Report
of Fact-finding Visit on “Infant Deaths due to outbreak of Japanese
Encephalitis / Acute Encephalitis Syndrome” in Malkangiri district, Odisha
1.
Introduction
The child
causalities due to outbreak of Japanese Encephalitis in Malkangiri district
were reported in 2011 and 2012. An estimated death of 36 children was reported
by District administration in 14
villages of the district within the period of September to 5th
December 2012, but the actual scale of causalities was more than that. During that time, being shocked over the
news, a 3-member team of Right
to Food Campaign, Odisha had visited
Malkangiri district from 18th to 20th Dec.12 on
a fact-finding mission to find out the reasons behind causalities, steps taken
by the District administration to check
child mortality and as to effectiveness
in implementation of food security programmes like MDM and ICDS,
two flagship programmes which aim to
provide nutritious food to the
children and thereby check IMR
and MMR in the country. The Fact-finding Report along with
host of recommendations
highlighting disastrous food
insecurity issues, failure of ICDS and MDM programme, chronic hunger among the children and subsequent loss of immunity capacity of
the children was presented to Govt.
to take steps for increasing nutritional standard of the children through
effective implementation of ICDS programme and close monitoring of health and nutritional standard
of the children by ICDS and health staff.
After gap of three years, the break out of same
disease Japanese Encephalitis ( JE) has
caused 60 child deaths in different parts of the districts
officially during September and October 16 and many more unofficially. The child
causalities highlighted by mass media exposed callous and insensitivity of the
district administration and ineffectiveness and break down of health system of the district to deal this dreaded
disease. After public reaction and outrage and protest by opposition political
parties, the State Govt. took a lot of
steps to check health hazard. It was
thought of by Right to Food
Campaign, Odisha to send another Fact-finding Team to Malkangiri
to find out the basic reasons of
child causalities, whether any preparedness and preventive measures
taken prior to outbreak of JE, nutritional standard of the children, status of implementation of various programme, intervention of the Govt. etc.
Accordingly, a four-member Fact-finding Team had visited different parts
of the district from 18th to 20th October
2016.
2. Members
of Fact-finding Team
A.
Pradip Pradhan
State Convener, Right to Food Campaign, Odisha
Member, Advisory Group of NHRC on Right to Food, M-9937843482
B.
Sri Ashok Patnaik
Advocate and RTI Activist, Malkangiri, M- 9437435399
C.
Sri Bikash Dandsena
Social Activist, Malkangiri, M-9437970303
D.
Sri Era Padiami
Tribal Activist, Malkangiri, M- 9437316380
3.
Objectives of the Visit
A.
To find out
the reasons of huge
child deaths- whether it is due to outbreak of Japanese Encephalitis (
JE) or degraded and ineffective health
service available in Govt.
hospitals or any other reasons.
B.
To study and
document the socio-economic condition of the family of child deaths reported by
Govt. and condition of the children
before their admission and death in hospitals collecting information
from Anganwadi Centres and the
people at large.
C.
To study the capacity and
effectiveness of District Hospitals, CHCs to deal such dreaded disease on the
pretext that preparedness measures, if
any taken on the basis of learning from
JE- related infant death hazards
of 2012.
D.
To understand the effectiveness
of ICDS programme to check malnutrition among children in Malkangiri.
E.
To make
recommendations to State Govt., Central Govt.
and other constitutional bodies
about necessary steps required to be taken to check
this dreaded disease in the district in the coming days.
4. Malkangiri
District- An overview
Malkangiri is one of the most
backward districts of Odisha and infamous for significant presence of
malnourished children and highest number of child causalities in the country.
Looking at the history of its development, the district is named after its headquarters
town Malkangiri. During the formation of Orissa Province in 1936 Malkangiri was
a "Taluk" of Nabrangpur sub-division of Koraput District in Orissa.
