On May 29, Putti Balamani, 44, a resident of Ramnarayanpet in Telangana, went to work after seven days of leave. A farm worker for 15 years now, along with her husband, Putti Ramulu, Balamani had asked for leave a week ago after temperatures in the region became unusually high, touching 48 degrees on a couple of days. On the 29th, though, her employer insisted she come to work — a new borewell was being sunk that day to provide additional water to the fields and it would be better, he said, if some women were present for the puja before the drilling started.
Balamani, her husband says, went for the puja at about 10 a.m., walking roughly 4 kilometres from home, and came back at about 2 p.m. She said she wanted to sleep, though for her an afternoon nap was unusual, but she insisted that she was just tired. By evening she had started sweating profusely and had frequent bouts of vomiting and diarrhoea. It was hours, though, before anyone could figure out what was happening. Her family rushed her to the local hospital where the doctor on call suggested they move her to a private clinic he worked in. There, he said, her condition had turned too serious and she had to be shifted to a bigger hospital in Hyderabad, about 70 kilometres away. By the time an ambulance was arranged and she was taken there, the doctors in Hyderabad said that she had suffered a heat stroke, which had caused a clot in her brain. Two hours later, at about 2.30 a.m. on June 30, Balamani died.
The story of Balamani’s untimely death is indicative of a series of systemic failures that have seen the twin States of Andhra Pradesh and Telangana record an extraordinarily high number of deaths in the deadly heat wave that swept across the country last month. The failures include a lack of general awareness about the symptoms of heat-related illness, a failure of the public health system in the country’s most remote areas, and a complete lack of intervention and foresight by the governments of both States, who really should, and could, have known better.
Long summers, punctuated with periods of intense heat, are not a new phenomenon in this region. Though not quite a desert, its landscape is one for which the term semi-arid could easily have been invented — shades of brown predominating over endless fields dotted sometimes with the hardiest varieties of trees. That summer is harsh is no surprise, but the stories of heat-related deaths form a depressingly similar pattern.
In the village of Dharmaram, in Medak district, Dudhela Madarsa, 65, went out to work as usual on May 26. His job was to lay tiles on the roofs of houses, work that involved several hours in the searing heat. His son Mohammed Shahadullah, who does the same work, says his father complained of chest pain and dizziness when he came home that evening. The next morning he had several bouts of vomiting. Shahadullah assumed it was a stomach problem and went for medicines to the local health care centre. When his father did not improve, Shahadullah took him to the health centre where he was given an intravenous drip and some pills. Soon after, the doctor on call said he was getting worse and recommended that he be moved to a bigger hospital in Karimnagar, about 90 kilometres away. By the time they got there, it was too late.
What Madarsa was experiencing was heat exhaustion, symptoms which, if not treated on time, can lead to a heat stroke. According to Dr. D. Chandra Sekhar, who practises in Medak, the most important thing to do when a person comes in with a heat-related illness is to try and stabilise the body temperature. Ideally, this should be done with ice slabs and, if that’s not available, by repeated sponging with a wet cloth. Even this basic treatment was not administered at the local health centre. Shahadullah says the family was informed only when they reached Karimnagar that it was a heat-related illness, loosely termed wada-bedda in Telugu.
Being prepared
Preventive measures for such situations are not complex — Dr. Sekhar says the best thing to do is to keep oneself hydrated and avoid being outdoors after 11 a.m. But for many workers in this region, this is simply not an option, as they need the money from the daily labour. In Medak district, Durgana Sailu, president of the Wadera Sangam, a group that works in the stone-cutting industry, says the workers spend fewer hours at work during the summer months but it still involves being out till about 1 in the afternoon. In Wadera colony here, a 70-year-man, Balamaiah, died on May 24 despite being encouraged to not work for a couple of weeks. “He said he needed the daily wage and besides, in every other summer before this one, he had worked regular hours,” Mr. Sailu says. Like for several other people, the local doctor looked at Balamaiah and immediately said he should be taken to Hyderabad, even though it would have been easy enough to take the basic steps to bring down body temperature. “The doctor couldn’t spot it for what it was,” Mr. Sailu says. “For any problem, the doctors here say the patient has to be taken to Hyderabad.”
Mr. Sailu says, over the years, they have managed to negotiate better working hours with the stone cutters union. But he insists that the main cause for the high number of deaths this year was that the heat — for a period of about 10 days towards the end of May — was like nothing he had ever seen before. “Usually it stays at about 42 or 43 [degrees] and we are used to that, but this year it touched 46 or 47 [degrees] on some days. Even the younger workers were experiencing problems,” he explains.
Dr. Sekhar talks of how the majority of people who came in for treatment were men above 50. Several had a history of other illnesses such as diabetes or asthma. Almost all of them were either involved in construction labour or were farm hands. “For older people it is very difficult to regulate the body temperature once it goes very high. Younger people can at least recover quickly,” he says. Among the women, however, it is not just the older women who have been affected. There are reported cases of women as young as 30 who died after returning from working in the fields.
What is the national policy?
This year’s heat wave has affected most States in India, but Andhra Pradesh and Telangana have reported more than a third of the total death toll. What is unique about the condition in these two States? One explanation is the sudden change in temperature, after a relatively benign early summer spell. According to a Centre for Science and Environment Report, heat wave conditions in 2015 have been of a shorter duration as compared to 2010, when the other major heat wave of the decade was reported, but has claimed more lives. The report says this could be due to the sudden change in temperature after rains in February and March had kept temperatures cool. In Andhra Pradesh and Telangana, the wet spell lasted until April before a sudden escalation in May, when temperatures in several parts were four or five degrees higher than had been recorded for decades.
