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The underfed and the unscrupulous

By Shahina K K

In Raichur district of Karnataka, where over 4,500 children face acute malnutrition and 2,689 have died of malnutrition in two years, there is a vested interest in maintaining the status quo. The greater the problem, the higher the multi-crore contracts for supply of completely inedible, even dangerous, supplementary food packets to anganwadis

‘Malnutrition is what you have when your body does not get enough nutrients’: I boarded the train to Raichur with this bit of Wiki knowledge. I was going to Raichur for a reason. This district of northern Karnataka was recently made infamous by a report that said 2,689 children here had died of malnutrition over the past two years; and this was the official figure, with the state’s Department of Women and Child Development expecting even more deaths. The number of children facing acute malnutrition in Raichur was estimated at 4,531.

As it turns out, the men and women I meet in Raichur’s villages have never heard the word ‘malnutrition’ before. It is not the fault of the local language. They don’t know apoushtikatha, Kannada for malnutrition, either. Hasn’t anyone from the government ever told them about it? The answer is uniform: nobody has.

Malnutrition is not to be confused with starvation. In this part of Karnataka, it is not difficult to find a family of five or six surviving on just 250 gm of rice -- or five-six rotis, one for each -- every day; sometimes accompanied by bhindi or palak. Dal is an unaffordable luxury, meat is for very rare occasions, and milk for children is something they never think about. This is enough to stay alive, but not for a normal existence.

The difference, or lack thereof, hits us in the gut when we enter a small mud house in Chikkasugur village. As we open the door, it’s dark inside. Lying on the floor we spot little Divyashree trying to raise her arms to cover her eyes because they can’t take the intrusion of sunlight. But she fails. She doesn’t have the strength. She looks like a six-month-old baby with bony limbs. But she is three years old, we learn, and running a fever.

Divyashree, who is among Raichur’s 4,531 malnourished children, is being taken care of by her sister Ashwini, a 10-year-old who has stopped going to school because there is nobody else to look after Divyashree when their mother goes to work. Madhavi, their mother, is out by nine in the morning and returns home at six. She cooks rice before leaving. Rice and chilli are what these two children eat the entire day. Occasionally, there is potato and palak, even bhindi or brinjal. The list of vegetables familiar to them is short.

“She does not like rice,” says Ashwini, of her sister. “She often cries in hunger. I give her kurkure when she cries.” A crispy snack that takes its name from a Pepsico product, kurkure is something they get free. In Raichur, it is a standard hand-out of India’s anganwadi network, which was set up in the mid-1970s to combat child hunger under the Integrated Child Development Services (ICDS) scheme. But Ashwini also buys small Rs 2 packets of kurkure from a nearby grocery shop. That’s 2% or more of the daily budget. “I get hardly Rs 100 for a day’s work (and that’s when I do get work),” says Madhavi, trying to explain how she manages life on her own. Her husband left them a month after Divyashree was born. “I don’t buy milk or dal because both are expensive. Rice costs Rs 20 per kg.” In their single-room hut, the only food item we see is a 5 kg sack of rice. She says she also buys 300 gm of tea and 1 kg of sugar, to be used sparingly to last an entire month, from the open market. She has a ration card, but kerosene is all she gets from the PDS shop; why she doesn’t get rice and sugar she has no idea. “I don’t think about such things,” she says, turning pensive. “I don’t think for even a minute about the life we live. I prefer not to think about the future of these two girls.”

Madhavi knows Divyashree is underweight, just 4 kg. She could not breastfeed her because she had “no milk at all” to do so. Why, Madhavi does not know. She has no idea whether she is anaemic or not. Clueless about her own health, she was married at the age of 12. Her elder child Ashwini was born healthy, but Divyashree was visibly much too tiny. “The doctor kept her in a box made of glass with a light inside,” recalls the mother. The baby was allowed home after a week and the doctor wanted her brought back for regular check-ups. “It was not possible,” says Madhavi. “We could not afford regular hospital visits… so no treatment was given after that.” Every month or so, Divyashree gets diarrhoea and fever, but Madhavi has no option but to go to work, leaving the three-year-old with Ashwini.

***

Mallamma, living in a hut not too far away, had two children: Anjaneya, 5, and Bhagyalakshmi, 2. The younger one died in August, and Anjaneya one month later. Both were on the official list of children facing acute malnutrition since 2010. But being on the list was not enough to save their lives. In fact, it made no difference. Bhagyalakshmi had stopped walking and talking two months before her death. Anjaneya had been unable to walk for quite some time.

Till this day, Mallamma has no clear idea of what malnutrition is. She once heard the word used by someone to explain a death in the village, that’s all. She is clearer about how little she earns: Rs 50 a day, if she manages to get work, which is something she can count on only in the rainy season. Her husband earns twice as much, also mostly in the rainy season, even if his earnings are of little help to the family, as she hints. A bag of rice is all the food they have at home. She hardly buys vegetables, dal or milk. She is reluctant to talk about her children, but admits they did not have enough to eat. She tried feeding them anganwadi-dispensed food. “The children did not like that food,” she sighs. “It had a bad smell and often caused stomach pain and diarrhoea. Before her death, Anjaneya had been unwell because of that food.”