In 1962 it was upgraded to a subdivision of Koraput District. The present
Malkangiri comprising an area of 5,791 sq.kms. got its identity as an
independent district with effect from 2nd October 1992 following the
reorganization of districts of Orissa as per notification dated 1st
October,1992. .Oriya is the main spoken language. The district is
divided into two distinct physical divisions. The eastern part is covered with
hilly terrain of Ghats, Plateaus and Valleys sparsely inhabited by primitive
tribes notable among who are Bondas, Koyas, Porajas and Didayis. The rest of
the district is comparatively flat plain broken by a number of rocky wooded
hills. Almost the whole of the district is covered with vast stretches of dense
forest.
Map of Malkangiri district
Tribals constitute the
dominant community in the district with a presence of 59.21% of the total
population. Most of the tribal people
are poor and live in abject poverty. As per Govt. report, 81.88% of the rural people
live under Below Poverty Line. The
whole district is affected by Naxal violence. Almost all development projects
and programme like PDS, ICDS, MDM, NREGA, Integrated Action Plan (IAP), ITDA,
OTELP, Banda Development Authority and Didayi Development Authority are being
implemented by Govt. to ensure livelihood and provide food security to the
people in the district. To curb naxal
violence in the district, both Central
and State Govt. have also undertaken
special development projects for socio economic development of the people in
the district by spending crores of
rupees.
5. Japanese
Encephalitis (JE)- What it is ?
Japanese
Encephalitis (JE) is a mosquito borne zoonotic viral disease. The virus is
maintained in animals, birds, pigs, particularly the birds belonging to family
Ardeidae (eg. Cattle egrets, pond herons etc) which act as the natural hosts. Pigs &
wild birds are reservoirs of infection and are called as amplifier hosts in the
transmission cycle, while man and horse are ‘dead end hosts. The virus does not
cause any disease among its natural hosts and transmission continues through
mosquitoes primarily belonging to vishnui group culex. Vector mosquito is able to
transmit JE virus to a healthy person after biting an infected host with an
incubation period ranging from 5 to 14 days. The disease affects the Central
Nervous System and can cause severe complications, seizures and even death. The
Case Fatality Rate (CFR) of this disease is very high and those who survive may
suffer from various degrees of neurological sequeale. (An estimated 25% of the
affected children die, and among those who survive, about 30-40% suffers from
physical & mental impairment). The children suffer the highest attack rate
because of lack of cumulative immunity due to natural infections. Acute Encephalitis Syndrome (AES) is a
general description of the clinical presentation of a disease characterized by
high fever altered consciousness etc mostly in children below 15 years of age.
Acute Encephalitis Syndrome (AES) has a very complex aetiology and JE virus is
only one of the many causative agents of Encephalitis. Further it is also
6.
Details
of visit of the Team
The Team
members visited three JE- affected blocks i.e. Malkangiri, Korkunda and Kalimela and 10
villages and interacted with
cross section of the people,
parents of deceased
children, Medical Officers of
CHCs, Panchayat representatives, Anganwadi Workers, Supervisors, the
villagers to find out the
reasons of death of
children and outbreak of JE. The Team
members also visited
Community Health Centres at
Kalimela and Korkunda and inspected
the Wards to understand the
health condition of the children
being treated. The doctors were very cooperative and explaining
details and responding the query. Most
of the children admitted in the hospital were visibly malnourished and suffered
from fever. The doctors have taken them
as suspected AES and
kept them under observation.
On 18.10.16,
the Team members also met Dr. U.C.Mishra, Chief District Medical Officer,
Malkangiri and discussed with him about
the reason of outbreak of Japanese Encephalitis (JE). He
explained in details about
how virus is transmitted from
pigs to man through mosquitoes.
This disease has broken out
due to bad sanitation condition,
pigs. He also said
that due to malnutrition , many of the
tribal children have lost their
immune capacity for which their
body could not resist this dreaded disease. He
admitted that as large number of JE affected
children got admitted, they could not handle it and many of them
died. Referring these patients to
Berhampur became problem for the
administration. Because many of them also died on the way. Now they
have taken a lot of steps
including mobilising doctors, staff nurse from
different districts, Sishu Bhawan and engaging
them for treatment. Pigs have been kept in enclosures
around 3 kms away from human habitation.
