The Story of Jethuram - Death by a Rabid Dog

As told by his widow, Sham Bai, in her own words.

Locale: A remote forest village of the Baiga tribe in Central Chhattisgarh accessible only by deeply rutted dirt roads that are impassible at times during the monsoon season.

Sham Bai

Our cows and oxen had gotten trapped in Khuriya, a neighboring village. Jethuram went to get the animals. On the way back, a dog bit him on the lower thigh of the left leg, just above the knee, and the dog ran away. Then, others with him sent him quickly to the village to get treated, and they followed later with the animals. The dog was not known to them. We collected herbs and roots from the jungle. He ate those and the pain lasted for about a week.

For three months, he had no problem. Then he started to have trouble again. Pain returned again to the thigh where he was bitten, climbed up his leg to his stomach and then to his head. He would walk around the house breaking things, like the water pots, and he would also try to hit me.

When he began to behave very badly, one fellow, Lakhiram, told us that if he was brought to Ganiyari, his life could be saved. Someone called Bamhni [1] and they sent a Marshal [2] to the village. They kept him all day and all night in Ganiyari. Even in Ganiyari, he would walk around his room and break things. We asked the doctor what to do and the doctor said he would not survive. So we asked and got permission to take him home.

When he came home, he caused a lot of trouble. We were afraid he would bite us. He would shout and scream like a dog and come after us like a dog. That night we cooked food for the evening meal. He ate it all, but he drank very little water. He wouldn’t sleep. When morning came, and we left the house to work, he locked himself up in the room. While we worked, he prepared tea for us all and served it on our return. But I wouldn’t drink it because I was afraid I’d fall sick as he had been bitten by a dog.

I told him “You are going to die because you have this disease.” He replied that my daughters will marry and go to other homes. “You will find another husband. My son will be an orphan. So I am going to kill you.” He attempted to kill me. When he wasn’t able to kill me, he said that when I go to work near the dam or in other people’s fields, I should make sure that the children get fed. He told our elder daughter that “You must go with your mother when she goes to the forest to collect mahua [3] and when she does other forest work.” He said: “I have five children. [4] How can you take care of so many? Get the land, that I have captured, plowed by someone else so you’ll have crops to live off of.”  He was throwing up while talking to us. As he stepped out of the house, he fell down next to the door. He fell backwards into the house. He vomited like a dog, lots of foamy vomit and then he died.”

On a daily basis, I think that if my husband were here, how much better I could manage. My heart is pained at the thought of his death. I didn’t have the courage to enter my home for three months after he died. I got scared whenever I thought of him. The children also were scared so we took down the house and got a small room. That is where we are staying now, close by.

When he died, I had to borrow 4,000 rupees to pay for the funeral. There is no one in the village to help us plow our fields, so our land is lying without use. He didn’t have any brothers living. They all had died of fever so I had no one to ask for help. I have brothers who live in Boiraha and asked them to help, to plow and sow the fields, but they didn’t agree to help me. Since there is no one else to help me, I am the only bread-earner in the house and I work as a laborer in other peoples’ fields. With the 40 rupees I earn most days, and the grains I am able to buy from the Society store [5], we have to get by. There is no one in the village to bring us rice, so my daughter and I go to Patpara to get rice. We each carry half of the 35 kilogram load. It’s a seven or eight kilometer walk each way.

Anything else?

Mola koi Posaiya Nikko. There is no one to take care of me. These are the exact words. I went to my panchayat [6] and this is what I said. I told the panchayat to get me some help because I have no help. I even had to submit my Parichaya Patra (ID card) and other papers. They checked if I had registered his death at the police station in Lormi [7]. I got the necessary documents from the block headquarters and submitted them at the Khuriya Forest Range office. The officer in charge of my village told me that he would send these documents to the next higher office in Bilaspur and would let me know when a check arrived in my name. After that, this office never contacted me again.

I returned to my panchayat. The sarpanch [8] told me my village was no longer under his jurisdiction. He sent me to another panchayat at Danghaniya. The new sarpanch noted my name among those who needed a nirashrit pension [9] but this too proved empty. I haven’t gotten anything from anywhere. It’s been over a year now.

We eat about 1.5 kgs. of rice in our home daily. When the rice I buy from the Society is used up, I have to buy khanda (broken rice) from the market.  And when I can’t afford even that, I borrow rice from other people’s homes. I am in constant trouble but I still work hard and I still feed my children.

