tag:blogger.com,1999:blog-35979977325963095622024-03-18T19:44:59.369-07:00Stories on Poverty and Illness in Rural IndiaTo the reader:
If you wish to contact the author, kindly write to him at jfine666@gmail.comJonathan E Finehttp://www.blogger.com/profile/07031814720598988581noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-3597997732596309562.post-42325143859457629042010-09-23T15:20:00.000-07:002010-09-24T02:19:54.085-07:00Dukhni Bai's Story - Diabetes and the Vortex of Poverty<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><span style="font-family: 'Times New Roman'; font-size: 12pt;"><i><b>A tale of illness and disability that have brought a good family to the brink of despair.</b></i></span><i><b> </b></i> <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWH2LM_LmFt4PwBAKFGxj3nVnDxq3EQizGq8DjLOP4NIFDI9trXc1C-L8gqVmDrsckTil23HeZG3LU_q7hPEHwMJvCKH8eAMmTSdRSaNq0EETU0d5KPhtFEhN8WKgODHwZq0IiPbFAw8A/s1600/Dukhni+Bai+Two.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWH2LM_LmFt4PwBAKFGxj3nVnDxq3EQizGq8DjLOP4NIFDI9trXc1C-L8gqVmDrsckTil23HeZG3LU_q7hPEHwMJvCKH8eAMmTSdRSaNq0EETU0d5KPhtFEhN8WKgODHwZq0IiPbFAw8A/s320/Dukhni+Bai+Two.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dukhni Bai, 36, ravaged by diabetes for eight months</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Duhkni Bai at the JSS hospital, skin and bones</td></tr>
</tbody></table><div class="MsoNormal">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.</div><div class="MsoNormal"><br />
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<tr><td class="tr-caption" style="text-align: center;">Landless laborers sewing paddy, rural Chhattisgarh</td></tr>
</tbody></table><div class="MsoNormal">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 <i>paddy</i><span style="font-style: normal;"> (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.<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference">[1]</span></a> These relentless daily assignations earned her 40 rupees daily – less than a single U.S dollar. </span></div><div class="MsoNormal"><span style="font-style: normal;"></span><br />
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<tr><td class="tr-caption" style="text-align: center;">Dukhni Bai's husband, Jai Hari</td></tr>
</tbody></table><div class="MsoNormal">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 <i>dhan<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference">[2]</span></a></i><span style="font-style: normal;"> 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.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">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. </div><div class="MsoNormal"><br />
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<tr><td class="tr-caption" style="text-align: center;">Another farmer with a plow like Jai Hari's on the road, Chhattisgarh</td></tr>
</tbody></table><div class="MsoNormal"><b><i>That’s a good question</i></b></div><div class="MsoNormal">Since Dukhni Bai became profoundly weak from diabetes, their income has been cut in half. I asked him the inevitable: <i>How have you managed financially since November? </i><span style="font-style: normal;">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: </span><i>That’s a good question</i><span style="font-style: normal;">.</span></div><div class="MsoNormal"><br />
</div><div class="MsoFootnoteText"><b><i>Half of nothing is nothing<o:p></o:p></i></b></div><div class="MsoFootnoteText">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.<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference">[3]</span></a> 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.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">An observation by Dr. Ravi da Silva, a JSS physician: <i>As the price of dal<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn4" name="_ftnref4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference">[4]</span></a> has zoomed, those that ate it once or twice a week can’t even do that any more. </i></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><i>No one helps<o:p></o:p></i></b></div><div class="MsoNormal">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 <i>Below the Poverty Line</i><span style="font-style: normal;"> (BPL) family,<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn5" name="_ftnref5" style="mso-footnote-id: ftn5;" title=""><span class="MsoFootnoteReference">[5]</span></a> 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.<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn6" name="_ftnref6" style="mso-footnote-id: ftn6;" title=""><span class="MsoFootnoteReference">[6]</span></a> 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. <b><o:p></o:p></b></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">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: <i>No one helps</i><span style="font-style: normal;">. </span><i>My three brothers are concerned with themselves, their families. </i><span style="font-style: normal;"><b><o:p></o:p></b></span></div><div class="MsoNormal"><i><br />
