Odisha in the times of Cholera

Minita Majhi is inconsolable. Her two daughters, seven and two years old, hardly aware of the tragedy that has struck the family, also cry upon seeing their mother unable to stop her tears. Minita’s in-laws, Palai and Krushna, try to console her but that brings no relief to the 30-year-old who lost her husband, Chaitanya Majhi, to cholera just about a week ago on July 27.

Incidentally, a week before his death, 35-year-old Chaitanya, a resident of Rengnasil village under Dangasil panchayat of Kashipur block in Odisha’s Rayagada district, had been hospitalised for diarrhoea at a hospital in Tikiri. Subsequently, he had been referred to the district hospital, Rayagada.

After being discharged and sent home, Chaitanya felt better and so travelled back to Rayagada for some work and returned home the same day. Subsequently, however, he complained of severe body pain and swelling. In no time Chaitanya was vomiting blood. Alarmed, the family rushed him to the Rayagada district hospital again where the doctors referred him to the SLN Medical College in Koraput. According to the local auxiliary nurse midwifery, the doctors attributed Chaitanya’s death to renal failure.

The family and fellow villagers say Chaitanya’s condition aggravated due to diarrhoea. His name, however, didn’t figure on the official list of cholera/diarrhoea casualties, till the time of filing this report. When The Federal reached Chaitanya’s house, villagers informed that the family hadn’t received the Rs 2,000 the state government grants for cremation under a scheme meant to provide relief in such a situation.

According to Rayagada chief district medical officer (CDMO) Dr Lalmohan Routray, as on August 1, out of the 159 diarrhoea/cholera patients admitted to different hospitals, 142 had recovered and were discharged. Routray said only seven patients now are undergoing treatment in Kashipur and Kalyansinghpur blocks.

“The situation is under control and we have kept a close eye on it,” Dr Routray told The Federal.

Though the CDMO put the casualty figure for diarrhoea and cholera at 10, unofficial sources said a total of 13 people have succumbed so far.

Cholera is an extremely virulent disease that can cause severe acute watery diarrhoea. It takes between 12 hours and 5 days for a person to show symptoms after consuming contaminated food or water. Cholera, the World Health Organisation says, can kill within hours if untreated. It is an annual disaster in Odisha. Whenever the rainy season comes, waterborne diseases of diarrhoea and cholera follow.

As deaths began to mount this year in Kashipur and Tikiri, the issue resonated in the Odisha Assembly during its monsoon session. As is customary, Odisha’s health minister Nabakishore Das, who had visited the affected areas, claimed all necessary measures were being taken to stop the spread.

So, what killed Chaitanya if he had recovered from cholera and returned home after being discharged?

A doctor busy attending to patients at the Kashipur Community Health Centre (CHC) says a patient with acute diarrhoeal disease (ADD) symptoms has to complete the antibiotic course for at least five to seven days depending on their condition. If one fails to complete the course, there are higher chances of recurrence of the disease. The cholera bacterium affects the kidney and can cause death.

“The kidney is also likely to be affected due to dehydration. In case of cholera and diarrhoea, body dehydrates fast. Unless rehydration is done, kidney failure is possible,” informed Dr Ashok Kumar Mohanty, who served in Rayagada hospital years ago.

Unending misery

Healthcare facilities are mostly found lacking in remote parts of Odisha despite the annual recurrence of deadly diseases.

Twenty-five kilometres from Kashipur block headquarters, Tikiri boasts of a railway station. Besides the government run Public Health Centre (PHC), Utkal Alumina International Limited (UAIL) has a small hospital in the Ushapada locality of Tikiri.

In Jhodia Pada (1) of Tikiri panchayat, fear of an uncertain future stares at Bali Jhodia, a 55-year-old widow. On July 15, she lost her youngest son Anja, 22, a daily wager to cholera. Her eldest son Dhoba had died eight years ago.

“Anja worked hard, and looked after me. With him, I have lost my hope and strength. Now, I have to entirely depend on my middle son Bhima, who finds it difficult to run the family and look after me at the same time. I don’t know what to do at this age,” Bali says, her dry eyes fixed on the cloudy sky.

The area has so far lost four people to the annual scourge.

“Cholera has consumed three lives in this village with 217 households, while our panchayat has reported four casualties. Families of each of the deceased have been provided Rs 2,000 for cremation,” an elected representative of Tikiri panchayat said requesting anonymity.
Community-level efforts are being pushed, meanwhile, to halt the spread of the deadly diseases.

“I have been paying door to door visits asking people to drink warm water, eat hot cooked food and maintain personal hygiene. Bleaching powder has been sprayed in the village and Halazone tablets are put in the water pots of the families regularly,” Asha worker Sabita Das told The Federal.

