Losing The fight Against Malaria

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Familiar tale Since 26 May, more than 45 people, most of them children, have died due to malaria, Photo: Abhisek Saha
Familiar tale Since 26 May, more than 45 people, most of them children, have died due to malaria, Photo: Abhisek Saha

Laxmi Tripura was only two when she succumbed to malaria. She hailed from a landless tribal family in the Deo forest reserve of Dhalai district in Tripura. Laxmi’s family did not have any access to basic healthcare; there are no roads to the forest village, no power, no education, no jobs and thus no money.

Laxmi’s death is not a one-off case. Hundreds of toddlers have fallen prey to the disease in Tripura, one of the most malaria-prone states in India. In fact, the state was declared malaria drug-resistant in 2009. And there is a fresh outbreak. At the time of going to press, more than 45 people, including 30 children, have died since the first death was reported on 26 May. As many patients do not reach the hospitals, the actual toll could be much higher. More than 22,000 people, mostly tribals, have fallen sick due to vectorborne diseases, and 4,000 of them are diagnosed with malaria.

“The actual toll could be double as many deaths from far-flung villages are never reported,” says senior Congress leader and MLA Ratan Lal Nath. “The tribals depend on village quacks as they have never seen the face of any medical service in their village. For them, malaria is an annual affair, a calamity that they know they have to face. Not only has the Left Front government been a total failure in fighting the annual malarial outbreak, but the entire health infrastructure in the state, too, is outdated and in a shambles.”

In the past fortnight, 800 people on an average have been reaching hospitals across the state every day with symptoms of malaria, say sources, forcing the state government to send distress calls to New Delhi for help.

The Centre has sent experts to capital Agartala and emergency medicine has been airlifted there even as five of the eight districts in the state are grappling to contain the outbreak.

“The situation is grim, but not out of control,” maintains Health Minister Badal Choudhury. “In fact, we have pressed the entire health apparatus into service and medical teams are reaching far-flung areas. We have asked the Centre for help as well. We have cancelled the leaves of all doctors, nurses and health workers. We are making arrangements to bring malaria-affected people to government hospitals. A helicopter is also on standby.”

But Tripura’s battle against malaria goes beyond the annual death toll. It is one of the few states that was declared malaria drug-resistant by the Union health ministry because traditional medicines used to treat the disease came a cropper. The tag came after the Centre conducted a survey in the state in 2007 and found that traditional anti-malarial drugs such as chloroquine are not effective on the malaria patients of Tripura.

“Initially, that was the case in only a few areas, but now the entire state is drug-resistant,” says health and family welfare department director SR Debbarma. “The bigger problem is that malaria takes malignant forms and causes brain fever and meningitis, leading to more deaths. Now, we are using second-generation drugs. The plasmodium falciparum found in infected persons here is only responsive to second-generation drugs.”

The recent bout of malaria has affected the districts of Dhalai, Gomti, Khowai, North Tripura and South Tripura. The remote Gandacherra and Kanchanpur subdivisions in Dhalai and North Tripura districts, respectively, are the worst affected with almost all the villages under malaria attack. Reports reaching Agartala suggest that the tribals who earn their livelihood by practising shifting cultivation on the Kalajhari range in Gandacherra were the first to be affected in the latest outbreak.

But Tripura should have been prepared for the outbreak given the fact that it is malaria-prone and a special anti-malaria drive is afoot, augmented by the National Rural Health Mission (NHRM) under the aegis of the National Vector-Borne Disease Control Programme.

“The government is getting huge funds from the Centre but they have either not been properly utilised or siphoned off,” alleges MLA Nath. “All work done is only on paper. If you go to any of the remote areas affected by malaria, you will see that there is no health infrastructure. There are no roads; patients are brought to the nearest road-head after trekking for hours.”

The Manik Sarkar regime enjoys huge support from tribals. In the 2013 Assembly election, the Left Front won all the 20 seats reserved for tribals in the 60-member House. But, it is the same tribals who are bearing the brunt of the disease.

“Tripura was declared malaria drug-resistant in 2009, so by what logic is the government still buying traditional anti- malarial drugs?” asks a health department official on the condition of anonymity. “We are buying them every month… for whose benefit? Nobody is probing it.”

Even the security forces deployed in Tripura are not immune. The worst affected is the Border Security Force (BSF), which patrols the 856-km border that the tiny state shares with Bangladesh. In fact, since 2006, the BSF has lost more jawans to malaria than to militancy.

“The BSF jawans who guard the border near our village also get affected but they get cured because they are provided with medical assistance straightaway. But for civilians like us, we have to wait for the state government, whose initiative is largely absent,” says Durbajoy Jamatia, 55, a landless tribal farmer who was admitted at Gandacherra Government Hospital with the vector-borne disease. “My wife and two daughters are also suffering from malaria and are in the hospital. This is not for the first time that I have been admitted with malaria. I have been infected four times before. For years, we never saw a medical team visit our area.”

There are hundreds like Jamatia who are waiting for Manik Sarkar to come up with an action plan to fight malaria, a promise he has been making ever since he became the CM in 1998.

“Globally, the death toll due to malaria is falling; the same is the case with other parts of the country,” says Arkadripta Chakraborty, a photographer from Agartala. “But here, people are still dying due to primitive vector-borne diseases. One of the key focus areas in the Northeast should be health infrastructure.”

Just before the recent outbreak, the Central government had warned Tripura to revitalise its vector-borne diseases programme as the state had managed to utilise only 21 percent of the total funds sanctioned in 2012-13. In 2013-14, Tripura was allocated Rs 193 crore under NHRM, of which only Rs 17.80 crore was given for vector- borne diseases as per the action plan.

“A major problem is the interference of the ruling party,” says a senior NHRM official on the condition of anonymity. “We have funds for malaria control, but not the manpower. In many cases, vacant posts were not filled. In cases where they were filled, political interference was a hurdle in hiring good candidates.”

Health Department officials hardly visit remote villages, says the official, so a proper action plan could never be implemented despite the drug-resistance alarm. That the state government had to suspend no less than 50 rural health workers for negligence in anti-malarial duties shows that Tripura is losing its battle against the killer disease.

ratnadip@tehelka.com

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