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By Rupa Chinai At the Rowmari state health dispensary in Bodoland, which caters to villages within an 8 km radius, there is no electricity, no anti-malarial drugs, no paper and pens even for birth and death certificates. The health facilities here are indicative of the state of all Bodo areas, which show shockingly high maternal and infant mortality rates
 The shrouded body of a woman being carried in a mock funeral procession of several hundred Bodo women brought traffic on Assam's arterial highway to a grinding halt on International Women's Day, 2006. They carried placards proclaiming the 'murder of thousands of women in childbirth', while holding the government health department squarely responsible. Coming from across the Bodo hinterland, on March 8, the women converged at the national highway in Chirang district of Bodoland, drawing attention to the high maternal mortality rate (MMR) in these parts.
 Health facilities in the Bodo areas of Assam are abysmal, perhaps the worst in the entire northeast. A survey conducted by the Action Northeast Trust (ANT), an NGO working with health and livelihood issues, showed that in Chirang district alone, an estimated 240 women die during childbirth every year. They estimated overall maternal mortality to be 4,000 per 100,000 women.
"Why are the authorities not filling all the staff vacancies at the health centres? Why do doctors and nurses not fulfil their duties? Why are there no roads and bridges, no ambulances available to transport the sick," the protestors asked. According to official estimates by the Assam government, in the 'Assam Human Development Report 2003', the state's maternal mortality rate was 409 per 100,000 live births in 1998. The WHO, however, in its 'World Health Report 2005', estimated it to be over 700 (India's national MMR average is estimated at 407). The Assam government report reveals that up to 70% of women and children, especially in rural areas, suffer varying degrees of anaemia. Under-nourishment is substantially higher in rural areas. Diarrhoea is a common cause of death amongst children in Assam, and there is high morbidity due to communicable diseases. Another sensitive indicator of health, infant mortality rate (IMR), shows Assam as having a rate higher than the national average. In 1998, the IMR stood at 78 per 1,000 live births (National Commission on Population, Government of India), while the national average was 64. Of even greater concern is Assam's high under-five mortality rate, which has so far received little attention. In 1992-93, according to official figures, it stood at 142.2 per 1,000, while the all-India average was 109.3 per 1,000 live births. Economists like Jayant Gogoi, economics professor, Dibrugarh University, maintain that such indices point to major loopholes in government policy and the misutilisation of money allotted to the social sector in Assam. The state does not lack resources for social sector development, he insists. Other Indian states that spend even less money than Assam in areas such as public health, water supply and sanitation are demonstrating better health outcomes, he points out. For instance, Assam's per capita expenditure on public health, family welfare, water supply and sanitation is the least among the northeastern states, at Rs 46 per capita. However, West Bengal, which spends less than Assam, at Rs 36.32, boasts better performance. West Bengal has extended drinking water facilities to 84.9% of rural households. Assam, despite its higher spending, has only covered 43.2% of households. The overall neglect of tribal areas in Assam is reflected in the agony of Bodo women living in Dwimuguri village, situated 10 km from the nearest town Bongaigaon. In the absence of roads, the villagers have to walk or cycle to get to the town. Getting to the nearest primary health sub-centre at Rowmari is a two-hour walk that includes two river crossings. The primary health centre at Balamguri is at least a three-four-hour walk away. Even then, there's no guarantee that a doctor will be available at either centre. A sick person has to be carried in a thela (a two-wheeled cart). Many patients die on the way. This is what happened to Lomoti, aged 40 and a mother of five girls. Her husband forced her into yet another pregnancy because he wanted a son. His previous two wives had given him sons, but still, he needed to prove his manhood. Asked why he forced this pregnancy on Lomoti, the husband said: "People say, 'Is this a man if he has no son? What kind of man is he'. I do agree that there is no difference between a boy and a girl but people of every caste still talk like this. If there is no boy in the house it is not a complete home. Girls will go away. Many think like that." Lomoti gave birth to a son. But the placenta was retained and the bleeding would not stop. A nearby Bengali quack was summoned. He tried to pull out the placenta and stop the bleeding by giving an injection, but Lomoti bled even more and trained medical help was too far away. Lomoti died while being carried in a thela to a private doctor at Rowmari. Lomoti is the second woman in this village to die during childbirth and within the span of a month. Jonila, aged 27, the mother of two boys and a girl, also died after giving birth to a son. Although it was a normal delivery, Jonila began to bleed heavily and later became psychotic, babbling in a semi-conscious state. As she began to weaken, a quack was summoned who put her on a saline drip, but to no avail. Jonila's story came to light during a societal post-mortem that takes place after the death of a person. The whole village gathers to talk about what happened and to relieve their sorrow, says Jenny Liang, one of the founders of ANT. Pregnant women here do not have access to a health