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Stress is killing the state's tribals

Lifestyle diseases are no longer the preserve of white-collar corporates. The acutely poor tribals of Melghat, a hamlet 850 kilometres from Mumbai, are suffering from hypertension caused by anxiety over their one square meal it's neither enough, nor nutritious

While city slickers associate the term 'lifestyle disease' with white-collar affluence and an urban preoccupation with sedentary careers, 850 kilometres from Mumbai poverty-stricken tribals are discovering that their sorry lives are not immune to such diseases either.

A Melghat infant eats a meal of Jowar Roti and Chilli Chutney. The tribals are too poor to afford vegetables or fruits, and the high percentage of salt in their staple meal, causes health complications.


Stress and hypertension are rampant among the 320 tribal villages spread in an area of over 4,000 sq kilometres, found Dr Ashish Satav, a physician, and his opthalmogist wife Dr Kavita Satav, who have been serving the area for 13 years and also run an NGO named MAHAN and Kasturba Health Society.
 
The duo conducted an extensive research in the area, probably the first of its kind, which threw up these startling revelations.

Sadly, the cause of these diseases among the tribals is the lack of food. The tension of not getting a meal the next day makes them fall prey to these illnesses.

Stressed about food
Satav says, "Death rates in the age group of 16-60 years are very high. Annually, there are 300 deaths per one lakh population. Children below the age of 5 years also have a high mortality rate of over 100 deaths per 1,000 live births, annually. Entire families have been orphaned by these premature deaths that affect the entire community."

He reels off some more depressing statistics. Over 90 per cent of the families depend on a paltry daily wage of Rs 100 to 120, earned from farms in the area.

Nearly 80 per cent of the villages do not have electricity and even areas that have power supply, face load shedding of 16 to 18 hours daily. The poor voltage during the few hours of electric supply that the villages get is about 100 mv to 120 mv, which is not sufficient even to run a pump to water the fields.

According to Satav, the survey covered 80 villages and took inputs of over 6,000 households. Most villagers were suffering from lifestyle diseases like stress and hypertension due to the lack of medical aid and the unavailability of life-saving medicines.

Even today, 20 per cent of the children up to 5 years are highly malnourished. The prevalence of protein energy malnutrition is over 75 per cent, and the prevalence of severe acute malnutrition is over 10 per cent.

"Since farming is their basic occupation and they usually grow rice, jowar and soyabean, most farmers work for six to seven months.

During the remaining four months (between Diwali and Holi), they are jobless and the constant worry about the next day's meal makes them fall prey to tobacco, alcohol and ganja/charas addiction," Satav explains.

Too much salt
The villagers are so poor that they cannot even afford regular vegetables or fruits in their diet. "This is a major health concern, as they have to depend on a high intake of salt and chillies for eating jowar roti and plain rice."
If that wasn't all, pregnant mothers do not get the nutrition they require, especially in the last trimester, and neither do their newborns.
 
Drinking water too, is a serious concern, as none of the villages have water taps connected to their houses, and have to depend on community water taps or walk two kilometres to get water from rivers.

"The lack of hygiene causes various water-borne and infectious diseases like diarrhoea, pneumonia, malaria, tuberculosis, and scabies," he adds.

What inspired the study?
"Nine years ago, a 20 year-old lady was brought to our hospital in a comatose condition with brain stem damage. A clinical examination and her history suggested Puerperal Sepsis with Encephalopathy (a potentially deadly infection contracted during childbirth, accompanied by an affliction of the brain).

The sight of her 8-day old newborn baby depressed me. She could not be saved because it was too late. If she had been brought to the hospital even seven days earlier, we could saved her life and the baby would not have been orpaned," he recalls.

This was followed by another case of a 40 year-old man who died of extensive pulmonary tuberculosis, a 23 year-old lady who succumbed to AIDS with TB, and a 38 year-old man who died of Acute Myocardial infarction (a heart attack).

In all these cases, the dependents in the family were orphaned. One man died of oral cancer due to tobacco chewing at the age of 30, leaving his young wife and 3 children helpless.

"All these deaths shook me a lot. That's when I decided to do intensive work in the area of village-based health care," he explains.

What MAHAN and Kasturba Health Society are doing
> The study has revealed that lack of health education is the major cause of the tribals' health problems. They have conducted 2,000 health education programmes for more than 33,000 people, and increased the incidence of hospital deliveries.

> The NGO trained 17 village health workers (VHW) for treatment of children under the age of 5. More than 81,000 individuals were given free treatment in the villages starting May 1, 2005. "We could reduce malnutrition by 60 per cent, and mortality in the productive age group of 16-60 years by 25 per cent over five years, which is a cost effective, acceptable and replicable model," says Satav.

> The Kasturba Health Society will start a 50-bed maternal and child hospital in January 2012, which will be the first such hospital in the area.

Findings of the study

> Prevalence of hypertension is seen in patients as young as 20 years
> Maternal mortality (death of mother) due to home deliveries is over 70 per cent
> Respiratory tract infections like tuberculosis and pneumonia are major killer of adults and children
> Iron deficiency leading to anaemia is seen in 80 per cent of the women

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