The root of Attappady tragedy

In 2003, the Health Secretary issued a government order defining the job responsibilities of multipurpose health workers and medical officers in primary health-care institutions in the State. The order called for identifying malnourished children and referring them to feeding centres or public health centres to provide nutrient supplements or treatment.

The recent deaths of 54 tribal infants in Attappady give a picture of how the order was implemented at least in this tribal heartland. So much so that T.K.A. Nair, Adviser to the Prime Minister, has written to Chief Secretary E.K. Bharat Bhushan, the then Health Secretary who issued the order, seeking “tracking of 900-odd pregnant women [and] children below 12 months and visit of joint teams of medical professionals and ICDS to each tribal hamlet.”

The government order (GO (P) No.254\2003\H &FWD), issued on December 9, 2003, to the Director of Health Services and medical officers of public health centres, contained many pieces of such advice, issued for the implementation of a sector investment programme supported by the European Commission for improving health services.

The order directed early identification of high-risk pregnancy cases; preference for institutional delivery; referring of cases of difficult labour to institutions; treatment of newborns with abnormalities; and providing at least three post-delivery visits to mothers. Iron and folic acid tablets and vitamin-A drops or syrups should be given to pregnant women. Adolescent girls should be monitored for anaemia and corrective steps taken. The growth and development of infants should be assessed.

The order wanted a registry of pregnant women and infants and children compiled through home visits. Separate lists of children of age less than one year and less than five years should be prepared.

On the field-level service to be given by junior public health nurses, the order says they should render care to pregnant women throughout the period of pregnancy.

All these directions remained on paper, and no action was taken against officials for not implementing them. A letter by the medical officer of the Community Health Centre, Agali, to the District Medical Officer, Palakkad, on August 9, 2012, is self-explanatory. It seeks “action against serious lapses on the part of health officials in depriving the people of Attappady of health facilities.”

The letter says the health sub-centres do not provide “medical facilities to pregnant women.” There are officials who do not visit the field but claim conveyance allowance. They fail to provide treatment to those affected by sickle cell anaemia.

Attappady has one tribal super-specialty hospital; one community health centre; three public health centres; 28 sub-centres; three mobile health units; a dispensary and an army of 500 paramedical staff to take care of a population of just 73,000.

A government order in 2003 directed health workers to identify malnourished children and provide them supplements or treatment — something seldom adhered to in Attappady.