AID - Report on CHOLERA EPIDEMIC IN MOHANA BLOCK, Orissa

The Mohana block of Gajapati district is one of the most remote, inaccessible tribal areas of the state. It has recently been in news for spread of Cholera which started from Kashipur and Dasmantpur blocks of neighboring Raygada district.

A two member team of AID India, Orissa chapter which operates out of the AID Rural Technology Resource Center (ARTRC) located near the district headquarters, Paralakhemundi in Gosani block visited the cholera affected area to understand the ground realities and figure out a way to help.

Map of Gajapati district. The Northern one-third of the district represents the Mohana block.

The above figures themselves illustrate how ill-served the population of the block is with respect to their needs. Combined with a very poor communication network, the people of this area have to fend for themselves in face of natural and man-made disasters.

The main cause of diarrhoea in the mohana block is the consumption of infected and contaminated water by the people. Most of the villages are in the middle of the hills where there is no tube-well. People are forced to drink and cook with the ‘nalla’ and spring water which is polluted during the rainy season. There is no clean and pure water available for consumption. Again the few tube-wells which are available in some villages are not functioning well. In many villages there is no cement platform around the tube-well. Many wells are in the low level to which outside water enters easily during the rainy season polluting the well water.

Another cause that exacerbates cholera in this area is the consumption of wild mushrooms without any treatment. Wild mushrooms are available in the forest area, particularly during the rainy season. Many people are unable to purchase any vegetables but cook this un-hygienic mushroom which often leads to stomach ailments.

Christian community & Tribal community dominate this block. They consume beef regularly, particularly on every Friday, Saturday etc. Even they store the excess beef by simply drying it and consume it after some days. This is a common practice by almost all Christian tribal communities in this block. In the rainy days the beefs are not dried properly so it becomes un-hygienic to eat after two or three days, which often leads to stomach upsets, diarrhea and makes cholera worse.

Open defecation is a common practice in this Block. Private toilet is a luxury in the remote hilly area. Also the people are culturally averse to using toilets instead of open fields. This often leads to contamination of water and spread of disease, particularly, in rainy season.

This is the most vital cause of health epidemic. Education & awareness are complementary to each other. As most of the people are illiterate, they are not aware about the environmental pollution .Even they are not able to follow the direction of Angawanwadi worker. This ignorance leads to blind belief, for which they are reluctant to take ORS, medicine, Chlorinated water etc. if at all available. Often epidemics like cholera is treated as an act of God and quacks and priests are called upon for treatment. This complicates the situation.

Abject poverty is the sole underlying cause of all the problems for the people. Most of the people belong to BPL families and lack the purchasing power to buy the very basic needs for their family. Water filter, clorine tablet, bleaching powder and even rubber sandals for their feet etc. are beyond the reach of most people.

Non-existent or very poor access makes a disaster situation worse. Many villages are on the hill top where there is no road access. Roads, where they exist are damaged badly. Recently many people died en-route while coming to the nearest health center for treatment. Patients have no alternative but to come in ‘sabari’ or some kind of a hand carried stretcher etc. which takes hours to reach hospital. Even the medical team and health workers are not able to reach to the people due to poor road network. This is worst in rainy season. People travel more than 20-25 kilometers to avail primary health treatment. Recently three person namely Dasuram Majhi, Joseph Majhi and Saimon Majhi of Gunduripanka village died en-route while coming to the Birikot hospital.

Government’s health facility in this block is very poor. The health infrastructure in this block is inadequate .There is only one C.H.C & one Mobile Health Unit in Mohana block. Where there are only 13 doctors and 10 staff nurse are working for 32 panchayat and 476 inhabited village and 23801 households & for 150,000 people (approx). Though cholera is affecting regularly, government does not take timely preventive measures. This year after some death and news paper reports, government took preventive measures, arraging mobile health unit, supplying more field staff to some villages etc. But many field staffs are not staying in the field due to fear of Naxalites and non availability of electricity, food etc. The provision ambulance, medicine, bleaching powder, chlorine tablet, saline etc. for the patients is inadequate which aggravates the situation.

Fear of naxalite attack is another problem for which the poor people are suffering day by day. It is just like a two way sword, in one way the local tribal people afraid to go to the hospital due to naxalite pressure and on the other hand the medical staffs are afraid to go to the interior hilly area due to the fear of naxalite attack. One naxalite leader Dasuram of Gunduripanka village died without coming to the hospital on the fear of arrest by the police. Similarly, the members of mobile medical unit are not staying in the remote/hilltop village due to the ear of naxalite attack.

So these are the major causes of the current cholera epidemic in the Mohana block. This needs urgent attention from both government and civil society organization.

The following steps are suggested as an immediate action to mitigate the situation.

Supply of sufficient bleaching power, chlorine and halogen tablets to purify the water.
Supply of water filter to as many households as possible or communities, particularly in the worst affected panchayatas like Guluba, Beganda, Gunduripanka, Paniganda, Birikot etc.
Supply of sufficient saline, ORS, injection to the mobile health unit in the affected areas.
Awareness campaign in villages about health epidemic and waterborne diseases.

Low income and low education are the two most important causes of sufferings of the people in this Block. So the first and foremost thing is to address this issue.

Functional education to help people with life skills need to be emphasized.
In every village one community doctor (Barefoot Doctor) must be created to give first aid treatment at any time. This can only be done with Government support.
A small gravity fed water tank with natural filtration system must be established in every remote and hilltop village where there is no tube well.
Roads to the hilltop and remote villages must be repaired and constructed.
Micro-credit and micro-enterprise interventions must be taken up to increase people’s income.

The budget is envisioned to cover about 60 villages spread over 16 GPs out of a total of 32 GPs. Once we are able to do the following work, we hope to have a base in the area and be in a position to work on the long-term issues.