Anatomy of child starvation deaths

 By Kathyayini Chamaraj

The shocking facts about the maladministration that led to the recent deaths of severely malnourished children in Raichur and Mysore districts of Karnataka. Fifty per cent of Karnataka’s 0-6 age-group suffers from various stages of malnutrition, with many on the verge of death

starvation deaths

 

Two stories have been hogging the headlines in Karnataka over the last few weeks.  One is the sensational and sordid story of illegal mining and looting of iron ore, the vulgar accumulation of wealth by the mining mafia and their use of this wealth to buy political power, keep a stranglehold on the government and hold democracy itself to ransom.  The denouement of this story has been the dislodging of the chief minister on charges of involvement in corruption.  

However, the above narrative has overshadowed a parallel but deeply disturbing story.  Mahalakshmi (2) and Anjaneya (4) allegedly died of starvation on August 6, 2011 in Malledevaragudda village of Raichur district of Karnataka according to Samajika Parivarthana Janandalona, which works on child rights.   The girl, Mahalaxmi was 2.2 years but weighed only 3.5 kg while her elder brother Anjaneya was 5 and weighed a mere 5 kg.  Officials are however attributing the deaths to consanguineous marriages which experts are rubbishing.  Chief Minister Sadananda Gowda, who visited the district, accepted that 1,233 children had died in Raichur district alone in the last two years and that 4,531 were on the verge of death due to malnourishment. 

Maani Moole Haadi is a settlement of the primitive tribe of Jenu Kurubas deep inside the forests of Dodda Byranakuppe gram panchayat of HD Kote taluka, Mysore district.  Sharan, a two-year-old, is alleged to have died here on August 6, 2011 of malnourishment aggravated by illness. A fact-finding team -- which included Clifton D’Rozario, state advisor to the commissioners of the Supreme Court in the Right to Food case, and Sudha K, state convenor of the Right to Food Campaign-Karnataka -- visited the settlement and released its report recently. 

The contrast between the two narratives above in a state that is considered one of the successes of liberalised India – the loot of mineral wealth through a globalised and liberalised economy, and the simultaneous neglect of the basic needs of the populace -- highlights the impact of the skewed development policies adopted by the state. Despite its growth saga, Karnataka is in the 11th position out of 17 worst districts on the Indian Hunger Index -- behind UP, Rajasthan and other southern states. One wonders how such a situation could arise with a bevy of ANMs, ASHAs and anganwadi workers all working to eradicate malnourishment.  According to statistics provided by the department of women & child development, out of 32 lakh children who were weighed (of a total of 71 lakh 0-6-year-old children) only 16,04,006 were found normal. 

More than 11 lakh were suffering from Grade 1 level of malnutrition, 5 lakh from Grade II, 8,000 from Grade III and 643 were on the verge of death.

According to a Supreme Court ruling in the Right to Food case, the state is supposed to universalise ICDS and provide anganwadis on priority basis in all SC/ST and tribal hamlets. If one assumes that about 25% children from affluent families, out of the 71 lakh children in the 0-6 age-group do not need the services of an anganwadi, 53,55,000 still need one.  On the basis of one anganwadi for 40 children aged 0-6, the state needs at least 1,77,500 anganwadis.  However, despite the high levels of malnourishment in the state, there are only 63,377 anganwadis currently, less than 50% of the requirement.   Only around 16 lakh children are receiving pre-school education.

Shockingly, in the five anganwadi centres in Raichur district that were visited by Clifton D’Rozario, none of the children weighed more than 10 kg. It was also noted that the blight of severe malnutrition disproportionately affected girl-children and children from the scheduled castes (SC). Other lacunae identified in the Raichur report include:

*All children between 6 months and 3 years do not regularly use the anganwadi facility. They were weighed only if they came to the anganwadi.
*The anganwadi teachers are required to submit monthly reports to the supervisors about children suffering from malnutrition, yet the supervisors had not taken any action.
*Even those identified as severely malnourished do not receive proper medical attention and no effective steps are taken to ensure that the condition of the child improves.
*Most of the malnourished children only receive a double dose of pre-packed food and not freshly-cooked food.
*The families of the malnourished children had temporary ration cards and the quantity of foodgrains received is insufficient.

One of the primary issues raised by civil society groups with the department of women and child development was the contract entered into by the department with M/s Christy Friedgram to supply food to the anganwadis even though the Supreme Court had strictly prohibited use of contractors to supply food to ICDS centres.  Further, the food was not palatable and hence there was a strong link between the lack of nutritious food being supplied and increasing malnutrition. The Lokayukta is investigating the irregularities in engaging M/s Christy Friedgram.  

The report of the fact-finding team throws light on the roots of the problem of malnourishment.  Sharan (2) of Maani Moole Haadi was suffering from measles and was taken by his parents to the Dodda Byranakuppe hospital on August 4, 2011.  The doctor gave them some tablets and a tonic and sent them home.  However, Sharan died on August 6. 