Fogging and restoration work has been started in affected villages. Dr. S.B.Mohapatra,
ADMO carried with him the team members and facilitated their visit to different
Wards, ICU, Nutritional Rehabilitation Centre (NRC) where the affected children are
treated. It was observed that most of
the children admitted in hospital and under treatment are malnourished.
Places visited and persons / officials interviewed by the Team and their response .
|
Name of Block
|
Name of villages/ offices
|
Person/ officials interviewed
|
Content of
Interview and query made
by the team
|
|
Kalimela
|
Koimetla village ( Koimetla GP)
|
Muka Madhi
|
His daughter Manjun Madhi , one year and eight months got
suffered from fever. He carried
her to
Kalimela CHC. The doctor referred her to District Hospital. No proper treatment was made. He brought
back her daughter to home on 6.10.16.
She got serious next day. While
carrying her to District Hospital, She died
on the way on 7.10.16 ( it
has not been reported in Govt. list)
|
|
|
|
Kasa Padiami
|
He admitted
his son Bikram Padiami, 3 years old in District Hospital. The Doctors could not treat his son
properly. He was told his son to be
referred to Berhampur. The doctor asked him to wait. He waited for one day
and his son ultimately died in Hospital on 10.9.16.
|
|
|
|
Sukra Padiami
|
His son
Bapi Padiami, 3 years and 9 months old died on 11.9.16 in M.K.C.G. Hospital,
Berhampur. He could not avail Hospital
Ambulance to bring back his son. Finally he hired private vehicle @ Rs. 22,000.00 to carry his dead son
to home.
|
|
|
|
Jaga Madhi
|
His
daughter Ananya Madhi, 3 years old died on 22.9.16.
|
|
|
MV-68 Anganwadi Centre
|
Shyamali Halda, Anganwadi Worker
|
She
reported about 3 malnourished children
identified in the centre
|
|
|
Kalimela Community Health Centre
|
Dr. Muktikanta Mallik , In-Charge of
CHC
|
He reported
that total of 74 children suspected AES (Acute Encephalitis Syndrome) were
admitted within two months Sept and Oct. 16. 40 patients referred to District
Hospitals and 34 treated and got cure.
|
|
Korkunda
|
Palakonda village ( Sikhpali GP)
|
Marsha Kabadi
|
His
son Rama Kabadi, 3 years old died
in District Hospital on 29.9.16
|
|
|
|
Bira Kabadi
|
His son
Deba Kabadi, 4 years old was admitted in district hospital. The doctors
neglected in treatment and did not prescribe any medicine. His son died
in Hospital on 21.9.16
|
|
|
|
Nande Madhi
|
His
daughter Debika Madhi, 2 years
old died on 21.9.16
|
|
|
|
Deba Kabasi
|
His son
Rame Kabasi, 2 years and 7 months
died on 15.9.16 in M.K.C.G. Hospital, Berhampur
|
|
|
|
Irme
Madakami, Anganwadi Worker, Palakonda
|
She gave
the list of 3 malnourished children and explained in details
about steps taken to refer malnourished children to the District hospital.
|
|
|
|
Jhunurani Mohapatra, ANM
|
She explained
about provision of two meals provided in Anganwadi Centre to all pregnant and
lactating women and children upto 6 years of age from 10.10.16 and mass
sensitisation programme undertaken by them to maintain proper sanitation in
the area.
|
|
|
MV-19 , Primary Health Centre ( new)
|
Dr. Chandan Soren, Medical In-Charge
|
22
suspected AES cases referred to District Head Quarter Hospital within last
two months. On query about
reason for death of only
tribal children, he said
that the tribals are not health
conscious and do not
maintain proper sanitation around them.
|
|
|
Patrel village
|
Ajay Madkami
|
His
son Aditya Madkami , 3 years and 10
months old is 8 kg suffering from Malnutrition
|
|
|
DO
|
Binod Bihari Takri
|
His
daughter Jhansi Takri, 4 years old died on 29.9.16. She was suffering from malnutrition.