*************

Postscript: Sham Bai’s husband is dead. One could say that poverty killed him. People bit by rabid dogs no longer die in the Western world. More people die of dog bites in India than in any nation on earth – at least 30,000 a year. The number is doubtlessly under-reported. Sham Bai meanwhile lives on, but stoically and painfully. She has four little children to feed and bring up – all alone. Her patience and her courage are remarkable. If you might like to help her, let me know.

Sham Bai with Manakram, 2, the youngest of her four children

Once the monsoon rains abate sufficiently and the roads permit a home visit, there will be a note added to this account.

---

[1] Bamhni is the remote forest village where JSS maintains a sub-center. It has a permanent staff of two senior health workers and support personnel. Physicians from Ganiyari, the village location of the JSS hospital and administrative headquarters, hold weekly clinics and monthly training sessions for over 100 village health workers and midwives at Bamhni.

[2] A four-wheel-drive vehicle maintained by JSS for ambulance and patient transport over the rough terrain of the forest region.

[3] An edible flower

[4] The elder daughter has since married, leaving four dependent children at home with Sham Bai.

[5] A reference to one of thousands of local government food stores that dispense grain at subsidized prices to families certified to be “below the poverty line”. Many poor do not qualify for this grain, usually rice or wheat. Moreover, I have yet to meet a family that hadn’t run out of the government-supplied grain by the middle of the month.

[6] The village council

[7] The block headquarters.  The block is an administrative unit of local government with 100 or more villages.

[8] The sarpanch is the elected head of the panchayat or village council.

[9] Literally nirashirt means “without help” –  hence, a pension for a destitute person.

The Story of Kala Bai - Tuberculosis of the Spine

A medical cure…and then what?

Kala Bai, 22

The illness

Kala Bai, 22, last felt her normal self two months before taking the arduous journey from her mountain village to the hospital at Jan Swasthya Sayog (JSS) in Ganiyari.^[1] Given the severity of her illness, this journey must have been of epic proportions.

Kala Bai had been experiencing increasingly severe back pain. The pain traveled from her mid-back, centered over the spine, to both legs. In July 2010, when first seen at JSS, Dr. Yogesh Jain^[2] took the history of her progressive disability. At the beginning, she felt only tingling in her legs. As the pain became more severe, she noted increasing weakness in both legs. By July, she felt so wobbly walking that she feared falling at any moment. Now, severe pain is her constant companion.

On examination, Jain noted a bulge the size of a walnut in her mid-back, directly over the spine. Clinically, he instantly knew the likely diagnosis: tuberculosis of the spine, commonly called Pott’s Disease.^[3] Pott’s Disease has all but vanished in the West but is often diagnosed in rural India. A confirmatory MRI is planned.^[4] On this first hospitalization, Dr. Jain initiated three-drug, anti-tubercular therapy.^[5]

Kala Bai on her hospital bed with her four month old daughter, Ritu

Her appetite is poor and her weight of 32 kilograms (70 lbs.) that of an eleven year old child and the result of pervasive hunger and semi-starvation. Such chronic malnutrition is a principal contributing factor to her susceptibility to the spread of tuberculosis to her spine.  Her recent pregnancy and the stress of childbirth, are additional major factors that undermined her immune response.^[6]

The long haul

There will be no sudden cure, no sudden relief. Nine months of drug therapy lie ahead. Until her illness incapacitated her in recent weeks, Kala Bai’s days consisted of housework, caring for her two children, weaving baskets and working as an agricultural laborer during the monsoon season.  She and her husband scraped along, among the poorest of the poor, together earning 100 to 150 rupees daily. Now, her illness is so advanced that she can’t even weave baskets, cook or wash clothes. Routine care of her two small children is impossible. She can’t even lift up her infant daughter. Nor can she travel to her home in Kurdar village, a five kilometer walk up a steep, rutted path. A 100 meter walk is about her limit.^[7]  So she, her husband and children have taken temporary refuge in her parents’ home in Aurapani, a village not far from the base of the mountain. And there’s the rub.

A full-blown tragedy

Visiting her at her parents’ home, the fuller tragedy became apparent. Out of earshot, her father confided that the welcome mat will not be extended much longer. She, her husband and children are too much of a burden for his poor household and must leave soon. “We are too poor and have no space”, he told us. Moreover, he admitted that he expects that her husband, an abusive alcoholic^[8], will soon abandon her for another woman. From the poorest of families, fully aware of the many months of disability ahead and the likelihood of eviction and abandonment, she lives with anxiety at every moment. "Nine months is an unimaginable eternity", she says.