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<tr><td class="tr-caption" style="text-align: center;">The exterior of Dukhni Bai's home, one room of several (on right)</td></tr>
</tbody></table><div class="MsoNormal">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.<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn7" name="_ftnref7" style="mso-footnote-id: ftn7;" title=""><span class="MsoFootnoteReference">[7]</span></a></div><div class="MsoNormal"><br />
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<tr><td class="tr-caption" style="text-align: center;">Jai Hari with two of his children. Daughter is crippled by polio.</td></tr>
</tbody></table><div class="MsoNormal" style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">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.</div><div class="MsoNormal" style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
</div><div class="MsoNormal">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?</div><div style="mso-element: footnote-list;"><br />
<hr align="left" size="1" width="33%" /><div id="ftn1" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference">[1]</span></a> 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</div></div><div id="ftn2" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref2" name="_ftn2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference">[2]</span></a> <i>Dahn</i><span style="font-style: normal;"> or </span><i>paddy</i><span style="font-style: normal;"> are the names of the unprocessed rice plants as harvested.</span></div></div><div id="ftn3" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref3" name="_ftn3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference">[3]</span></a> 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.</div></div><div id="ftn4" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref4" name="_ftn4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference">[4]</span></a> Dal, a mixture of a variety of lentils and spices, is a staple of the Indian diet.</div></div><div id="ftn5" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref5" name="_ftn5" style="mso-footnote-id: ftn5;" title=""><span class="MsoFootnoteReference">[5]</span></a> 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.</div></div><div id="ftn6" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref6" name="_ftn6" style="mso-footnote-id: ftn6;" title=""><span class="MsoFootnoteReference">[6]</span></a> 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.</div></div><div id="ftn7" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref7" name="_ftn7" style="mso-footnote-id: ftn7;" title=""><span class="MsoFootnoteReference">[7]</span></a> 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.</div></div></div>Jonathan E Finehttp://www.blogger.com/profile/07031814720598988581noreply@blogger.com4tag:blogger.com,1999:blog-3597997732596309562.post-66723046148795196992010-09-17T16:41:00.000-07:002010-09-19T13:47:09.259-07:00Sonarin Bai's Story - Death in Delhi<div class="MsoNormal" style="text-align: center;"><b><span class="Apple-style-span"><span class="Apple-style-span" style="font-size: x-large;">Sonarin Bai, Chronic Myelogenous Leukemia</span></span><o:p></o:p></b></div><div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><b><i><span class="Apple-style-span"><span class="Apple-style-span" style="font-size: x-large;">Dead in Delhi: At Whose Door?</span><o:p></o:p></span></i></b></div><div class="MsoNormal"><br />
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<tr><td class="tr-caption" style="text-align: center;">Sonarin Bai (on the left), Eeswari, 10, her daughter, and Leela Bai, her aunt<br />
July 12, 2010, JSS hospital grounds, Ganiyari, Central Chhattisgarh</td></tr>
