The soldiers who inspect all that passes through the barbed wire barricades at their checkpoint here have spotted villagers bearing a tragic and unlikely burden.
“Bodies,” said Chintagupha Town Inspector Kurre, “I've seen at least 20 corpses in the last month; bodies in vehicles, bodies carried on simple wooden stretchers.” Bodies of Adivasis from interior villages in Chhattisgarh's conflict-ridden Dantewada district.
A sickness is sweeping through Dantewada's Konta block on the Andhra Pradesh-Chhattisgarh border, killing more Adivasis this year than the guerrilla war between the Indian state and fighters of the Communist Party of India (Maoist).
Residents of Tarmetla, Chintagupha, Burkapal and Chintalnar say that at least 40 Adivasis have died of dysentery and vomiting this monsoon season, and many more are ill.
The district administration has confirmed 19 deaths from vomiting and dysentery, yet the remoteness of these villages has meant that many, like two-month-old Madavi Dulle of Burkapal, were born, struck down by illness and buried without enumeration in the records of the administration.
The almost complete absence of trained doctors has forced traditional village healers, called Vaddes, to tackle a gastrointestinal infection that kills patients within as little as 12 hours. The illness manifests as a slight fever followed by vomiting and watery stools.
The hands and feet shrivel up, and “it sucks up all the blood,” said Muchaki Kosa of Tokanpalli. “The veins collapse, the eyes start rolling back in their sockets. It is as if the person has become a corpse before he dies.”
As the infection accelerates, most patients die in two days.
Burkapal's Vadde, Madakam Joga, said he has seen nothing like this before. To treat his patients, Joga begins by lighting a purifying fire before the patient and praying to the village Ayo — a Gondi term for ‘Mother Goddess.' He then prescribes a combination of herbs and extracts that he collects from the forests. If the treatment is successful, he accepts gifts of food and alcohol in Ayo's name, but refuses money for his services.
“If I accept money, the treatment won't work,” he said. Joga has successfully treated 14 villagers this month; the 15th, Madkam Lakke, came to him too late and died despite his prayers and potions.
“The symptoms suggest that the villagers are dying from fluid loss and extreme dehydration,” said Binayak Sen, who has worked extensively in rural Chhattisgarh and is a recipient of the Paul Harris award for service to the rural poor. “The treatment is straightforward using oral rehydration or intravenous drips to keep patients hydrated until they recover.”
Dr. Sen explained that in normal circumstances, the human body absorbs fluid from the intestinal tract; in case of infection, the process reverses, whereby patients are unable to absorb water from their intestinal tract and instead steadily lose fluid.
It is believed that the epidemic could be caused by contaminated drinking water. For instance, in Tarmetla, where 25 people have died of acute gastro-enteritis this year, none of the bore-wells in the village are operational, forcing villagers to drink water out of a muddy ditch.
If true, rehydrating patients using the same contaminated water could only worsen the situation.
Lack of infrastructure
The epidemic ravaging the Konta block is symptomatic of a larger malaise afflicting Dantewada and neighbouring districts. Apart from Dantewada, at least 100 people have died of “dysentery-vomiting-diarrhoea” in Bijapur district this year, pointing to a complete breakdown of the region's medical and civic infrastructure.
The district administration's response to the crisis is no different from the village Vadde.
“Everything in Dantewada is being run by Ayurvedic doctors,” said Dharmendra Nayak, the Ayurvedic practitioner at Chitalnar, a village at the centre of the current epidemic. Dr. Nayak is the sole occupant of a public health centre (PHC) that is supposed to have six other staff, including an allopath.
Twenty-four of the 30 PHCs in Dantewada and Bijapur are staffed with Ayurvedic doctors, and the remaining six centres have no doctors at all.
Dantewada, a district with a population of 0.7 million, has 12 doctors with an MBBS degree. Only three PHCs in the urban areas of Barsur, Kirandul and Bacheli have an MBBS doctor — the remaining nine doctors are either posted at the district hospital or fulfilling administrative duties.
As Ayurveds are prohibited from prescribing allopathic medication by law, the district medical system, for all practical purposes, is being run on Ayurvedic principles — the ancient medicinal system more suited to dealing with chronic medical conditions rather than immediate relief.
“The Ayurvedic system does not have a remedy for active diarrhoea,” said Ashok Shukla, Dantewada's District Ayurvedic Officer. Dr. Shukla said that under the AYUSH scheme of the Union Ministry of Health and Family Welfare, each PHC is supposed to have an allopathic doctor for emergencies and short-term conditions and an Ayurved to treat long-term conditions.
While the Ayurveds have been assigned to their posts, the district administration has been unable to find allopathic doctors willing to serve in rural areas.
To raise salaries
Dantewada Collector Prasanna R. has sent medical teams into the area to assess the extent of the current illness and has promised to post more trained doctors at the PHCs. In his prior posting as Collector of Bijapur, Mr. Prasanna made up vacancies by raising doctors' salaries using money from the National Rural Health Mission, and said he would attempt the same in Dantewada.
“The State government provides a salary of up to Rs. 30,000 per month,” he said. “We are willing to pay our doctors between Rs. 50,000 and Rs.1,00,000 if they opt for a posting in the interior areas.”
Mr. Prasanna said the district administration is in talks to post a highly qualified doctor at Konta, but noted that qualified doctors were reluctant to stay in remote parts of the district. While the security situation in Dantewada remains precarious, the CPI (Maoist) has not attacked a single doctor to date.