Covid-19 Deepens Healthcare Nightmare For Adivasis
By - Sushmita (thethirdpole.net)
As the Covid-19 pandemic ravaged the world and employment opportunities dried up, in many countries including India, indigenous people returned to their intergenerational, ancestral homes, often situated near forests.
In the course of the reporting of this story, many of the Adivasi (indigenous) community workers from Jharkhand echoed one sentiment: “If at all we have to die, it’s better to die among our loved ones.” India announced a nationwide lockdown on March 24. Within a few days of the announcement, the distress among the communities on the margins of society was palpable. Even as indigenous people made long journeys home, some were beaten to death simply for attempting such arduous travel, while others could not finish the trip at all. In one of the most chilling incidents, a 12-year-old girl Jamalo Madkam from Chhattisgarh fell dead from exhaustion just 11 kilometres short of her Bijapur home after having walked 100 kilometres. Despite the immense hardships that indigenous communities faced as a result of the stringent lockdown, the first response to their distress did not come from the Ministry of Tribal Affairs (MoTA) or the Ministry of Health. Instead, it came from the Ministry of Environment, Forests, and Climate Change which, on April 6, restricted people from entering protected forests on the grounds of human to animal transmission, despite there being little scientific evidence of any such transmission possible. In fact, highlighting a major blunder which hurt Adivasis and forest communities, reports suggested that MoTA minister Renuka Singh may have quoted from a non-existent study. MoTA had earlier said that less than 3% of the indigenous population was impacted by the Covid-19 pandemic. Limited Access To Healthcare Adivasi communities who are already victims of neglect when it comes to rights, recognition and state support suffered even more during the pandemic. The National Family Health Survey (NFHS) 2015-16 points to some grim statistics for the health of Adivasi communities in India.
Some of the biggest problems that Adivasis faced in accessing healthcare were concerns related to unavailability of drugs and providers (56.5% and 54.9% respectively) followed by concerns of absence of a female provider (45%). This was closely followed by issues of distance to health facilities (42%) and lack of transport (40.9%).
Overall, as many as 76.7% Adivasis faced at least one big problem in accessing health care facilities.
Despite policymakers agreeing that there is no comprehensive policy for indigenous healthcare, a solution based on reliable data is still absent.
Poor Data, Grim Prospects
An expert committee set up by the two ministries responsible for health and family welfare of tribal rights, in 2013 had studied the health issues, culture, and the extant healthcare infrastructure in scheduled areas and sought a way forward through consultation.
They published their findings in 2018, after four years of research. Though the report titled ‘Tribal Healthcare in India: Bridging the Gap and a Roadmap for the future’ noted that “tribal people face triple burden of diseases”, it also noted that there is no single source of data available about indigenous populations to create a countrywide disease burden profile.
They did, however, find that indigenous people bear a “disproportionate burden” of communicable diseases, including diseases like tuberculosis and malaria.
As many as 30% of all malaria cases are reported among Adivasis, who also account for 50% of the mortality associated with malaria even though they account for only 8% of the population.
An Indian Journal of Medical Research (IJMR) paper traces the reasons for this, saying: “The presence of various malaria parasites and vector species, climatic diversity favouring growth and proliferation of the parasite and vector as well as a highly susceptible human population have resulted in high malaria transmission in tribal areas”.
Alarmingly, the death rate among indigenous communities is 703 per population of 100,000 against a national average of 256. Only 11% of these cases are treated.
(A tribal healer is curing a baby by agitating bhel leaves in front of him. All of the people belong to the Bhil tribe [image: Alamy])
Given the severe shortage of healthcare professionals in Adivasi-dominated areas, the report suggested the need to motivate and train local people, especially Adivasi youth, to join the healthcare workforce.
About the presence of frontline workers like the Accredited Social Health Activists (ASHAs), the report had noted that “no numbers are available as to the density of ASHA workers in tribal areas or the average number of people covered by them.” It added that, in these areas where there is little trust in the health systems, they could play a crucial role.
Deplorable Quarantine Quarters
As migrant workers returned to their home states, Covid-19 cases spiked, especially in Adivasi-dominated areas. This trend also coincided with the relaxation of the lockdown in various states.
Rajim Kewas, a resident of the Khair Khuta village in the Mahasamund district, Chhattisgarh, described the conditions at the centres where the returning workers were being quarantined. “The quarantine centres are in deplorable condition. There is no arrangement for water, nor are there toilets or food. As a result, their family members had to supply food from their homes in a clandestine manner.”