Jaanu, Sharan’s mother, informed the fact-finding team that the ANM at the hospital had taken money from them. “We are poor, how shall we pay hospital charges? There is no weighing machine at the hospital.  Our child was hence not even weighed. There is no anganwadi in our settlement and hence our children get no supplementary nutrition. We do not even possess ration cards,” she told the team.

Sharan reportedly died because starvation left him too weak to withstand the disease.

Twelve of the 24 enrolled children in the crèche run by the NGO Deeds in the hamlet were suffering from measles. The hamlet has no clean drinking water facility or electricity. Since there is no anganwadi, growth charts of the 24 children have not been maintained and pregnant and lactating mothers too have been denied supplementary nutrition and counselling. The fact-finding team’s visit prompted officials to promise that an anganwadi would be opened within the next 15 days in the hamlet. 

Of the 38 families in the hamlet, only 23 have Antyodaya cards, while the remaining 15 have none. The food inspector of the department of food & civil supplies explained that when officials visited the hamlet to take photographs for the ration cards, these families had migrated on work and were unavailable.  He promised to speak to his superiors and take action.

There was no water or electricity at the primary health centre (PHC).  The doctor at the PHC told the team that though there are supposed to be four ANMs, there were actually just two.  The PHC has no vehicle and hence it takes half-a-day to visit one hamlet.  If there is an emergency, people are unable to  call for an ambulance as there is no telephone network in the area.  It takes a minimum of four hours to come by other means and anything can happen during this time.  The doctor told the team, “If the government provides all facilities, I can work efficiently.”  

Since the PHC lacks adequate facilities, the doctor refers most delivery cases to the Mahanandawaadi hospital in the neighbouring state of Kerala.  Given this situation, home deliveries are common.  Only after Sharan died were 10 children examined and Vitamin A tablets given.

A gram panchayat member told the team that when the PHC doctor refers patients to other cities, the people in the hamlet cannot afford to spend money on the bus charges and medicines.  There is only one bus that runs from the hamlet.  Patients have to travel to and fro in the same bus.  If the queues at the hospital are long, they often have to return without treatment as they would otherwise miss the bus.  None have the Yeshaswini health insurance either. 

Under the MGNREG Scheme, 50 persons in the area had worked for 30 days in the forest two years ago.  But they had received wages only for 10 days at Rs 82 per day.  While wages for 20 days are still due to them, the scheme is no longer being implemented in the hamlet. 

Families frequently migrate to Coorg for work, leaving their small children behind with the elderly. There is no one to take care of the children properly, resulting in malnutrition and frequent ill-health.  Though a scheme to distribute 1-2 gunthas of land to each of the families has been announced by the government, the families are opposing this saying they need five acres each to live with dignity.

Six senior citizens, two widows and two mentally challenged people in the hamlet applied for social assistance pensions two years ago, but are still to get any benefits. While the hamlet is deprived of all amenities that could bring about inclusive growth, vested interests are trying to bring back liquor shops that had been closed earlier.  Some development indeed!

While children like Sharan were dying, Karnataka’s politicians were flying to resorts with their coterie of MLAs, to guard them against horse-trading by their own party members and/or those of the opposition.  They were confabulating at party meetings to devise strategies to counter their opponents. They were holding press conferences to deny the corruption charges hurled at them by opposition leaders. Almost daily, they were flying to Delhi to apprise their party leaders of party goings-on in the state and take orders from them.  They were visiting heads of religious organisations to get their blessings and secure the lasting support of their caste vote-banks. And in between all this running to and fro, they heli-hopped to temples to conduct special poojas and pray for their political survival.  One wonders when they had the time to govern amidst this busy schedule.  Did any of them have time to enquire why Sharan, Mahalakshmi and Anjaneya died? 

Their political survival  would have been better served if they had heli-hopped to remote hamlets like Maani Moole Haadi or Malledevaragudda, understood why development hadn’t ‘trickled down’ to them, or why growth had not been ‘inclusive’ enough, and done something to make it happen.

Recommendations

The recommendations of the state advisor to the commissioners of the Supreme Court include:
*Every single anganwadi must be provided with a weighing scale.
*Community-based nutrition centres (which could be the anganwadis themselves) should be started in villages with severely malnourished children, and these children should be fed a special diet of khichdi, eggs, milk, bananas, etc. 
*The government should consider setting up nutrition rehabilitation centres, linked to the community health centres or district hospitals.
*The state government should terminate its contract with M/s Christy Friedgram and instead provide children with milk and hot cooked meals of rice, dals, gram, eggs, vegetables and fruit at the ICDS centres.
*The state government should increase the budgetary allocation for provision of nutritious food and other services under ICDS.
*All vacant posts must be filled and an additional worker needs to be appointed in the anganwadis, with the specific task of looking after children below the age of 3.
*A pre-fixed Nutrition and Health Day should be observed each month, with mandatory joint presence of the anganwadi worker and community health worker, which could also serve as the designated day for the distribution of 'take-home rations' together with weighing of children below 3.

(The writer is Executive Trustee of CIVIC Bangalore and convenor of the Bangalore Urban district chapter of the Right to Food Campaign-Karnataka)

Infochange News & Features, November 2011