</tbody></table><div class="MsoNormal"><b>Terrible forebodings</b></div><div class="MsoNormal">I first met Sonarin Bai, 30, mother of three, on July 12, 2010. With worsening health, she had traveled for two days from her village in the neighboring state of Madhya Pradesh to Jan Swasthya Sahyog (JSS) located on the outskirts of Ganiyari Village<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference">[1]</span></a>. Neighbors and relatives advised that it would be worth the arduous journey to see a good doctor. She and her husband, landless laborers, borrowed 3,000 rupees for the trip to Ganiyari.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">She arrived at the JSS hospital accompanied by her mother, Sumantri Bai, her aunt, Leela Bai, and her middle child, Eeswari Bai, a cherubic-looking 10 year old with outsized dark, inquiring eyes. Though the child remained silent throughout, Sonarin explained that Eeswari had been terrified by her illness. She was crying and would not leave her mother’s side. So Sonarin had to bring her along. The child had terrible forebodings.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>A steep decline<o:p></o:p></b></div><div class="MsoNormal">Sonarin spoke of ten or more episodes of fever and cough over three years, each lasting a week or more. But since January 2010, she had noted pain and swelling on the left side of her abdomen. Both got progressively worse. By the time she sought help, she had lost a great deal of weight, suffered back pain and felt feverish many days. Progressively weak and exhausted, she had to give up working in the fields. With any exertion, she could not catch her breath. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>A diagnosis and hope<o:p></o:p></b></div><div class="MsoNormal">The doctors at JSS quickly determined her problem – a rare form of bone marrow cancer called Chronic Myelogenous Leukemia (CML)<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference">[2]</span></a>. They noted huge enlargement of her spleen that accounted for the swelling in her abdomen.<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference">[3]</span></a>. A simple blood test revealed the countless millions of cancerous white blood cells that are characteristic of this disease.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The only hope for her survival would be an anti-cancer drug, Glivec, controlled and marketed by Novartis, a pharmacological giant. For years, Novartis had been battling the Government of India to gain patent protection for this product. The penultimate legal action took place in 2007 in the High Court of Chennai in the southern state of Tamil Nadu. Novartis lost again though it appears still to be planning further appeals. Perhaps to appease the public and presumably the courts, Novartis agreed to provide Glivec<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn4" name="_ftnref4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference">[4]</span></a> free of charge to all poor Indian patients in need of the drug<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn5" name="_ftnref5" style="mso-footnote-id: ftn5;" title=""><span class="MsoFootnoteReference">[5]</span></a>. The catch, however, has been that these near-indigent patients would have to make their way either to Delhi, Mumbai, Calcutta, Vellore, or another major cancer treatment center of Novartis’s choosing, to get the drug. Every three months, they would have to return for another round of treatment.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>Death in Delhi<o:p></o:p></b></div><div class="MsoNormal">So it is that Sonarin Bai learned that she would have to travel to the All India Institute of Medical Sciences in Delhi to get the medicine that would hold her otherwise fatal illness at bay. Her physicians at JSS advised that she return in a week to join seven other patients with a variety of ailments for the trip to Delhi. On July 28, Sonarin came back from her distant home, this time accompanied only by her mother, Sumantri Bai.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Jai Kumar, a member of the JSS staff, had guided patients from JSS to Delhi on two prior occasions. He knew the ropes. But this time, for one of the 8, Sonarin Bai, tragedy lay ahead.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWjgmrQ_ZjkbygL95P26LUfijkX2MN8JCJOJL7-i_F6-cZF_PNyL0efBj5lV2QrP4nfi1liXFtj5W9t9kIzmW-XRzPkB4oHmYKyNB41t5rQuLeHxQ-DdE-6WGUrhnXkZdmFwlJYH474Bs/s1600/IMG_5241.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWjgmrQ_ZjkbygL95P26LUfijkX2MN8JCJOJL7-i_F6-cZF_PNyL0efBj5lV2QrP4nfi1liXFtj5W9t9kIzmW-XRzPkB4oHmYKyNB41t5rQuLeHxQ-DdE-6WGUrhnXkZdmFwlJYH474Bs/s320/IMG_5241.JPG" width="218" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Jay Kumar recalling Sonarin Bai's final hours</td></tr>
</tbody></table></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><b>Jay Kumar's account - <span class="Apple-style-span" style="font-style: italic;">Don't cry mother. She's no more.</span></b></div><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><b><i><br />
