Madhepura, Measles, Musahars, and Malnutrition.
This article was published in the Outlook magazine: a popular newsmagazine in India with a weekly circulation of 650 thousand copies.
https://www.outlookindia.com/website/story/madhepura-measles-musahars-and-malnutrition/328820
The year 2008 was a watershed
year for Bihar. In the middle of August that year, the Kosi floods ravaged
mid-eastern Bihar. The district of Madhepura bore the brunt of the monsoon
deluge. The river Kosi changed its
meandering course on the outskirts of the district and flowed right through its
middle, hitting spot on into its populous headquarter town and flowing beyond to the villages downstream. Displaced populations, broken roads, toppled
bridges appeared like burst seams of the underbelly of Madhepura’s hunger,
hardship, and health inadequacies.
Yet, fascinatingly, the
government’s administration rose like a phoenix with its myriad agencies,
workers, schemes and resources; and helped by organizations big and small who
joined the bandwagon, put together the challenging process of relief, rehabilitation
and restoration.
Measles epidemics are known to
flare up during natural calamities when large populations congregate in limited
spaces. As a consultant with an international development organization, my role
during the post-Kosi flood rehabilitation process was to support the health
department in its fight against a possible measles epidemic. In Madhepura, a
new Chief Medical Officer was flown in and Measles vaccines supplied on
priority in helicopters. By heroic efforts of ground-level
public health workers, 256,989 doses of measles vaccines were administered[1]. This helped effectively
prevent the epidemic. Even with a heightened surveillance system in the camps
of displaced people and flood-affected
villages, no measles deaths were reported from Madhepura till the very last day
of the year!
The last day of that year was
when the tides turned. The news was ominous. Seven measles deaths reported in
the papers from the Chandistan Musheri of Puraini block, district Madhepura.
Early in the morning, the District Immunization Officer and I headed east
towards Puraini. With much of the road still damaged, it took us a good half of
the day to reach the Primary Health Center of Puraini. The news had spread and
there was a mad rush for vaccination. A crowd of a few hundred men and women
with young children surrounded the lone nurse. Following some crowd management
and ensuring some more hands to help the nurse, we continued on our journey to
Chandistan Musheri.
Musheri
meant a hamlet of the Musahar people from the words “Mus” which meant “rat” and
“ahar” which meant “eater”. Musahars
represented the lowest stratum of Bihar’s society, landless and often moneyless
people. They had adequate food in their bellies only during the harvest
seasons. In between harvests, they were known to hunt for field mice and eat
them, thus getting their Musahar title.
As we approached Chandistan musheri, we met with an eerie huddle of quiet women.
Mothers, aunts, sisters, grandmothers; mourning the loss of young children who
had died the day before of measles.
A recurring question in my mind,
made me ask the mothers; “Did the children get their measles vaccine?” The
surprising answer was a resounding yes!! What then
was the reason behind this failure? Why were only Musahar children affected?
Where was this leading to?
I tried to find the answer with a
very simple medical device; a strip of colored paper
called the Shakir’s tape. Majority of the living children fell into the “red-zone” in the Shakir’s tape, as I measured
their mid-upper-arm-circumferences. The diagnosis was clear, the children were
acutely and severely malnourished. Despite the vaccination, they did not have
enough proteins in their bodies to muster antibodies to fight the measles
infection. The festering measles infection and a sudden dip in the already low immunity had made the children succumb to
simple and common childhood diseases; diarrhea
and pneumonia.
Measles, Malnutrition and
Mortality form an obnoxious “M” trinity. It is now well known that malnutrition is the underlying cause of over
45% of childhood deaths. The story of the
Musheri in Madhepura goes on to teach us that fighting the battle of childhood
diseases with weapons such as vaccines and medicines are not enough. With India
having very high rates of malnutrition, and states like Bihar with every second
child stunted, a more concerted effort is needed to engage the giant perils of
childhood illnesses in the last frontiers, such as the Musheris of Madhepura.
What then are these concerted
efforts? Simply said, these are a combination of efforts that raise the
quality of life in the Musahar family, enabling them to gain resilience to tide
through economic, social and health challenges. It will not only take the suite
of disjointed schemes to reach them but also the innate will and ability of the
Musahar family to maneuver the complex web of entitlements, services, and schemes, to make the most out of them.
We are hopeful about a few waves
of change that have reached the Musahar household in Madhepura. Musahar women are
becoming a part of self-help groups. They can now leverage micro-credits for
newer livelihood opportunities and overcome their dependence on the harvest
seasons. Behavior change interventions, based on simple doable actions and peer
influence are leading to better child feeding practices. Madhepura continues to
ensure 88% of its children get their full package of vaccines; even as a
special round of Measles and Rubella vaccination reaches a large cohort of
children with a second dose of the vaccine. Sanitation is taking giant strides
as more Musahar homes are constructing toilets and using them. Yet, there are
other schemes which are still on their way to the Musaheri hamlet. Public
distribution systems, land-holdings, agriculture, food production, primary
health care all need to prove their mettle in the Musahar’s home. Till such a
time as concerted efforts of the National Nutrition Mission ignites a Jan-Andolan
or a people’s movement; the hope that malnutrition will reduce, measles deaths become
rare and the Musahar children of Madhepura get a new lease of life, will still
be a dream. A dream difficult, but possible to achieve.
Comments