Over the past fortnight, the narrow streets that snake through the lush, green Sahyadri slopes and over gurgling streams in Mokhada taluka of Palghar have suddenly turned busy. High-end cars and police vehicles zip through these roads, trucks carrying bags of rice and small pouches of dal park themselves on the roadside and villagers queue up to get their share after sitting through political speeches.
Villages in Jowhar and Mokhada talukas, which fall in the eastern part of Palghar and are tucked between Mumbai and Nashik, have, over the past week, hosted senior ministers, health officials and social workers who have descended in large numbers to supply food.
But this cascading effect of the four malnutrition deaths reported in Palghar since August 30 appears both surprising and misplaced. To begin with, Palghar has recorded 82 child deaths in August alone; each death directly or indirectly linked to malnutrition. What this frenzied reaction to four deaths also overlooks is a critical point that experts tracking the issue for years have been trying to explain: Palghar’s malnutrition problem is a perennial one and cannot be fixed with nutritious food alone.
Numbers and perspective
Rajyashri Madhukar Malak, a mother of five, works as a daily wager with her husband and is barely able to feed her children. Last week, she sat outside the rural hospital at Mokhada with her youngest child, who was admitted there only the previous night. “He is malnourished,” she says, holding her frail son.
Rajyashri’s son was among the 22 children admitted overnight in the hospital’s children’s ward that has a fresh coat of paint and bright Tom and Jerry posters plastered on the walls. Another 12 children were admitted to a hospital in Jowhar taluka. Many admissions were from Khoch village, where two-year-old Sagar Wagh’s death due to malnutrition on August 30 drew attention to a problem plaguing these parts for years. Steaming meals of rice, dal and bottle gourd were served at lunch time to the families, even as senior health officials from Mumbai and Pune took stock of the children’s medical condition.
Doctors said these children were admitted as they fell in the severe acute malnutrition (SAM) category.
About 35 km from Mokhada rural hospital is Bhospada village, where an acutely malnourished Rijesh Malak was just discharged from hospital. At the age of six, he weighs 11 kg. “But he struggles to eat. The doctor said he is too weak to swallow food,” his mother Sangeeta says.
The problem is serious: Officials confirm there are 4,900 children in the SAM and MAM (moderate acute malnutrition) categories in Palghar. Between April and August this year, 208 children have died: that’s over 40 deaths on average every month. The district has recorded 400 to 500 deaths on average every year since 2013. Officials are busy extracting data from the eight talukas of Palghar from when it was part of Thane district (till August 2014), pointing out that the problem was there all these years, but got camouflaged by the overall Thane figures.
“Palghar is at the bottom of the ladder in terms of number of deaths vis-à-vis the population. In numbers, the most deaths due to malnutrition would be at Nandurbar. But my immediate concern is to save these 4,900 children in Palghar,” says Vinita Ved Singhal, Commissioner of the State’s Integrated Child Development Scheme (ICDS). Post medical intervention, a diet improvement plan is needed for these children, she says.
But 80 deaths in August alone are reflective of a bigger concern: numbers peak during this time of the year, every year, when villagers return from the cities they migrate to for daily wage work. “People move to Thane, Mumbai, Nashik for daily wage work and are out of our network [of anganwadis] during this time,” says Nidhi Choudhari, CEO of Palghar Zilla Parishad. She draws out the pattern in the four deaths reported since August 30. In each case, the child weighed between 2.5 kg and 3 kg at birth (anything below 2.5 kg is considered low birth weight) and was growing well before the family moved out for work. “In each of the cases, the child became vulnerable after falling from our network,” says Ms. Choudhari, who is part of the committee that has analysed each death since April this year. “Of the 208 deaths recorded till August, at least 25 per cent were due to low birth weight and pneumonia,” she says.
The land of ragi
On a wet weekday, Vivek Pandit, chief of Shramjeevi Sanghatna and former legislator, is busy running a health camp at Jowhar taluka. Small resorts and restaurants dot the main road here. The air is fresh and crisp, the taluka picturesque, an odd setting for the State’s capital of malnutrition deaths. “This can be a hill station if it is nurtured as one,” says Mr. Pandit, who has been working on the malnutrition issue for a while.