check-up, let alone institutional delivery, and there is no one in the village who can offer them knowledgeable advice. Lomoti's friend Deepa Brahma says that since her marriage, in 1993, she has seen a trained PHC nurse visit their village only twice, when she came to administer the children pulse polio vaccines. For all other health problems the villagers are on their own, or at the mercy of quacks. Whether we accept them or not, these quacks do provide the villagers some succour. Deepa's 12-year-old daughter witnessed Lomoti's death. Economically better-off, Lomoti used to help Deepa with food and small amounts of money when she was in dire straits. Traumatised over what she witnessed, the young girl was wont to go around with a blank, stony face, and then suddenly erupt in hysteria. There is no psychiatrist in Bongaigaon, and none of the medical stores there have drugs that are prescribed for such cases. The only person who finally helped the girl calm down was a tantrik whose mumbo-jumbo of prayers for the appeasement of the gods served to ease her trauma. The Rowmari state health dispensary, catering to villages within an 8 km radius, wears a deserted look on most days. There is no electricity connection; the labour room is bare; the only medicine available is paracetamol and treatment for worms, some antibiotics and ORS packets. There is no pharmacist. Anti-malarials, the most urgently needed drugs, are out of stock. Birth or death certificates cannot be issued in the absence of paper or pen or storage facilities. The recently appointed doctor says there is no security for his life and property against militants and anti-social elements. "What kind of services can a doctor provide when there is no access to basic resources? We refer cases and dispense a few simple medicines here," says the Rowmari medical officer, Dr P N Patel. "The main problem is that there are many poor people who suffer lack of hygiene and awareness. This is a malaria-infested area and waterborne diseases and tuberculosis are common. Patients are not able to purchase a single medicine, and we do not receive supplies. They say 'We would rather die than buy medicine; if we have to buy (them) then why would we come here?' I feel so disheartened." Nobody is really sure who is responsible for health infrastructure and access to services in the newly-formed Bodoland Territorial Council, thanks to the ambiguous clauses of the Bodoland Accord. Power to control financial resources and make key appointments still lies with the bureaucracy in the Assam administration. The long-standing neglect of tribal areas in Assam is resulting in some of the worst abuses of human rights seen in the northeast today, but neither the Assamese nor the Bodo elite have demonstrated enough concern at the plight of the poor in Bodoland. If the health services in and around Rowmari are abysmal, things are even worse in the interior villages of Bodoland where nothing exists. The worst of conditions are to be found in the Santhal refugee camps, such as the one visited at Bengtol which has been in existence since 1997 following ferocious clashes between the Bodos and Santhals over the issue of land. Around 97 Santhal families have taken shelter in this camp, and the past decade has seen no attempt at their rehabilitation. According to its inmates, around 77 people have died here from diseases like diarrhoea, malaria, typhoid and jaundice. "Nothing is available in the government dispensary. They tell us to buy the medicines but we have no money," says camp inmate Purmila Soren, a widow with two children. Her husband and son died during the clashes, and the rest of the family were forced to flee, abandoning the four bighas of land they owned. Purmila's neighbour, Muniram Mormu, says he had five children but only two are still alive. He lost his other children to pneumonia, typhoid and jaundice a year ago. Doing daily wage labour at the local bazaar, Mormu earns around Rs 50 a day, when work is available. The residents say no anganwadi worker or health staff has visited the camp. Even the most basic health services remain beyond their reach. Pregnant women pay up to Rs 700 for a delivery. The only bright sparks at the camp are the children who go to Hindi or Assamese-medium schools in the vicinity and receive three kilos of government rice per month. This is what they are entitled to, as cooked midday meals at school, but the food ends up being shared with the rest of the family. Lack of clean water has made the camp vulnerable to disease, and tuberculosis is common. Pegu Murmu, aged 70, and Danu Soren, aged 60, are both tuberculosis patients who are amongst the large number of people here who cannot access treatment. This despite the nation's TB programme that claims to have been successful in its outreach efforts to supply free treatment under the Directly Observed Treatment -- Short Course (DOTS) programme. Udoy Soren, 41 years and unemployed, is one of the leaders of the Santhal camp. He speaks of the desire of his people to return to their villages and farm their land. Although the local district administrators sought to bring about a reconciliation, and twice called the Bodos of his village for talks, no response was forthcoming. Soren says with a deep sadness: "We never thought anything like this would happen -- that the Bodos and Santhals would quarrel. We do not know how it happened all of a sudden. Today, when we meet our Bodo neighbours in the bazaar they do not say anything. They are no longer our friends. They do kheti on our land and eat its produce. There is nothing left for us. They do not give us even one maund of rice. Even then we have not said anything." (Rupa Chinai is an independent journalist based in Mumbai.) InfoChange News & Features, July 2006
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