</i></b></div></div></div><div class="MsoNormal">Day 1 - On July 28, the eight patients and their relatives, numbering 19 in all, boarded the train in Bilaspur. The 24-hour trip to Delhi proved uneventful.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Day 2 – We arrived the following evening and checked in at the darmsala hostel for patients and family. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Day 3 – I took Sonarin Bai to the AIIMS Hospital. But she was one of four patients who could not be seen by a doctor as she had no prior registration and we ran out of time to get this done. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Day 4 – The following day registration was closed. “It was an Outpatient Day”. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Day 5 – Sonarin Bai finally got her registration card. But the oncologist to whom she was referred left word that, before she was to be seen, blood tests and x-rays had to be done.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Day 6 – Only the blood tests could be done. Sonarin complained of fever.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Day 7 - We went for the x-ray. The clerk advised: “Go back to the doctor and request that the x-ray be without charge.”<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Day 8 – The doctor wasn’t in his office. We went to the Outpatient Department but we couldn’t find him.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Day 9 – We returned to the X-ray Department and paid 30 rupees and the x-ray was taken but no report was given. We were told to return the following day.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Day 10 - We returned to the X-ray Department and got the report. Then we went to the doctor’s waiting area and got in a queue. By then, it was 2 in the afternoon. At 7PM, the oncologist finally saw Sonarin. He examined her abdomen and prescribed some medicine. He explained, however, that he could not be her physician, nor follow her, as his specialty was limited to cancer in children. Therefore, he advised that he would refer her to an oncologist for adult patients. The appointment would be the following week. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Day 11 - I went to a pharmacy and got the medicine. On my return, Sonarin Bai said: “I don’t feel well at all.” I told her that the medicine had come. “Take it”, I advised. Towards evening, she developed stomach cramps and diarrhea. She had a fever and appeared quite ill. We decided to take her in a wheelchair immediately to the hospital emergency room, a fair distance to go on foot. When we got there, she saw a succession of three physicians. They placed an intravenous line. While her mother waited outside on the hospital veranda, one of the physicians came to me and said: <i>She is</i><span style="font-style: normal;"> </span><i>seriously ill</i><span style="font-style: normal;">. Soon they informed me that her condition was </span><i>critical</i><span style="font-style: normal;">. Then they took her elsewhere in the hospital.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Day 12 - At four in the morning, one of the physicians returned. He approached me and said: <i>Tell her mother, she’s no more. </i><span style="font-style: normal;">I went to her mother on the veranda outside of the hospital and spoke to her. </span><i>Mat ro mataram sonarin ab duniya mai nahi hai. - Don’t cry mother. She’s no more.</i><span style="font-style: normal;"> <o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFKo8QQVz5d7IRphac9WbJd5WNxclLFtDIXe9k6J11Ib8d9gbAeQKOtAfFZCMgZ3bjjlIeQf1r5JAlQESdlwdRPNymBWpPr3n86D_K-B3ikXj0dwV4_x3tjvOfpO0ZKsfrLhtjqEYPD8I/s1600/IMG_5145.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFKo8QQVz5d7IRphac9WbJd5WNxclLFtDIXe9k6J11Ib8d9gbAeQKOtAfFZCMgZ3bjjlIeQf1r5JAlQESdlwdRPNymBWpPr3n86D_K-B3ikXj0dwV4_x3tjvOfpO0ZKsfrLhtjqEYPD8I/s320/IMG_5145.JPG" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Sonarin Bai's mother, Sumantri, recalling her daughter's recent death in Delhi</td></tr>
