The Story of Dasrath - A Burn Patient

JSS, Ganiyari Village, Bilaspur District, Chhattisgarh, India

A preliminary report

Ref. purposes: 46 Indian rupees = About one dollar, U.S

Informant: Jhum Bai, sister-in-law of Dasrath, the injured boy

Part I – Initial Presentation and Surgery

Dasrath, age 10

Jhum Bai, Dasrath’s sister-in-law, age unknown

Yesterday, a clinic day, Dr. Raman, JSS’s general surgeon, called me over to see Dasrath who presented at the Outpatient Clinic with a serious, infected burns to both legs. Dasrath suffers from a seizure disorder.

According to Jhum Bai, Dasrath often wanders off from his home, a matter of concern to her as she cares for him. Dasrath’s mother died before Jhum Bai married into the family six years ago. Dasrath has four or more seizures a day. Four days ago, while visiting another family in his village, he fell, unconscious, into a fire. Children came running to his home to tell Jhum Bai. She carried Dasrath home.

Dasrath and Jhum Bai in the JSS clinic at Ganiyari

The next day, her husband, Dasrath’s older brother, took his bicycle, cut through a shortcut in the jungle to the town of Kota, and bought ointments for 200 Rs. As the child’s supply of anti-seizure medication had run out, a frequent occurrence, Jhum Bai asked the village health worker to help her get resupplied. It was then that the boy’s burns first came to the health worker’s attention. The health worker called ahead. Each of JSS’s village health workers has a cell phone. Approval was given immediately to bring the boy to the JSS compound to be seen. The JSS ambulance/bus provided prompt transportation.

Dasrath’s burned, infected legs.  Burns are common complications of epilepsy in rural India.

Returning to the OR after seeing several additional patients, Dr. Raman debrided Dasrath’s burns, covered his wounds with sterile bandages and place the boy on antibiotics. He then asked Jhum Bai if she and Dasrath would wait to tell me their story.

Over at the Administration Building, where quiet space exists, Dasrath sat on the floor while Jhum Bai spoke. First she mentioned that the boy was famished. We promptly arranged for an ample meal which he ate voraciously.

Dasrath, chronically semi-starved and famished.

But, at the moment he finished, he suddenly, without warning, began to fall forward, grimacing. His eyes glazed over. He was motionless. No cry uttered. Jhum Bai rushed forward, stooped down and embraced him from behind, propping him up.

Within less than a minute, he seemed to recover but then sat listlessly while Jhum Bai continued her story. This spell, she said, was how it always happens, several times a day.

Missing the JSS ambulance-bus, the boy and Jhum Bai stayed over at the JSS compound in Ganiyari. We got them supper; this morning I continued to learn their story.

Dasrath at the moment of a seizure during interview

A month ago, Dasrath’s father, age about 50, was found dead on the road returning to the village. The police took the body for autopsy. When the family showed up to get the body for burial, the police extorted Rs. 2,000 claiming falsely that it was a fee for the autopsy. Without paying, the body would not be released. Thus, there was no alternative but to sell the family’s two oxen. The proceeds, Rs. 5,000, went to pay the bribe; the balance went for the traditional burial at a cost of Rs. 3,000, to which all the village was invited and fed.

Two weeks ago, when the boy’s grandfather learned of his son’s death, he abruptly stopped eating and died earlier this week of a broken heart. This time Jhum Bai and her husband had to mortgage their small plot of land to pay out an additional Rs. 5,000 for the grandfather’s funeral. The interest on this loan is 5%/month or 60% per annum. As they now have depleted all resources, they have no prospect of paying back the loan, only the interest, without which the property would be confiscated.

The six surviving family members live in the one room home in Naktandha, one of 53 remote, forest villages where JSS has recruited health workers to provide more robust services. In Naktandha, most families are below-the-poverty line. Six years ago, Jhum Bai married Dasrath’s older brother. Due to the boy’s frequent seizures, either she or her husband cannot work outside of the home on any given day. Thus, Jhum Bai usually stays home to keep the boy from serious harm. Her income is gained by weaving baskets, yielding 100 Rs. for a week’s work. “How many hours of work are involved?” I asked. “All day, every day”, she replied. Her husband and another brother earn 50 Rs each daily chopping wood in the forest as day laborers. The boy’s aunt and her grown son are the 5^th and 6^th in the household. Sometimes the aunt gathers firewood in the forest, as does Jhum Bai. The trip by foot is three hours out and three back, carrying the load of firewood on their heads. Her aunt’s son, though grown, does not work. Jhum Bai doesn’t know why.

The six survivors share the one room hut but the aunt, her son and Dasrath's other brother sleep elsewhere. The government is supposed to provide electricity for one light bulb as it does for others “below the poverty line”, an absurdly low “line”, leaving countless millions destitute just above the poverty line. (Visiting their hovel, I discovered that the connection is out of order; no light within the one room home. The bulb is mounted outside.)

The family has no radio or other electrical device. Drinking water is available from a bore well that serves the entire village.

Nutrition

Yesterday, when I asked Jhum Bai if the family had enough food, she said, “Yes”. She said that their diet in the main is dal and rice, plus occasionally eggplant or other vegetables. Today, when Dr. Ramani joined me, I learned the contrary. This family has three ration cards to provide rice once a month at a subsidized price. But this rice runs out mid-month. To survive, Jhum Bai says they must buy an additional 30 Kg/month on the open market, paying 20 Rs a kilo. (600 Rs from where?) A similar story with dal. They are able to afford a cup’s worth of dal three or four times a month, enough for one meal only for all six in the household. All told, they eat something twice daily but sometimes go entirely without.

Asking “What would the family do if they could double their income, Jhum Bai advised that they would buy more dal and rice. If any money were left over, she said that she would save it for emergencies. Parceiling out miniscule portions and running out of food altogether is the norm in these impoverished villages. That’s why it took deeper probing to document the chronic hunger and near-starvation confirmed by the stunted growth and almost universal abnormally low weight of the rural villagers.

Dasrath and Jhum Bai returning to their village in the JSS ambulance/bus