|
|
|
DO
|
Sukanti Karasta, Anganwadi Worker
|
She
provided list of 3 malnourished children identified and necessary steps taken for their recovery.
|
|
|
MV-53
|
Pinku Biswas, Anganwadi Worker,
|
She was
seen managing the centre well.
|
|
|
Puspali ( Tarlakota GP)
|
Puspali Anganwadi Centre
|
Immunisation
programme was going on in the presence of Mathamai rath, Supervisor and
Minati Panda, Anganwadi Worker. She provided list of 3 malnourished children.
|
|
|
Mahulput
|
Shyamali Biswas, ANW
|
She was
appraised about non-distribution of egg to pregnant and lactating woman of
Jamuguda village. After complaint, she
agreed to provide food and egg to them
|
|
|
|
Sangita Panigrahi, Supervisor
|
During
visit, the team spotted her supervising provision of cooked meal
to pregnant and lactating woman in the centre.
|
|
|
Siraguda
|
Bipasa Mandal, ANW
|
Many
beneficiaries have not received money
under Mamata Yojana for years together
|
|
Korkunda CHC
|
|
Dr. Tanmaya Acharya
|
He
said that total no. of 73 JE
suspected children were admitted
within two months. Out of it 28 referred to District Hospital.
|
|
Malkangiri
|
Tamasa
|
Muka Madkami
|
His son Bidesh Madkami , 6 months old died
on 7.10.16 in hospital.
|
|
|
|
Padia Kabasi
|
His daughter
Puja Kabasi , 4 years old died in
home.
|
( MV 68- Malkagiri village 64 -
habitation of refuse Bengalis
rehabilitated by Govt.)
7.
List of Malnourished children collected from Anganwadi Centres and identified by the team during visit
|
Sl.No
|
Name of Block
|
Name of village
|
Name of malnourished children
with age
|
|
1
|
Kalimela
|
Koimetla
|
Rasmita Padiami, 1 year and 8 months old
|
|
2
|
DO
|
DO
|
Radhika Madi, 3 years
and 7 months old
|
|
3
|
DO
|
DO
|
Bimala Madi, two years and 11 months
|
|
4
|
DO
|
Palakonda
|
Tami Padiami, 2 years old
daughter of Aite Padiami
|
|
5
|
DO
|
DO
|
Santu Kabasi, 2 years and 10
months old
|
|
6
|
DO
|
DO
|
Surya Kabasi, 11 months ,
Father- Bimal Kabasi
|
|
7
|
Korkunda
|
Potrel Village
|
Mangul Madi, 2 years And 3
months , son of Sama Madi
|
|
8
|
DO
|
DO
|
Sabar Padiami, 1 year and 3 months , son of Dabe Padiami
|
|
9
|
DO
|
DO
|
Ganga Padiami, one year and
3 months
\and
Jamuna Padiami, one
year and 3 months, twin of Munda Padiami
|
|
10
|
DO
|
Puspali village
( Tarlakata GP)
|
Kasa Beti , 1 year and 8 months
|
|
11
|
DO
|
DO
|
Rita Madkami, 2 years and 2 months
|
|
12
|
DO
|
DO
|
Jangi Kuasi, 2 years
and 7 months
|
8.
Analysis of the problems
aggravating health hazards and JE epidemic
A. Child
death is not new phenomena in Malkangiri
district. Every year thousands of children died of fever, malaria and other
small ailments. The information
obtained under RTI from the office of CDMO, Malkangiri on
3.11.12 has exposed that
from 2007-08 to 2011-12, around
7400 children have died due to
contraction of various diseases
like Epilepsy, ATI, LBW, Diarrhea,
Ashthma, Fits, Burning, UND, Septicemia, Birth Asphyxia, Fever related ailments
and Boll cancer etc. it means in
normal period, thousands of children mostly
tribal children died
of minor ailments, The death due to outbreak of Japanese
Encephalitis in 2012 and 2016 has only aggravated the situation exposing the ineffectiveness of health
system of the state.
B.