The lush landscape is interspersed with a crop that appears to be a darker shade of green. “This is nachni (finger millet),” Mr. Pandit says, pointing at the multiple plots cultivated with ragi, a nutritious food rich in calcium, protein and iron. Ironically, in this land of ragi, malnutrition is rampant. Almost all daily wagers say the farm owners give them a lunch of ragi bhakri. But clearly, it is an incomplete meal, as many mothers remain malnourished at the time of child birth. “Fifty per cent of the women we get are anaemic at the time of delivery,” says Dr. Mahesh Patil, chief medical officer at Mokhada rural hospital.
Palghar’s malnutrition irony is not limited to its rich ragi cultivation. The district has 46 Primary Health Care centres, 12 rural hospitals and two sub-district hospitals (in Dahanu and Jowhar). In addition, as part of the Rajiv Gandhi Bal Suraksha Karyakram 2013, about 46 teams of five members, of which two are doctors, are stationed in the district. Why the deaths then? “There is better detection now. The reporting has improved,” says Dr. P.Y. Waghmare, assistant director (family planning) who was in the Jowhar and Mokhada talukas following the deaths. He says when people migrate from their villages for work they are in good health, but return in poor health; children are particularly vulnerable, their immunity compromised by poor nutrition.
Migration: the real culprit
In an ideal world, death knows no caste, creed, or religion. But in Palghar, it does. Of the four child malnutrition deaths here since August 30, two were from the Kathkari tribe. “The tribe comes under a particularly vulnerable group. They are landless and have traditionally been employed in extracting kaath from khair trees, which is used as katha (catechu) in paan (betel leaves). They know how to maintain the correct temperature in the furnace to make katha,” says Milind Thatte, founder of Vayam, a movement for tribal development. However, the number of khair trees has declined sharply over the years due to deforestation, and that has had a spiralling effect on the livelihoods of this tribe.
But then the bigger malaise here, as doctors and officials admit, is unemployment and rampant migration. Mr. Thatte points out that malnutrition wasn’t a problem about half-a-century ago. He refers to books such as Primitive Tribes of Central India, published in 1934, and Jungle che Raje (Kings of the Jungle), published in 1954, that focused on these areas but made no reference to malnutrition. Besides, the healthy relationship that people living here had with the forest has deteriorated. “To address malnutrition, livelihood options need to be strengthened,” he says. He has seen children grow up on anganwadi food, and at 18 or 20 years of age, they now have children who also depend on the anganwadi for food. “The focus needs to shift from ICDS to employment. The government cannot think of feeding generations as a solution to tackle malnutrition,” he says.
Government officials say local villagers here have been provided with jobs and land under Mahatma Gandhi National Rural Employment Guarantee Act and Forest Rights Act respectively. “Work such as construction of forest tanks or short tanks to store water has been given under MNREGA to stop migration,” says Dr. Sivabala S., Deputy Conservator of Forest, Jowhar, a division that covers eastern Palghar including Wada, Jowhar, Mokhada, Vikramgad talukas and parts of Dahanu. He says that under the Forest Rights Act, 90 sq. km. of forest land has been given to 16,788 families so far.
“People have been given work under MNREGA but there are issues such as delayed payments and the amount being insufficient,” says Varsha Parchure, CEO of Parivartan Mahila Sanstha, based in Mokhada taluka. She says there are many related issues that need to be addressed such as water scarcity, which has not got any attention till date.
Meanwhile, data collection is in full swing.
At the anganwadi at Poshira village in Mokhada, there is a steady stream of people walking in with their children, getting their heights and weights recorded. The official here puts babies in a cradle-like sling to check their weight and then wraps a measuring tape around their upper arms to record their width. He keeps checking the WHO checklist to put children under SAM or MAM. It’s 3 p.m. and his sheet is almost full. The official scans the list twice over and confirms there are no SAM children here. So far.
For now, it’s a small victory.
Financial Year | Deaths |
2013-14 | 512 |
2014-15 | 435 |
2015 -16 | 257 |
2016 – until August | 208 |
July 2016
Taluka | SAM | MAM |
Jowhar | 230 | 1194 |
Mokhada | 291 | 1138 |
Dahanu | 113 | 265 |
Palghar | 270 | 1336 |
Talasari | 61 | 450 |
Vasai | 37 | 157 |
Vikramgadh | 300 | 460 |
Wada | 154 | 864 |
Data sourced from Shramjeevi Sanghatna Maharashtra