Kala Bai with her father and her daughters at the entryway to her parents' home

Closing comment

Here we have a young woman, mother of two, literate and bright, whose future is as bleak as can be imagined.  Capable of reading books, she readily confides that she has not read one in four years of marriage: A poor person like me never has a chance to read a book. No income, no savings, total disability, no one to help, plenty of fear, no hope.

What is our responsibility?  No question: to save this woman and many like her.  Impossible? Not at all. You join in, I’ll join in. We pretty much know the challenges. We can work through – and team up – with groups like JSS in Chhattisgarh and see that this tragedy and others like it are brought to an end…and not at some vague never-to-be-seen “tomorrow”.  Foolish nonsense? If you and I think so, we’re the pain in Kala Bai’s back, the weakness in her legs, the ache and hopelessness in her mind and heart.

Beyond Kala Bai’s immediate need, we can help local groups like JSS set up village-level agricultural cooperatives producing produce that can sell locally, producing significant revenue^[9], preventive healthcare for those at risk, cures for those who are curable, literacy programs and solid educational opportunity for those that lack, and social service programs for the elderly, the handicapped and chronically and long-term ill like Kala Bai.

Kala Bai will be helped. JSS already has her on the road to recovery from the slow death of tuberculosis. JSS will also provide financial support through a fund that may spare her the anguish of abandonment. With a pittance of income from the JSS fund, there’s a fair chance that her father and husband will relent.^[10] We can contribute to support her through the crisis of her illness. There could be a happy ending to this story.

Kala Bai smiling

What use is it to spare her life through timely medical intervention and fail to help make her life worth living?

Postscript

After writing this story, I must sadly report that Ritu, 4 months old, fell into a fire and sustained extensive burns on her left arm. She is now admitted to the JSS hospital in Ganiyari for debridement and treatment of the ensuing infection. Kala Bai is with her.

Footnotes

---

[1] To get to Ganiyari from Kurdar,  she had to walk for four hours from her mountain village to Aurapani, a larger village, then two or three additional kilometers to Samariya, a market town, where, finally, she caught a bus to come to Ganiyari. The bus trip, which cost 20 rupees, took 3 hours.

[2] Dr. Jain, a reknowned pediatric oncologist and, now, general practitioner as well, is a founding member of the group of eight physicians that came to Ganiyari in 1999 to found JSS.

[3] The history and then her neurological examination re-enforced the diagnosis – hyperactive reflexes and loss of muscle strength in the lower extremities. Tuberculosis has infiltrated her spine, a condition known as osteomyelitis.

[4] If the MRI shows a collection of pus at the site of the lesion which has caused osteomyelitis and is putting pressure on nerve roots, then surgical intervention will be considered unless Kala Bai shows progress on re-examination after a month of therapy. If improved, medical treatment will continue for most of the year ahead.

[5] Compliance issues loom large in India’s villages. But Kala Bai is an intelligent woman, 8^th standard graduate and literate. Compliance is not likely a problem.

[6] National data in India reveals that extra-pulmonary tuberculosis is found in less than 15% of cases. However, among the extremely poor in the 53 villages in the JSS service area, 43% of patients present with tuberculosis of many other organs, e.g. the bones, as in this case, the stomach, even the brain.

[7] Often impassible in the monsoon season, there is road access to Kurdar Village, a 25 km ride.  Yet, due to her incapacity, Kala Bai can’t return to her mountain home for many months either by foot or in a vehicle. There would be no way to get down in case of emergency or for medical appointments and diagnostic tests.

[8] Alcoholism among village men in India is rampant. It is often accompanied by verbal and physical abuse of wives and impoverishes many a family.

[9] JSS early viewed such agricultural cooperatives as a partial answer to the profound poverty in adivasi communities. The demands of the JSS medical program proved of such magnitude, however, that this initiative awaits funding and core staffing to bring it to reality.

[10] In this case, a stipend of as little as 2,000 rupees ($40 U.S) per month may be all that is needed to see Kala Bai through this crisis.

The Story of Dalsingh – A fatal snake bite

As told by Aghni Bai, his mother

In the face of death, he said: Ram Johar – Goodbye to All

The locale : A forest village of the Baiga tribe in the Achanakmar Tiger Sanctuary, 70 kms. north of Bilaspur in central Chhattisgarh, India.