Enforcing precautionary measures are, however, a herculean task in the village.
Post the cholera outbreak, drinking water is being supplied to the residents through a tanker with villagers being advised to not use water from the tubewell located in the middle of the village. An advisory has been put up at the well telling villagers to not use the water from the well because it can cause diseases. Despite the warning, The Federal found villagers drawing water from the tube well.

“It’s peak sowing season. The water tanker arrives around 10-11 am. We have to cook and leave for the fields early. So, we have to use the tubewell water,” argued a youth.

Despite years of cholera outbreaks plaguing Kashipur, clean piped drinking water is conspicuous by its absence in scores of villages across Odisha. The same holds true for most tribal districts. In Tikiri, the waterborne disease is believed to have broken out due to a contaminated open well in Maliguda village from where it spread to nearby villages.

At several places in Kashipur and Tikiri, The Federal found women carrying water from tubewells with unclean surroundings. Many could also be spotted carrying pots filled with water from the river and streams for cleaning and other purposes.

Independent MLA from Rayagada, Makaranda Muduli, in a recent interview to a newspaper said that there’s no tap water connection in Kashipur block because no projects have been started in the recent past. The government has announced a Rs 332 crore project for Kashipur block and once it’s complete, lives of people in the area will change, he said.
Muduli added that the project could take up to two-three years and until then the situation has to be managed by the government.

Missing sanitation

What complicates the problem for the area is that though signboards in every village claim it to be open defecation free, the reality is quite the contrary. One can easily spot people defecating in open spaces, which doctors say, is the principal reason for water contamination.

Loudspeakers fitted on vehicles wrapped with banners blare messages on how to stay away from the bacteria through the day in villages and posters carrying the same message are ubiquitous in the village.

Agragamee, an NGO working in Kashipur and other tribal areas of Odisha for over four decades, helps organise awareness campaign in over 150 villages of Kashipur block.

According to Agragamee’s director Achyut Das, safe drinking water is a huge issue in the villages. Though in several villages, the government has made provision for toilets, they are not in a usable condition due to various reasons including lack of water connection, small safety tanks and even absence of doors. In many places, they used the toilets are being used as sheds for goats, poultry or even to store firewood.

Das says there is a cultural resistance towards the use of toilets among the people.

Das agrees that post the cholera-diarrhoea outbreak, the district administration has been actively taking steps to contain the spread.

However, leading activist Prafulla Samantara, who along with members of the Fact Finding Team of National Alliance of People’s Movements (NAPM-Odisha), visited the affected pockets, is furious.

“The government has generously handed over tribal land, forest and water to companies. For a government keen to promote mining industries, the value of tribal life is negligible,” Samantara said.

Both Samantara and Das agreed that the worst-affected villages are near Tikiri and more or less come under the domain of UAIL. “The company must answer why it hasn’t been able to ensure supply of safe drinking water in these villages,” the duo said.

Referring to 2007, when 70 tribals had died of diarrhoea in Kashipur block, Samantara said, it’s unfortunate that the government failed to learn any lessons from the 2007 tragedy.

Samantara said that in the Kashipur CHC, only four doctors are present, against the approved strength of 13. Of the existing four doctors, only two were looking after the patients in Kashipur while the other two had been sent on deputation to the PHC in Tikiri, the cholera hotspot this year.

Incidentally, Tikiri hospital has a reputation for non-availability of doctors. There have been no doctors here for the last six months, informed a staff. Even delivery cases are referred to Kashipur or Rayagada, roughly 60 km away.

If there is one ray of hope in the dismal state of affairs it is the efforts of the young team of doctors brought in on deputation post the cholera outbreak at the Tikiri PHC.

“We are overworked,” said one of them with a faint smile. “But we will perform our duty to the best of our ability,” he said before heading for a quick lunch sometime past 3 in the afternoon.

What compounds the problem for the doctors is that despite their advice patients often refuse to get admitted.

During our visit, The Federal found that two patients with acute diarrhoeal disease symptoms – one at the UAIL hospital and the other at the Kashipur CHC-said no when asked to get admitted despite the doctor’s advice.

According to ex-IAS officer Aurobindo Behera, the tribal people are a bit finicky about being admitted as indoor patients because culturally they like to enjoy greater freedom of their natural surroundings.

“Besides, the fact remains that our health service delivery system has not been able to create health seeking behavior by winning their trust,” Behera, who spent many years in tribal districts during his career, said.

He also informed that the administration must gear up to control such outbreaks before the onset of monsoon because there are greater chances of water getting contaminated and unhygienic and unhealthy practices being followed because of food insecurity due to incessant rains.

“Precautionary steps like clean drinking water and availability of adequate food grains in the households should be ensured in advance,” he said.