not been forthcoming so far. “We have asked the police to prosecute under section 75 of the Juvenile Justice Act (punishment of cruelty to child) but instead they act under the Drugs and Magic Remedies Act which is much weaker. The Rashtriya Bal Swasthya Mission is empowered to hold monthly camps to create awareness and take doctors to villages to increase trust, but this barely ever happens,” the official said, asking not to be named. The maximum punishment under section 75 of the JJ Act is three years in jail, but for the Drugs and Magic Remedies Act is six months.

Health activist Shah Ahmed identified another problem with the information dissemination strategy. “They write on walls and paste posters, but most vulnerable families struggle to read. They don’t print posters that have pictures. Just taking thumb prints on resolution letters and writing walls makes no difference,” he said.

Shahdol superintendent of police Kumar Prateek said that while they act on complaints based on the Drugs and Magical Remedies Act, and seven FIRs have been registered in 2023, it was difficult to proceed against the accused— in many cases the immediate families of infant victims. “The court only punishes when intent is criminal, but here intent is a gray area. Additionally, when we conduct post mortems, branding is rarely the direct cause of death. It is often pneumonia or the illness that the child suffers from. How does one prove that in court?” he said.

Amulya Nidhi, convener of the Jan Swasthya Abhiyan said that what is needed is a separate allocation that deals with the issue such as government aid that covers for out-of-pocket expenditure for trips to hospital. “This can come from collaborations with organisations like the Red Cross,” he said.

Megha Pawar, member of the state commission for protection of child rights said that the body was going to coordinate with the health and WCD departments and organise awareness camps every month that will see counsellors speak to villagers about the dangers of branding.

Back at Patasi, Ganeshiya is glass-eyed, fatigued by the tears that have run dry, and the blame that comes from every conversation around Ragini’s death. She has stayed on her haunches, her head bowed for close to two hours. Suddenly, she rises, folds her hands, and clasps them atop her head. Thus far, she spoke in barely a whisper. Now, she screams. “They say go to the hospital, but my husband wasn’t here. They say go to the hospital, but what will we eat if we don’t earn. We went to the hospital. I have no children left.”

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