Yet, heat-related deaths, though not as many as currently being reported, have occurred here before. But despite that, on this occasion, neither State had the mechanism to either foresee or plan for such an emergency. This is in stark contrast to States like Gujarat and Odisha, which have both come up with specific action plans.
In 1998, over 2,000 heat wave-related deaths were reported from Odisha. Since that year, by about end-February, the State government prepares each year for the possibility of another heat wave striking. Schools and colleges shift to early morning sessions — between 6.30 a.m. and 12 noon — as do government offices. Public transport does not operate between 12 noon and 3.30 p.m., while public wage programmes such as the Mahatma Gandhi National Rural Employment Guarantee Act are stopped during these times. In May this year, when reports broke of an approaching heat wave, the State Special Relief Commissioner ordered all district collectors to ensure that no labourer was allowed to be in the sun between 11 a.m. and 3 p.m. In addition, as part of its guidelines, the State government ensures that public health centres are equipped with ice slabs to treat patients. The government puts out a series of advertisements advising people on the precautions to take.
In Ahmedabad, the city’s municipal corporation has evolved an operational heat alert system that has been in place since 2013. It was developed after more than 1,000 people were reportedly killed after the heat wave of 2010. The Ahmedabad Heat Action Plan is a four-pronged strategy, the first step of which is to inform people about the risk of heat illnesses and the preventive measures they should take.
The second is to map out actionables for various government agencies. The third involves training healthcare professionals to deal better with heat-related illnesses. In the last step, the corporation ensures that drinking water is easily accessible in several places, and temporary cool spaces are built during periods of extreme heat. In May this year, the Maharashtra government held a two-day workshop in Nagpur to develop a similar heat action plan for the city.
Nothing in place
In the absence of similar preventive measures or even awareness campaigns in Andhra Pradesh and Telangana, the effects of the heat wave have, in fact, also been felt heavily in urban areas, and have not been restricted to the periphery alone, as several officials claim. In Warangal, for instance, a colony called Rangampet has reported seven deaths over a ten-day period between May 24 and June 2.
Some of these deaths were due to the nature of work that the people were involved in. Sudhaveni Rajkumar, for instance, worked for a cable TV company. The 50-year-old Sudhaveni’s job was to go around the colony collecting money and installing satellite dishes. On May 28, he came home after work and simply collapsed. He died within an hour. His family claims that a nearby hospital refused to state on his death certificate that he had died of sunstroke.
Other deaths in this colony could have been easily avoided with just a change in timings or an advisory informing people what to do in case of heat-related illnesses. Bokka Samaiah, 58, worked as an attendant in a government office. On June 1, he fainted while at work. His colleagues advised him to rest for a few hours before going to a hospital. By the time he was taken there, his condition had worsened and he died. Similarly Komala Ganarapu, a widow who used to sell vegetables, suffered heat exhaustion on May 26. Though she was vomiting and had diarrhoea, her family assumed it was a stomach problem. She was taken to hospital only five days later. She died within a few hours of being admitted.
Local officials and doctors in Warangal insist that the number of heat-related deaths is being inflated by the media, despite the fact that a number of people have exhibited similar symptoms over a specific period of time. At MGM Hospital, the town’s biggest, several cases over the last months with symptoms similar to heat stroke have been classified as viral pyrexia, high fever caused by a virus. A senior doctor in the hospital even claims that some people have tested positive for malaria, though he concedes it is “very uncommon” at this time. To be classified as sunstroke death, he says, various parameters have to be met including hypotension, a sharp drop in sodium and potassium levels, and dehydration to the point of shock and confusion. “Unless these conditions are there, it is hard to say if the death is heat-related.”
Compensation for deaths
It is unclear as of now what the compensation policy of the Telangana government will be. Though the reported cases from the State are over 500 according to its disaster management committee, the State government may first choose to ascertain the number of deaths caused due to heatstroke before announcing compensation. Andhra Pradesh has already promised a sum of Rs. 1 lakh to each family, and has declared that a post-mortem will not be required.
The uncertainty over compensation and the lack of preventive measures taken by the Telangana government has raised a debate over why heat waves are not classified as national calamities while cold waves are. In 2013, the then head of the National Disaster Management Authority, M. Shashidhar Reddy, floated a proposal to bring the two on par with each other. Mr Reddy, a Congress politician from Andhra Pradesh, used the frequent heat-related deaths in his home State as an example while arguing his case. Still, it appears that the lessons of the past have not yet been learnt.
Classifying a heat wave as a national calamity is only logical given that the number of deaths reported across the country this year is five times the number of deaths in the recent floods in Jammu and Kashmir. The classification would help, as the onus would then be on the government to make sure that prevention, rehabilitation and compensation measures are effectively provided.
However, according to Amit Sengupta, Associate Global Coordinator, People’s Health Movement (a network of grassroots health activists), that would only solve half the problem. “If you have an inadequate public health system that is not equipped to deal with emergencies, then the right classification is not going to help,” he says. Given how simple it is to prevent a heatstroke death, it is a shame that the country should have lost so many lives to it in 2015, at the height of the age of information.
jayant.sriram@thehindu.co.in