While visiting
the Anganwadi Centres, CHCs,
District hospitals and interacting with
Anganwadi workers, it was
observed that most
of the children who have
died or
under treatment are malnourished.
More than 95% of JE-affected children are tribals and all of them are
malnourished. It is interesting to be noted here that among the affected
tribal children, most of them are girl children. Due to chronic hunger and lack
of food, the tribal children have suffered from malnutrition. A malnourished child is easily susceptible to any disease. Because, their immune capacity
gets lost. As a result, they have
succumbed to dreaded disease like Japanese Encephalitis. As reported by health experts, the children
are highly vulnerable to this disease. Malnutrition among
the tribal children can be
attributed to extreme poverty, lack of
employment opportunity or less
accessibility to food and
ineffectiveness of Govt.
programme. During interaction
with the villagers, they were asked
about daily consumption. All of the
replied that they consume rice and jungle leaves (forest leaves) as their
staple food and sometimes rice and dal.
It shows horrible food insecurity situation among the tribals. As they could not get any work, they could
not earn to feed their children. The
employment generation programme implemented by district administration has
failed to provide employment to the tribals.
During interaction with the
villagers of Koimetla
village, it was
found that the NREGA labourers have not been paid
their wages since
7 months.
C.
It was observed that ICDS programme is badly implemented in
Malkangiri district. For example,
the beneficiaries of
Jamuguda village under Tarlakota GP have not
been getting egg and food for years together because
of 2 km distance from Anganwadi Centre. The Anganwadi Worker has not taken any
proactive step or extra initiative to ensure
food/ THR to them. The Team also came
across a lot of complaints relating to distribution of substandard
Chhatua. Many beneficiaries are not consuming
it and using it for food of pigs. Under Mamata Yojana, the beneficiaries like lactating woman have not
been paid money for years together across the district. Either ICDS
programme have miserably failed to ensure
nutritious food to the
children and P & L woman or has
it been ineffective to address
malnutrition among the children
which requires further
study or review of the project in
Malkangiri.
D.
Though a
number of children died due to
Japanese Encephalitis (JE) during
2011 and 2012, the administration could not learn anything and
remained callous and indifferent to
take steps for prevention and
control of the disease in
the district. It is worth to
mention here that Ministry of Health and Family Welfare,
Govt. of India decided in 2011 to implement
National Programme for Prevention and
Control of Japanese Encephalitis/Acute Encephalitis Syndrome in the country. This programme is implemented with cent percent
Central Govt. support in 171 JE-prone districts of 19 states. Though Malkangiri has been affected from
2011, the year of beginning of National programme, the State Govt. has precariously failed
to influence the Central Govt. to be part of the National programme. It is
also fact that the State Govt.
has not even tried
to be linked with National
Programme to combat this
dreaded disease, despite
of its ineffectiveness and
incapacities to deal it. It has happened due to inept
political leadership and
insensitivity bureaucracy of our Govt.
E.
Malkangiri district is extremely backward and
poverty-stricken district in the country which has drawn attention of the
policy makers several times. That’s why
a good number of development projects and special tribal welfare programme is undertaken
for improvement of socio-economic
condition of the people. Crores of rupees
are sanctioned for implementation of various project. On the other hand, the District Hospital and CHCs and PHCs
are seen ill-equipped with
lack of infrastructure, vacant of
post of Doctors, ANMs and Para-medical staff for
years together. If proper
treatment had been offered to the patients in a coordinated way, life of many innocent
children could have been saved. Whatever staff and para-medical staff are available
in the district, they are not working properly. ANM, male and female health workers hardly
visit the field. There is no monitoring
of health programme and activities of
medical staff by the higher authorities.
The patients are not provided proper treatment
in Hospitals rather got neglected and died.
F.
The insensitivity of the district
administration to deal critical health hazard situation and lack of preparedness has aggravated the
problems resulting in huge child causalities.
