Varsha Torgalkar exposes the lack of essential health services in the interior forest villages of the western Indian state of Mahatashtra and identifies the gaps in India’s health policies based on this
Nashik, Maharashtra: Sumibai Taral, who is in her 70s, doesn’t remember what it is like to use her left hand. For over 20 years now, she’s been using only her right hand to perform all chores, ever since she fell on the slopes of a hamlet in Chinchale Khair in the reserved forest of west Nashik, and injured her hand.
Taral is a Thakur tribal and resident of Ughadwadi hamlet in Igatpuri block of Nashik district, 166.8 kilometres (km) from Mumbai. Her family chose to treat her at home using traditional methods as they could not trek for an hour through the forest, crossing three streams of water. It was only a month after the fall that they managed to take her to the rural hospital in Igatpuri, but it was too late by then.
Less than 200 km from the country’s glitzy financial capital, there are several tribal villages in Igatpuri, Nashik, that have no access to basic healthcare facilities. Take the case of Chinchale Khair gram panchayat, which comprises five hamlets with a total population of 1,100 people — Ughadwadi, Vaitagwadi, Khairewadi, Umberwadi and Chinchale Khair. Of these, except for Chinchale Khair, others do not have access to electricity. All five lack a primary health centre (PHC) or sub-centre. The nearest PHC is at Nandgaon Sado village, 10 kilometres away. The tribal people prefer to go to Igatpuri, which is also 10 kilometres away, as it is more accessible, transport-wise, with a state highway.
Usually, PHC members should visit hamlets once a month, said a block health officer. But, tribal people say that even in Chinchale Khair at the foothills, which has road access, they visit only one in three or four months. And when they do, people from the five hamlets that make up Chinchale Khair trek down to meet the PHC staff.
Maharashtra’s reserved villages
In May 2016, Oarm Jual, the then Union tribal affairs minister informed the Lok Sabha that Maharashtra has 73 villages in reserved or protected areas in forests, having a population of 81,675, of which 80,000 people belong to the scheduled tribes.
Many of these tribal hamlets, which are located in hilly areas of the state and are thinly populated, neither have a sub-centre nor a PHC. For instance, Chinchale Khair gram panchayat, with over 1,100 tribal population has none.
As per Indian Public Health Standards, one sub-centre takes care of 5,000 people in the plains and 3,000 people in tribal and hilly areas. In the plains, there is supposed to be one PHC for 30,000 population while in the hilly tribal areas it is one PHC for a 20,000 population.
And, it is this official standard that the administration cites for the lack of medical facilities in tribal forest villages. “We can develop a sub-centre for a five thousand tribal population, but cannot do so for a population of a thousand people. Besides, we cannot build any structure on forest land as the land needs to be in the name of the health department. We can, however, send ASHA [Accredited Social Health Activist] and ANM [workers or Auxiliary Nurse Midwife] to the hamlets periodically,” Kapil Aher, district health officer, Nashik, told Gaon Connection.
And hence, tribal people continue to suffer decades of neglect.
Poor access to medical help
Thirty-two-year-old Balu Bhaushil’s uncle Sadashiv died in February last year after he could not get medical help on time. “My uncle developed a stomach ache when we were at work in the afternoon. We carried him for two hours on a wooden stretcher to Chinchale Khair and from there to the rural hospital in Igatpuri in a car. We were told to take him to the district hospital in Nashik. He died before we could get an ambulance,” Bhaushil of Ughadwadi told Gaon Connection. The tribal people are too poor to afford private healthcare.
Manga Balu Khadake, sarpanch, Chinchale Khair, told Gaon Connection that when someone in one of the hamlets falls ill, they have to be carried for an hour on a makeshift wooden stretcher or doli to reach Chinchale Khair. “Though two to four people can carry a stretcher, we need eight people, so that no one gets too tired, and we can carry it in rotation,” he said.
Khadake said that it was difficult to carry patients after dusk due to fear of wild animals as these hamlets are located round dense forests. “During rains, we prefer to not take a patient to hospital as we have to cross three swollen streams. Every year, at least one or two people die because they don’t receive treatment on time,” he added.
Meanwhile, there is no road connecting Ughadwadi, Khairewadi and Vaitagwadi to Chinchale Khair, he elaborated.
To take tribal pregnant women to the hospital in Igatpuri for delivery is a daunting task, villagers said. “Eight men have to carry the woman in labour, on a makeshift stretcher, for at least half an hour,” Chhaya Balushil, 25, an anganwadi helper who stays at Ughadwadi, told Gaon Connection.
Every month, one or two women from these four hamlets deliver a child. Almost all of them are carried this way. “No one has so far died en route, but that does not mean it cannot happen. There should be a sub-centre,” Chhaya added.
Predictably, Sakru Bhurbude, 29, of Ughadwadi decided to deliver her third baby at home as her earlier experiences were painful. “Villagers took me in doli to the rural hospital in Igatpuri for my earlier two deliveries. That experience was painful. And so, I decided to deliver at home with the help of other women,” she told Gaon Connection.
Do the villagers have access to the Pradhan Mantri Jan Arogya Yojana (Ayushman Bharat), which aims to provide free access to healthcare for 40 per cent of people in the country? Only 10 to 15 people have it, claimed Khadake. Many either don’t have documents, or don’t have the time or energy to visit the department concerned several times.
Bhagwan Madhe, activist, Shramjivi Sanghatana, Nashik, agreed with Khadake. He told Gaon Connection that “Hardly eight to ten people in Chinchale Khair group gram panchayat have Ayushman Bharat cards. Many don’t have the necessary documents to avail of free treatment under various schemes. They find it difficult to travel to the taluka office for this.”
Chinchale Khair isn’t alone in its suffering
Something similar is happening at Yelawali, a tribal village with a population of 108 people in Bhimashankar Sanctuary, which falls under Bamle gram panchayat in Rajgurunagar block of Pune. The village has no PHC or a sub-centre. “Our village is in the hills amid a dense forest and the mobile network is patchy. An ambulance can reach Bhorgiri near the foothills, but we have to carry patients and walk through the forest for a kilometre-and-a-half, crossing a river and a traditional wooden bridge,” Subhash Dolas, a resident, told Gaon Connection.
Many pregnant women from this village also go downhill to stay with their relatives so that they don’t have to struggle for their regular check-ups, Dolas said.
Abhay Bang, a social activist and community health researcher in Gadchiroli district, Maharashtra, said hundreds of revenue villages in the forests don’t have easy access to healthcare facilities. “If the government cannot develop infrastructure in interior villages, it should make villages self-dependent. Youth and women should be trained to work like ASHA workers,” he told Gaon Connection.
(This story was reported under NFI Fellowships for independent journalists. It first appeared in en.gaonconnection.com)
Varsha Torgalkar @varshasuman exposes the lack of essential health services in the interior forest villages of the western Indian state of #Mahatashtra & identifies the gaps in #India's #health policies based on this. #TheIndianSunhttps://t.co/VgqEXEhQ4q
— The Indian Sun (@The_Indian_Sun) May 10, 2021