While the monsoon plays truant many a time and is delayed, seasonal diseases like malaria and dengue are punctual and strike the tribal areas with alarming regularity.
Reason? Delayed spraying of insecticides, inadequate supply of drugs, shortage of doctors and test kits apart from other causes.
Inaccessible basics
Visakhapatnam Agency is one of the biggest tribal regions in Andhra Pradesh with about 6.5 lakh people living in 3,500 tribal hamlets spread over 11 mandals in the district. Lack of access to safe drinking water, unhygienic surroundings, lack of proper accessibility and superstitions among tribal people put their lives at risk.
Usually, spraying of insecticides has to be done during April, May and June every year. "But its delay is reducing the effectiveness of the programme. April and May being the hot summer months, the insecticide would kill the mosquitoes before the breeding season," says Setti Nagaraju, a Health Assistant, who is also district president of the Tribal Area Medical Girijana Prantha Vaidya Arogya Udyogula Sangham.
Irrational jurisdictions of health centres
"The irrational rules, in fixing jurisdictional boundaries of health sub-centres, are playing with the lives of the tribal people. A person has to visit the health centre, under the purview of his/her area, which may be 20 or
30 km away, but cannot
seek treatment at another centre, even when it is closer to his/her home," points out Mr. Nagaraju.
Further, anaemia is prevalent in the tribal areas. But there is gross under-supply of iron tablets. The government supplies eggs, milk and nutritious food to the Anganwadis. However, delays in supply due to poor road connectivity to the interior hamlets often results in the eggs and milk getting spoilt by the time they reach the Anganwadis.
While RMPs (Registered Medical Practitioners) are quite common in the Agency areas, they are authorised only to give first aid.
"Often, they act like qualified medical practitioners in the absence of proper supervision. They are increasing the drug dosage to earn more money resulting in the patients developing drug resistance," says CITU district president R. Sankar Rao.
Too little to cure
Each Accredited Social Health Activist (ASHA) worker serves between 200 and 500 households under her jurisdiction. An ASHA worker in Paderu, for example, is being supplied 50 paracetamol tablets for a month. A patient has to be given at least six tablets under the two-day course, and the ASHA worker’ stock would not suffice to treat even 10 patients. There is no supply of diclofenac, which is a pain killer.
The Praja Arogya Vedika (PAV) had submitted a memorandum to the then District Collector in July last year seeking the setting up of a dengue confirmation test centre at Araku Valley to prevent exploitation of the poor tribal patients by private diagnostic centres, which were charging exorbitantly.
Have beds, not enough staff
"The ELISA test is presently available only at the King George Hospital (KGH) and the NTR Vaidyasala at Anakapalle. The government is yet to implement our demand for setting up of the ELISA test centre at Araku for early confirmation and speedy treatment to tribal patients. Barely two months ahead of the election,
the previous government had upgraded hospitals in the Agency and provided infrastructure. Though the bed strength was increased, there was no commensurate increase in staff and appointment of doctors," says T. Kameswara Rao, State general secretary of PAV.