Both Anjaneya and Bhagyalakshmi had recurring fever and diarrhoea, their bouts of illness lasting four-five days each month. If Mallamma had the money, she would take them to a private hospital 25 km away from the village, since the primary health centre nearby was closed most of the time. “The doctor would say nothing,” she recalls, clueless about the cause of their illness, “just prescribe medicines”.

Mallamma, who was married at 12 and is still a teenager, is currently in her ninth month of pregnancy with a third child. The delivery will take place at home. “It is not practical to go to hospital,” says her husband Venkitesh. But it’s not as if she has had no medical attention. A month ago, she had a scan and blood test, we are informed, as medical reports are fished out and presented to us as proof. She cannot read them. They are in English and suggest that Mallamma has acute anaemia. She does not know that she has this condition. Or what it is.

Their elder daughter’s death received its share of media coverage, public outcry and political posturing. But Mallamma’s life has not changed at all. “A minister came. He told us that they would call us soon,” she says. Her guest was C C Patil, Karnataka’s minister for women and child welfare. That was the last they heard from the minister.

***

Nagaraj died on October 23. He too was on the list of malnourished children. He was diabetic. The family, already burdened with a Rs 70,000 debt to moneylenders, could not afford insulin injections. “These had been stopped four-five months (before his death),” says his mother Parvathamma. She did not know that the child was undernourished. “We had no money to buy the medicine,” she says, “that is the reason for his demise.” The boy was “eating well,” she adds. A diet of 250 gm of rice and a roti is what she considers wholesome fare. That’s what each of the six members of her family -- including two younger children and her mother -- have every day, with a potato or palak serving on occasion.

If the people in Raichur are unclear about malnutrition, district officials appear only slightly better informed. District Collector (DC) V Anupkumar, for example, is vague about how malnutrition is measured in the area. “We have launched a programme to measure the weight of all children,” he says. Asked if that’s enough to identify an undernourished child, he says nothing. On relief provisions, the DC says: “We give nutrition supplements, but that is only an addition to the regular food they consume.” What the ‘regular food’ is, he has no clue, since no proper survey has been done by the government to find out. And the ‘nutrition supplements’ he speaks of are the food packets handed out by the anganwadi network. Lately, the quantity of packet food delivered to it has been doubled, adds the DC, hoping to impress us. Whether the food causes diarrhoea or whether children find it edible are questions he does not answer.

***

Malnutrition data in the district is dodgy for a reason. Somebody seems to have an ulterior interest in keeping the numbers large. This is clear from a visit to an anganwadi in Chikkasugur village. It has 123 children on its rolls as malnourished. We meet only 14, and the teacher present here -- the scheme covers education as well -- says that daily attendance ranges from 15 to 20.

The food hand-outs, we discover, are not very sought after. “Please take more packets, we don’t want it here,” the teacher tells us when we ask for a few sample packets. “The children hate this food. Their stomachs ache and they have diarrhoea when they eat this. When we complained, we were told that there would not be any change in supply for two more years. That is when the tenure of the contract with the private supplier of these packets will end.”

There is a pile of food packets dumped in a corner of the hall, easily traceable by its unpleasant odour. There we spot packets of Nutri kesari bhaath, Nutri masala mix, kurkure and a nameless powder in pale yellow without any label. “Till 2009, the menu was different. Rice and green dal were provided to children. Now they are provided with these powder packets,” says the teacher. Another anganwadi teacher opens a packet and hands us crispy munchies popularly called ‘kurkure’. In shape, it does not look like the branded variety made by Pepsico, but it tastes much the same. She also opens a packet of masala mix, which claims to be a nutritious mix to be cooked with rice (not on offer). This brown powder also tastes like kurkure.

“Kurkure is nutritious,” says a senior official at Karnataka’s Women and Child Welfare Department later, on condition of anonymity. “The allegations of diarrhoea and stomach pain are baseless. People are always reluctant to eat something new.” Why supply these packets instead of regular rice and dal? His answer is simple: “To attract more children to anganwadis.” More children means a larger contract. Explains Kavita Ratna, communications director of the Bangalore-based NGO Concerned for Working Children: “The contract is of Rs 900 crore, and M/s Christy Friedgram Industry, a processed food company based in Tamil Nadu (which did not respond to our queries), provides these food packets to anganwadis.” She adds: “It is a clear case of violation of the rights of children and the Supreme Court order prohibiting the use of contractors in the ICDS.” In an order dated October 7, 2004, India’s apex court made it clear that the procurement and preparation of ICDS food should be carried out only through village communities and self-help groups. “Besides,” says Kavita, “the food contains certain constituents in higher quantities than the permitted levels. For example, in the tested results, it was found that the content of zinc is in dangerous proportions. It is a nutrient, but if it crosses the permitted limit it turns toxic.” In tests conducted in early-2010, the NGO found that the content of transfats (commonly found in hydrogenated vegetable oils like Dalda) was much too high. “They changed it when we made a great hue and cry,” says Kavita, who alleges that the children’s food scheme has become a sordid money-spinning exercise for those involved. This also explains why control of the ICDS, a scheme that was placed in the charge of gram panchayats by the 73rd Amendment of the Indian Constitution (as also the Karnataka Panchayati Raj Act), was taken back by the state government.

So long as there are multi-crore contracts to be had, you can be sure of two things: long malnutrition lists and apathy towards the malnourished.

(Shahina K K is Assistant Editor of Open magazine. This article first appeared in Open)

Infochange News & Features, July 2012