Kewas said this led to people falling sick due to a lack of care and nourishment.
She painted a grim picture based on her visit to the Khair Khuta quarantine centre. “We could see that there were snakes and lizards. The khapra (roof) was broken and water was dripping. They were not getting food nor sleep. Those in quarantine centres were kept like prisoners.”
Kewas added that “no one was checking on the pregnant women and children suffering from malnutrition” so “[they] suffered even more”.
“Because of fear, people didn’t want to go to the mitanis [a term used in Chhattisgarh for ASHAs],” she added.
The Community Fends For Itself
Given the lack of an existing, robust health network and the absence of governmental support, many indigenous communities over the years have resorted to various coping mechanisms.
One example is that of the Bhot community in the Spiti Valley town of Kaza, in northeast Himachal Pradesh.
The region experiences harsh winters with night temperatures dropping to 25 degrees Celsius below zero. Because of its remote location, access to healthcare is a major issue here. Close to 10% of the total indigenous population of Himachal Pradesh stays in the Lahaul and Spiti district, including other communities like Lahaulas, the Lambas, the Swanglas, and the Khampas.
In the course of the reporting of this story, many of the Adivasi (indigenous) community workers from Jharkhand echoed one sentiment: “If at all we have to die, it’s better to die among our loved ones.” India announced a nationwide lockdown on March 24. Within a few days of the announcement, the distress among the communities on the margins of society was palpable. Even as indigenous people made long journeys home, some were beaten to death simply for attempting such arduous travel, while others could not finish the trip at all. In one of the most chilling incidents, a 12-year-old girl Jamalo Madkam from Chhattisgarh fell dead from exhaustion just 11 kilometres short of her Bijapur home after having walked 100 kilometres. Despite the immense hardships that indigenous communities faced as a result of the stringent lockdown, the first response to their distress did not come from the Ministry of Tribal Affairs (MoTA) or the Ministry of Health. Instead, it came from the Ministry of Environment, Forests, and Climate Change which, on April 6, restricted people from entering protected forests on the grounds of human to animal transmission, despite there being little scientific evidence of any such transmission possible. In fact, highlighting a major blunder which hurt Adivasis and forest communities, reports suggested that MoTA minister Renuka Singh may have quoted from a non-existent study. MoTA had earlier said that less than 3% of the indigenous population was impacted by the Covid-19 pandemic. Limited Access To Healthcare Adivasi communities who are already victims of neglect when it comes to rights, recognition and state support suffered even more during the pandemic. The National Family Health Survey (NFHS) 2015-16 points to some grim statistics for the health of Adivasi communities in India.
According to the NFHS report:
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Some of the biggest problems that Adivasis faced in accessing healthcare were concerns related to unavailability of drugs and providers (56.5% and 54.9% respectively) followed by concerns of absence of a female provider (45%). This was closely followed by issues of distance to health facilities (42%) and lack of transport (40.9%).
Overall, as many as 76.7% Adivasis faced at least one big problem in accessing health care facilities.
Despite policymakers agreeing that there is no comprehensive policy for indigenous healthcare, a solution based on reliable data is still absent.
Poor Data, Grim Prospects
An expert committee set up by the two ministries responsible for health and family welfare of tribal rights, in 2013 had studied the health issues, culture, and the extant healthcare infrastructure in scheduled areas and sought a way forward through consultation.
They published their findings in 2018, after four years of research. Though the report titled ‘Tribal Healthcare in India: Bridging the Gap and a Roadmap for the future’ noted that “tribal people face triple burden of diseases”, it also noted that there is no single source of data available about indigenous populations to create a countrywide disease burden profile.
They did, however, find that indigenous people bear a “disproportionate burden” of communicable diseases, including diseases like tuberculosis and malaria.
As many as 30% of all malaria cases are reported among Adivasis, who also account for 50% of the mortality associated with malaria even though they account for only 8% of the population.
An Indian Journal of Medical Research (IJMR) paper traces the reasons for this, saying: “The presence of various malaria parasites and vector species, climatic diversity favouring growth and proliferation of the parasite and vector as well as a highly susceptible human population have resulted in high malaria transmission in tribal areas”.
Alarmingly, the death rate among indigenous communities is 703 per population of 100,000 against a national average of 256. Only 11% of these cases are treated.