Aghni Bai

Her story in her own words

The night he was bitten
It was the month of Sawan (1), three years ago, the day of the festival, Hareli (2). We had eaten well and retired to our separate homes. We all lay down on the floor and went to sleep. Three daughters of my elder son, who had been visiting, were spending the night with me. My son, Dalsingh, was asleep in his home, next to mine, with his wife, two sons and three daughters. (3)  Sleeping on his side, Dalsingh awoke suddenly feeling something cold on his neck. That is when he realized something was there. When he felt the cold, he said What is this? He picked it up and it bit him on the wrist.

Aghni Bai pointing to the site of the bite

Dalsingh saw the snake and the snakebite in the dim light of the lantern. He shouted from his house: Mother, Come! I have been bitten by a snake! He took a stick and moved it out of the house. He said: Let us not kill the snake. Let’s just get it out of the house. The snake climbed up the mud wall of the house and crawled in a hole in the brickwork and that is when we realized it was a poisonous snake, a Karaith (The Common Krait). (4)  I recognized that snake.


In the dark of night, I collected the elder villagers and shouted that they come and they came. There was much confusion and running here and there. It was still dark, the predawn hours. Several villagers ran to the forest and, with torches and by lantern light, dug up the roots of an herbal plant for snake bite. They returned immediately. The roots were ground up and mixed with a cup of water. The paste was placed on the wound on his wrist and he was given the same mixture to drink. We also called a jholachap (a village doctor) from the nearby village of Danganiya. (5)  He came and gave Dalsingh two injections, one in the left arm and one in the upper right arm.

Once all the remedies proved futile, Dalsingh spoke: My mother and my brother : I know you will not be able to save me now. He put his hands up, Ram Johar (Saying goodbye and paying respect to all present). (6)

Aghni Bai showing how her son said Ram Johar (Goodbye) on dying

He did not talk of pain but he must have been in pain because of the swelling of his hand and arm. He was alert the whole time, though lying down. Before he died, his whole body had become yellow as if someone had put tumeric powder on it. We continued to give him the herbal medicine throughout the pre-dawn hours. At first, his fingers puffed up and separated. By early morning, his arm had become hugely swollen up to the elbow. As the cock crowed, he died.

Following Dalsingh’s death
Later, in mid-morning, once Dalsingh had died, boys in the village cracked open the wall, took out the snake and killed it. It was that long (shoulder to hand). It was a ghoda karaita. (7)

Aghni Bai showing the length of the snake

My son believed that if the snake was killed immediately after he was bitten that he too would die, so he didn’t kill the snake. I believe that as well. Only after his death could we kill the snake. When my son was bitten, someone must have done jaadu tona (black magic) on him and that must be why the herbs and the injections didn’t work. My son was educated through the 8th standard (8), so that when forest officers or the sarpanch (the head of the village council) came to the village, they would always talk to him. That is why some were jealous of him. Others have taken these herbs and have gotten better.


The funeral
My sons and I had a funeral and we fed everyone. After eating, we all went and washed our hands in the lake. (9)  I had to borrow 3,000 rupees from his wife’s family. I could not pay the debt so I gave them Dalsingh’s harmonium. (10)  It would have been very difficult for me to meet these expenses alone, so my elder son and Dalsingh’s widow, Laliya, also contributed. But I still shoulder 2,000 rupees of debt from the funeral. (11)


Persistent fears
The children remember little as they were very young but they do ask what happened to that uncle (12)  who was bitten by a snake. When the first rains arrived this year, the children were on the veranda. There was lightening and they saw a snake entering. Greatly frightened, they cried out. My elder son came and killed the snake, another poisonous krait. It’s not common to see snakes. Only when the first monsoon rains arrive.


Ever since, I live with that night. I keep a stick under the khatiya (a cot). (13)  Any noise at night wakes me with a start. Is it a snake? Or a mouse on the roof rustling about? I get up with a torch terrified and look into every corner of the house. When I go back to bed, the children ask: "Why did you get up?" I make up a story like “An insect made a noise.” I do not tell them of my fear of a snake. They fear snakes so, and I do not want them also to be frightened. Then I get back under the mosquito netting and try to sleep.


Her struggle since
Dalsingh left behind a tiny daughter, Panchvati, who is six now and has just been admitted to school. She helps me out, bringing water to the house. So I have tied her to my side and brought her up. Dalsingh second daughter, Phul Bai, is 10 and in 6th standard. I am bringing her up as well.


