September 23, 2010

Dukhni Bai's Story - Diabetes and the Vortex of Poverty

A tale of illness and disability that have brought a good family to the brink of despair. 

Dukhni Bai, 36, ravaged by diabetes for eight months

Duhkni Bai at the JSS hospital, skin and bones
Dukhni Bai, 36, first presented at the JSS hospital in Ganiyari in January 2010. She spoke of falling ill in November 2009, at the time of the rice harvest. At first, she noted weakness in her legs and a growing, ultimately disabling, weariness. Both were accompanied by constant thirst and frequent urination. A gnawing backache tormented her throughout the day and night. She progressively lost weight despite a good appetite.

Landless laborers sewing paddy, rural Chhattisgarh
Until then, she worked in the fields in the vicinity of her village, Nevra, in the Bilaspur District of Chhattisgarh. Every year, beginning in July with the onset of the monsoon season, like most other day laborers in central India, she sowed rice seedlings in the fields around her village, weeded the growing plants and then, in October and November, harvested the mature paddy (rice stalks). Like others around her, these months, Dukhni Bai could be seen all day bent over at the waist, much of the time exposed to the brutality of the sun and high humidity.[1] These relentless daily assignations earned her 40 rupees daily – less than a single U.S dollar.

Dukhni Bai's husband, Jai Hari
Her distinguished-looking husband, Jai Hari, earns a few rupees more than his wife at hard labor and fieldwork, gaining often 50 rupees daily. Such marginal employment is available most months, September being the usual exception. In July and August, it’s sowing seeds and plowing. Following harvesting in October and November, in December and January, it’s threshing season, turning dhan[2] into edible rice. The rest of the year, February through May, when there is no fieldwork, Jai Hari looks for work “digging things up”. When available, he hires on to plant vegetables in other people’s fields.

If showers come in June, Jai Hari can plow the fields of landowners. He owns a massive wooden plow. Owning no animals, like most other farm laborers in these villages, he shoulders this massive beast and takes it a kilometer to the fields of his employer. 

Another farmer with a plow like Jai Hari's on the road, Chhattisgarh
That’s a good question
Since Dukhni Bai became profoundly weak from diabetes, their income has been cut in half. I asked him the inevitable: How have you managed financially since November? At first, no answer was forthcoming. Just silence while Jai Hari thought how to put it. Finally, after a forever pause, he replied in a measured, almost inaudible, voice: That’s a good question.

Half of nothing is nothing
The cost of diabetes treatment alone for an insulin-dependent patient averages 1,000 rupees a month ($20), annualized, a fortune for a poor village family.[3] Medical treatment is the second largest source of debt burden in rural India, the first being indebtedness to merchants for agricultural supplies and food. And who can afford a death in the family – four to five thousand rupees for a proper village funeral? The answer: more indebtedness.

An observation by Dr. Ravi da Silva, a JSS physician: As the price of dal[4] has zoomed, those that ate it once or twice a week can’t even do that any more. 

No one helps
Jai Hari’s family includes Dukhni Bai, their three children, his 80 year old mother and himself. To cope with his catastrophic loss of income, he has been taking advances from the farmer he works for. When he and Dukhni Bai both had earnings, they’d just get by. As a Below the Poverty Line (BPL) family,[5] they are eligible for a government subsidized 35 kgs. of rice monthly. This lasts a scant two weeks of the month. Then, it’s skimping and going hungry. Vegetables are unaffordable, except in absurdly small quantities. We watched them eating scraps only one day. Prices for rice and dal in the market have almost doubled in the past two years.[6] The family of six used to have two kilograms of rice a day; now it’s one. Dal is unaffordable. Think of it, after a full day’s hard labor for him and the exhaustion of diabetes for her, only small portions of rice and bits of vegetables.

Jai Hari is by disposition an impressively uncomplaining and reserved man. He does not raise his voice. Does family help out?, I asked.  Without a trace of bitterness, he replied: No one helps. My three brothers are concerned with themselves, their families.

The exterior of Dukhni Bai's home, one room of several (on right)
Their home is one small, mud-walled room in an extended family compound of five rooms. The government provides an electrical connection, one bulb and a single light socket, the usual subsidized set-up for rural families designated below the poverty line. The family has one additional bulb, freely, almost proudly, admitted as stolen, but to this end, the wiring has to be shifted from one room to the other, allowing only one light to be on at a time. Like most homes in the villages of Central Chhattisgarh, theirs has no latrine. Sometimes it’s to the forest, a kilometer away; at other times, they find a place next to their mud house. There is, however, an abundant supply of water available at all hours from a public school just across from their house.[7]

Jai Hari with two of his children. Daughter is crippled by polio.
Before Dukhni Bai fell ill, over five years, she was able to save several hundred rupees by carrying heavy loads of grain on her head, a kilometer distance. Finally, the savings were sufficient for her husband to buy a second-hand bicycle. But like many bicycles in India, it is idle now for want of repairs.

The moral of the story: an incapacitating chronic illness, has tipped this family into  desperate poverty.  Once Dukhni Bai’s insulin-dependent diabetes is well controlled, perhaps their extreme suffering will be mitigated and that then they may return to a life of hard labor allowing simple year-around, below-the-poverty-line penury. Is this too much to hope for?

[1] With the harvest, the rice shoots, cut down first with scythes, are then dried, bundled and carried, 30-50 kgs in a load, often a few kilometers to an area where the grain is threshed
[2] Dahn or paddy are the names of the unprocessed rice plants as harvested.
[3] Dr. Yogesh Jain, a founding member of the JSS staff, says that 1,000 rupees is a conservative estimate of the combined monthly cost of laboratory tests, physician visits, and insulin kits.
[4] Dal, a mixture of a variety of lentils and spices, is a staple of the Indian diet.
[5] BPL, a complicated story. Vast numbers of rural poor do not qualify. For those that do, government subsidies are absurdly inadequate. Of promise, is the National Rural Employment Guarantee Act of 100 days of labor, at the minimum wage, for a family in a year. As yet, 100 days remains an unattained right for most. Jai Hari hasn’t even applied for the benefit as the enrollment in his village has been only when he has been away working in the fields.
[6] Three years ago, 2007, dal cost 45-48 rupees/kilo in the market and now 80 rupees; rice in two years has gone from 19 rupees/kilo to 35. Source: Dr. Rachna Jain, a JSS physician.
[7] A 2007 JSS study, however, on the water from randomly selected bore wells in villages of the region showed that 40% contain significant titers of pathogenic e-coli, due to fecal-oral contamination. This water, as well as lack of hand-washing facilities for the handling of food, are major sources of gastroenteritis causing disability and life-threatening dehydration in infants, small children and the elderly. In 2010, JSS has in development additional resources and initiatives to address these problems.