</tbody></table></div><div class="MsoNormal"><span class="Apple-style-span" style="font-weight: bold;">Postscript</span></div><div class="MsoNormal">Why did this poor woman, mother of three, die in Delhi? Here is what I think and have learned to date.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><i>Sonarin Bai did not have to die. She could have received Glivec at JSS and avoided the trip with all the delay, systems failures and fatal neglect in Delhi.<o:p></o:p></i></b></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><i>For reasons unknown, Novartis has refused to provide this life-saving medicine to qualified oncologists, and other physicians capable of administering chemotherapy, at reputable medical institutions, like JSS, throughout India where poor patients have ready access and can receive treatment without delay.<o:p></o:p></i></b></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Novartis insisted that she, and thousands of others like her, come to a treatment center they have authorized in one of India’s major cities, e.g. Delhi, Mumbai, Calcutta. It is alleged that Novartis may be motivated in part to restrict access points in order to do clinical research on the referred patients at these centers.<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn6" name="_ftnref6" style="mso-footnote-id: ftn6;" title=""><span class="MsoFootnoteReference">[6]</span></a><o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Qualified oncologists and general physicians who administer chemotherapy exist in many smaller cities throughout India who could administer Glivek competently.<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn7" name="_ftnref7" style="mso-footnote-id: ftn7;" title=""><span class="MsoFootnoteReference">[7]</span></a><o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Novartis on its own web sites makes contradictory statements about which among India’s poor receive Glivek free of charge:<o:p></o:p></div><div class="MsoNormal"><blockquote>“The price of Glivec is almost irrelevant in India as 99% of the patients who need the medicine receive it free from Novartis...” <span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: black;"><span class="Apple-style-span" style="text-decoration: none;"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn8" name="_ftnref8" title="">[8]</a></span></span></span></blockquote></div><div class="MsoNormal"><blockquote>Contrast that with the following statement by Novartis: “…In India, 99% of patients prescribed Glivec receive it free.”</blockquote></div><div class="MsoNormal"><i>Which is truthful? <o:p></o:p></i></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Is Novartis claiming that it reaches 99% of the patients in India with CML who need Glivek to survive? This is patently absurd. Novartis itself claims that it has treated 6,600 individuals with CML in India. However, S. Srinivasan, an authority on pharmaceuticals in India has written: There are “over 30,000 cases of …CML…reported in India every year.”<a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn9" name="_ftnref9" style="mso-footnote-id: ftn9;" title=""><span class="MsoFootnoteReference">[9]</span></a></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Thousands among them are poor. Many are undiagnosed. Only a minute fraction could afford to buy Glivec on the open market or the generic, far cheaper but still prohibitively costly. Others have no way to travel from their villages to the designated treatment centers. They are too poor and may know nothing of the program or how to gain access.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">And what awaits patients who do make it to a treatment center after many days and weeks of delay, an arduous journey and a system that fails them on arrival, as it did Sunarin Bai?</div><div class="MsoNormal"><br />
When I first interviewed Sonarin Bai, I asked her if she knew why she had to go to Delhi and could not be treated at JSS in Chhattisgarh. Her reply was immediate: <i>Because I am poor. There is no medicine here</i><i>.</i><br />
<i><br />
</i></div><div class="MsoNormal" style="text-align: left;"><span style="font-size: 14pt;"><i>Death in Delhi. At whose door?<o:p></o:p></i></span></div><div class="MsoNormal"><span style="font-size: 14pt;"><i><br />
</i></span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhem_rLozjpJBQElF8IE4wDaXiQ6m7zx-4aVd-W4m8f2wYO1gxN1bJX4GwOTgyqdUrs8rUC5uQ_S3BAB5Twl-kNkeXQYIShXBNAf8uZvDN8qC1g31E6lCTj2XBkpNOJc9MtXA5o-rWe4YE/s1600/Sonarin+Bai%27s+10+yr+old.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhem_rLozjpJBQElF8IE4wDaXiQ6m7zx-4aVd-W4m8f2wYO1gxN1bJX4GwOTgyqdUrs8rUC5uQ_S3BAB5Twl-kNkeXQYIShXBNAf8uZvDN8qC1g31E6lCTj2XBkpNOJc9MtXA5o-rWe4YE/s320/Sonarin+Bai%27s+10+yr+old.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Eeswari Bai, 10, July 12, at JSS in Ganiyari<br />
She would not leave her mother's side.<br />
<br />
</td></tr>