Since Dalsingh’s death, I have to support myself and my two granddaughters. I work in the fields from 8 to 4, four or five days a week, earning 40 rupees daily. As I am elderly, I can’t plow my land, so I give my land to others to work. I get half of the harvest. If it rains well, the land produces about five sacks of grain. Two sacks go to the person helping in the field, two go to me and the fifth is for seed. (14)  And for the past three years, I’ve served with three other elderly women in my village as a dai. (15)  For this, I receive a 100 rupees a month to attend an overnight training in Bamhni and 50 rupees more goes to the dais credit group. (16)  I walk for about an hour and a half to get to Bamhni every month. With the 100 rupees, I buy rice, and I have applied to the government for a widow’s pension but have heard nothing for the past five years. (17)


No elderly widow in the village like me has ever received a pension. But if I do get one,
I’ll keep it to take care of the children well, to bring them up well and to pay off my debts. I’ll save some for the children’s future. Once my granddaughters grow up, I’d like to get them married. They are now both in school. I can get them educated until the 8th standard by sending them to other villages close by. Soon after that, they can be ready for marriage and will be more intelligent. Better in marriage for girls if they finish the 8th standard. (18)


Emotional aftermath of Dalsingh’s death
I have a lot of pain in my heart. I cry a lot. I think When will I be united with him again? Tears come to my eyes whenever someone reminds me of his loss. It feels like I have lost my soul.


Footnotes

(1) Sawan is the 5th month of the Hindu calendar and runs from July 16 until August 16, the height of the monsoon season.
(2) Hareli is celebrated each Sawan, the end of the season of planting new crops to give thanks, a puja, for the farm implements that made the planting possible and to pray for a good yield.
(3) Dalsingh’s three daughters were from his first marriage with Ramkali. When she died of cholera, he married her sister, Laliya. They, in turn, had two boys. Following Dalsingh’s death, Laliya remarried taking her two boys with her. Dalsingh’s oldest daughter also is now married. The two younger girls live with their grandmother, Aghni Bai, herself a widow.
(4) The Common Krait is one of “The Big Four” - the poisonous snakes considered responsible for the most fatalities in India. The others are the Russell Viper, the Saw-Scaled Viper, and the Indian Cobra.
(5) An untrained village medical practitioner. Typically, they give saline injections regardless of the nature of the illness.
(6) A common term for farewell or goodbye among the forest people. 
(7) There are different kinds of poisonous kraits in the villages of this region, a banded krait and the common krait, a ghoda karaita, as in this instance. 
(8) Eight years of formal schooling, the completion of primary school, is considered quite an achievement in village India, though short of high school.
(9) A ritual cleansing that follows the cremation of the body and the ritual meal.
(10) It is common to find three or four harmonia in the adivasi villages in central Chhattisgarh. Dalsingh used to play it while singing Chhattisgari folk songs. The instrument is valued at about 300 rupees. 
(11) The funeral ritual goes on for 10 days. The berieved family give the guests daru (an alcoholic beverage). The village collectively gives the widow distinctive clothing and glass bangels to identify her to all persons thereafter as having lost her husband.
(12) Besides its literal meaning, Uncle is also an honorific term for an older person to be afforded respect.
(13) A khatiya is a cot made of a type of wood from the forest called balli across which strips of canvas are stretched.
(14) The two sacks of paddy (rice) will provide for about three months of this staple of the Indian diet for a family of three. Additional rice is provided by the government for persons certified below the poverty line, but this subsidized rice last only about half the month for most families.
(15) A dai is a village midwife. 
(16) Jan Swasthya Sahyog (JSS) maintains its most distant subcenter at Bamhni, a remote forest village, two and a half hours by road from its main facilities in Ganiyari, a village in the Bilaspur District of Chhattisgarh. In Bamhni, JSS physicians and senior health workers hold monthly trainings for over 150 volunteer village dais and village health workers.
(17) As astounding and improbable as this sounds, it is confirmed by Prafull, the JSS head village specialist. He explains that the sarpanch or village chief is elected every five years. In this case, Aghni Bai fell between stools. A new sarpanch came in and as is so often the case, the application process has defeated the whole purpose of the pension provision for the totally helpless and destitute, such as elderly widows. Moreover, Aghni Bai, and others like her, had no idea initially of her entitlement. She learned of this possibility from a staff doctor at JSS.
(18) Marriage at such a young age (about 13) for a village girl is common and completion of the primary school grades a source of pride.


PART II – A Visit To Aghni Bai’s home will follow.