After hue and cry in mass media,
the district administration took a number of preventive measures at village level to
counter spread of disease by putting para-medical staff in different locations, conducting massive
awareness programme among the people, fogging, keeping pigs in enclosures at distance place from human habitations and
offered fantastic treatment in hospitals
to check child causalities. If this
kind of arrangement had been taken
earlier, the magnitude of
child causalities could have been avoided.
Recommendations
In view of
the above problems, the team endorsed the following recommendations to make Malkagiri a district of zero child causalities.
A.
The State Govt. should
constitute a Judicial Commission
headed by a retired High
Court judge along with
medical expert as members
to make a thorough investigation into
magnitude of causalities of only
tribal children due to
outbreak of Japanese Encephalitis,
factors responsible for it, reason of susceptibility of tribal children
to this dreaded disease. The
recommendation of the Commission should be carried in letter and spirit.
B.
The Team is of the view that the malnourished
children have been susceptible to this disease.
There is high malnutrition among the tribal children in every
village across the district. the
children who have died or under treatment inspected
by the Team are seen and
examined as malnourished. So to save the
precious life of the tribal children requires intervetion of the Govt.
to check malnutrition among the
children. The food insecurity and extreme hunger has
resulted in children suffering
from malnutrition. ICDS
programme which has mandate
to increase nutritional
standard of the children
has precariously failed due to
its bad implementation, huge corruption
and irregularities in
distribution of Chhatua ( Take Home
Ration). The team felt that the provision of Rs. 6.00 for food
per head per day in Anganwadi centre
is not at all sufficient
to meet nutritional need of the tribal children. secondly, though it is not
sufficient, but whatever is given is
again misappropriated by
Anganwadi workers and other ICDS
officials. There is a chain of
misappropriation of ICDS fund
from top to bottom. So,
it is recommended that ICDS programme needs to be revamped with allocation of required
fund in context of
Malkangiri district along with
independent monitoring team to be put in
place to moitor its implementation.
C.
As the outbreak of Japanese Encephalitis has assumed alarming proportion in Malkangiri, there is urgent need to cover
this district under National programme launched
by Govt. of India for
Prevention and Control of Japanese Encephalitis/Acute Encephalitis Syndrome .
So that with cent percent support from Central Govt., Japanese Encephalitis disease can be
controlled. So, the State Govt. should be engaged in
dialogue with Central Govt. for
coverage of Malkangiri
district under the said
programme.
D.
A number of tribal welfare programme under various
schemes, tribal sub-plan schemes supported by Central Govt. and State
Govt. with allocation of huge fund is implemented in Malkangiri. Despite huge funding,
why the Primitive Tribal Groups
like Didiya, Bonda are suffering. Time has come
to examine why these programme have failed
to bring any changes
in life and livelihood of
tribals. Why their socio-economic
condition is still disastrous. Whether the programme are itself
defective or it is badly
implemented by unscrupulous
officials. It needs to be studied
by experts in context of Malkangiri and their recommendations should be carried out in letter and spirit.
E.
The medical system of
Malkangiri should
be revamped and
well-equipped with appointment of doctors, para-medical
staff making it effective to provide free health service to the patients.
F.
There must be independent
grievance redressal and monitoring mechanism
in place to monitor the
implementation of various welfare programme meant for tribals.
The report of the monitoring should be taken into consideration by the
higher authority. Time-bound grievance
redressal system should be put in place and massive sensitisation programme to be
conducted among the tribals across the district.
G. The Japanese Encephalitis epidemic is just like disaster. It
requires trained personnel to deal this disaster situation. The team
recommended that the officials should be trained on disaster management to take
preventive measures to counter any epidemic in the district.
H.
Governance system
with transparency and
accountability in implementation of various programme should be enforced at every administrative level ensuring participation of the beneficiaries.
Pradip Pradhan Sri
Ashok Patnaik
State Convener, Right to Food Campaign, Odisha Advocate and RTI Activist, Malkangiri
Member, Advisory Group of NHRC on Right to Food M- 9437435399
M-9937843482
Sri Bikash Dandsena Sri Era Padiami
Social Activist, Malkangiri, Tribal
Activist, Malkangiri,9437979303 M- 9437316380
