IF TARUN SEHRAWAT’S tragic death helps us put paid to the meaningless nostrum that simple people’s illnesses require simple remedies, then it will at least have served some larger purpose. In fact, nothing could be further from the truth. In recent months, it has come to our knowledge that a number of young journalists covering events in south Bastar have fallen prey to acute febrile illnesses of life-threatening intensity. Not all these episodes could be reliably ascribed to malaria, or indeed, any specific diagnosis. Similar episodes have occurred among paramilitary forces posted in this region. These illness episodes are important because they are indicative of the kind of milieu in which the ordinary citizens of these areas, with the same rights and entitlements as you or me, live out their lives — their infancy, their pregnancies, and their old age — all of them periods of special vulnerability. It is in these circumstances that women face the prospect of an anaemic labour without benefits of the possibility of Caesarian section, should the need arise.
Indicative, but of what? The common occurrence of these serious illnesses shows that appropriate conditions exist for the transmission of disease — that there are ample reserves of disease-causing organisms in the community, as well as large populations of pathogen-transmitting vectors. For example, in the case of cerebral malaria, this would mean that there are large reserves of Plasmodium falciparum in the community, as well as large populations of Anopheles species to transmit the disease. It would also mean that routine public health epidemiological surveillance to detect — and reliably report — levels of pathogen in the community is not in place. It would also mean that entomological measures to detect and control vector populations are absent. The same story is repeated, disease after disease, and region after region. What it all adds up to is a complete collapse of public health and primary healthcare across the country.
There are two additional variables that need to be factored into the equation thus described. One is the largescale prevalence of chronic malnutrition, which renders normal immune resistance unavailable. Close to half of all children below five years of age — Manmohan Singh calls it a “national shame” — and 37 percent of all adults, including over 50 percent of STs and 60 percent of SCs are malnourished. They enter this literally life-and-death struggle with their chances compromised due to socially generated inequity. As the World Health Organisation’s Committee on the Social Determinants of Health says, “Inequity is killing people on a grand scale.”
The second factor is that of the current shape of economic policy and planning. The high-level expert group set up by the Planning Commission recommended that appropriate healthcare should be available to all people as an entitlement, free of charge, and funded out of tax revenues. Subsequent discourse has made it clear that funding for this bold initiative is not going to be available.
I first visited south Bastar as a member of a People’s Union for Civil Liberties team to investigate an epidemic of blood dysentery, three years before Tarun was born. The disenfranchisement and distress I encountered then remains in place today. An old man now, I suddenly find myself grief-stricken — for a brave lad I never met, but also for a question Umrao Jaan asked in the film named after her: “Yeh kya jagah hai doston?(What is this place we have come to, my friends?)”
Dr Binayak Sen is a Public Health Specialist & Human Rights Activist