(A tribal healer is curing a baby by agitating bhel leaves in front of him. All of the people belong to the Bhil tribe [image: Alamy])
Given the severe shortage of healthcare professionals in Adivasi-dominated areas, the report suggested the need to motivate and train local people, especially Adivasi youth, to join the healthcare workforce.
About the presence of frontline workers like the Accredited Social Health Activists (ASHAs), the report had noted that “no numbers are available as to the density of ASHA workers in tribal areas or the average number of people covered by them.” It added that, in these areas where there is little trust in the health systems, they could play a crucial role.
Deplorable Quarantine Quarters
As migrant workers returned to their home states, Covid-19 cases spiked, especially in Adivasi-dominated areas. This trend also coincided with the relaxation of the lockdown in various states.
Rajim Kewas, a resident of the Khair Khuta village in the Mahasamund district, Chhattisgarh, described the conditions at the centres where the returning workers were being quarantined. “The quarantine centres are in deplorable condition. There is no arrangement for water, nor are there toilets or food. As a result, their family members had to supply food from their homes in a clandestine manner.”
Kewas said this led to people falling sick due to a lack of care and nourishment.
She painted a grim picture based on her visit to the Khair Khuta quarantine centre. “We could see that there were snakes and lizards. The khapra (roof) was broken and water was dripping. They were not getting food nor sleep. Those in quarantine centres were kept like prisoners.”
Kewas added that “no one was checking on the pregnant women and children suffering from malnutrition” so “[they] suffered even more”.
“Because of fear, people didn’t want to go to the mitanis [a term used in Chhattisgarh for ASHAs],” she added.
The Community Fends For Itself
Given the lack of an existing, robust health network and the absence of governmental support, many indigenous communities over the years have resorted to various coping mechanisms.
One example is that of the Bhot community in the Spiti Valley town of Kaza, in northeast Himachal Pradesh.
The region experiences harsh winters with night temperatures dropping to 25 degrees Celsius below zero. Because of its remote location, access to healthcare is a major issue here. Close to 10% of the total indigenous population of Himachal Pradesh stays in the Lahaul and Spiti district, including other communities like Lahaulas, the Lambas, the Swanglas, and the Khampas.
(Spiti can be beautiful in the winter, but the conditions are harsh [image by: Nawang Targay])
These communities, the Bhots in particular, were successful in keeping Covid-19 at bay for long by practicing rigorous self-isolation. Only recently have some Covid-19 cases been detected. As Takpa Tenzin, a 37-year-old social activist and president of the Spiti Civil Society, put it “There is a health clinic (CHC) in Kaza and there are primary healthcare centers (PHCs) at the village level. But we don’t have any specialists or surgeons. Even to get an ultrasound, we have to either go to Shimla or Rampur, both at a distance of more than 450 kilometres.”
(Taking care of both themselves and their animals is difficult in Spiti [image by: Nawang Targay])
“The problem is that even if we get a doctor appointed by political pressure, the doctors also don’t want to come to these areas. They resign and join a private facility or apply political pressure to go somewhere else.” Postings in Adivasi majority areas are seen as “punishment” postings. Tenzin laments that while the government says that it will provide helicopter services, even basic services are not available. The residents of Kaza were extremely worried as they had heard about the spread of the disease. They feared that, if Covid-19 infections spread in the community, there would be “great trouble as health services are not at all up to the mark”, said Tenzin. People migrate to warmer areas like Dharamsala, Dehradun, etc. in the winter as the extreme weather conditions are difficult for the elderly and the children to endure. The period of lockdown in March coincided with their return. Strict quarantining measures were adopted by the community to protect themselves. “It was only after some weeks passed that the administration hired a vehicle and started taking people to Simla for testing. We didn’t have ventilators and it was only provided after pressure from the local community here.” The population of Lahaul and Spiti districts is around 31,000. In the scenario of a community spread one ventilator would not suffice at all. “Even the government seems confused – sometimes they enforce the lockdown, sometimes they lift it. Sometimes they ask us to use N95 masks, sometimes they say that the masks are not effective.” Tenzin thinks that such mixed messaging is not helpful for remote communities as the flow of information is already restricted and difficult. “Pregnant women have to leave for Simla two to three months before their due date. So how would we have travelled during Covid-19? We are aware of the situation of health facilities in the rest of the country, compared to which the situation in areas where indigenous people live is worse,” he added. To read the complete article, click here.Latest Videos