</tbody></table><div style="mso-element: footnote-list;"><hr align="left" size="1" width="33%" /><div id="ftn1" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference">[1]</span></a> Ganiyari is the headquarters site of JSS in the Bilaspur District of Chhattisgarh. All levels of health care are offered by JSS. Patients come from 1,500 villages and an intensive medical and public health program is offered in 53 remote forest villages where JSS has 3 subcenters and over 100 volunteer, trained village health workers and midwives. There is a demonstration agricultural program as well to help farmers produce more organic produce with greater yields, free of chemical fertilizers.</div><div class="MsoFootnoteText"><br />
</div></div><div id="ftn2" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref2" name="_ftn2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference">[2]</span></a> “Chronic myelogenous (or myeloid) leukemia (CML), also known as chronic granulocytic leukemia (CGL), is a cancer of the white blood cells. It is a form of leukemia characterized by the increased and unregulated growth of predominantly myeloid cells in the bone marrow and the accumulation of these cells in the blood. CML is a clonal bone marrow stem cell disorder in which proliferation of mature granulocytes (neutrophils, eosinophils, and basophils) and their precursors is the main finding. It is a type of myeloproliferative disease associated with a characteristic chromosomal translocation called the Philadelphia chromosome. It is now treated with imatinib (the generic name of Glivec) and other targeted therapies, which have dramatically improved survival.” – Wikepedia</div><div class="MsoFootnoteText"><br />
</div></div><div id="ftn3" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref3" name="_ftn3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference">[3]</span></a> 15 cms. below the left costal margin. Even minimal enlargement of the spleen below the rib cage is abnormal. The spleen is the principal graveyard for abnormal blood cells. With a daily huge outpouring of cancer cells from her bone marrow, the spleen became progressively engorged.</div><div class="MsoFootnoteText"><br />
</div></div><div id="ftn4" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref4" name="_ftn4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference">[4]</span></a> Novartis comments: “Sustainable access to medicines in developing countries is complex and requires much more than the availability of generic drugs<i>. </i><span style="font-style: normal;">Generics alone do not solve the issue. For example, in India the cost of a one-year treatment with the generic imatinib is USD 2,100, or 4.5 times the average annual income. Even our critics recognize that generic versions of Glivec are not the solution for the poor in India. Furthermore, generic makers in India have yet to come forward with an access program for generic imatinib…Glivec is not an exception. As a matter of business principle, Novartis is deeply concerned that patients have access to the medicines they need, as demonstrated by our well-regarded record in social responsibility.”</span></div><div class="MsoFootnoteText"><br />
</div></div><div id="ftn5" style="mso-element: footnote;"><div class="MsoNormal"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref5" name="_ftn5" style="mso-footnote-id: ftn5;" title=""><span class="MsoFootnoteReference">[5]</span></a> Novartis reports: “Novartis has secured access to Glivec both in India and globally.<b><o:p></o:p></b></div><div class="MsoNormal">When we launched Glivec, Novartis committed that no patient in need should be denied this life-saving cancer treatment. We fulfilled this commitment by establishing the Glivec International Patient Assistance Program (GIPAP), which is one of the most far-reaching patient assistance programs ever implemented on a global scale. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“In India, Novartis currently provides Glivec at no cost to more than 6,600 diagnosed patients… For more information, please visit the Max Foundation which administers the program, <a href="http://www.themaxfoundation.org/">www.themaxfoundation.org</a>.” - Novartis’s official web site.<o:p></o:p></div><div class="MsoFootnoteText"><br />
</div></div><div id="ftn6" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref6" name="_ftn6" style="mso-footnote-id: ftn6;" title=""><span class="MsoFootnoteReference">[6]</span></a> Personal communication: Dr. Gopal Dabade</div><div class="MsoFootnoteText"><br />
</div></div><div id="ftn7" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref7" name="_ftn7" style="mso-footnote-id: ftn7;" title=""><span class="MsoFootnoteReference">[7]</span></a> Personal communication: Dr. Yogesh Jain, staff physician at JSS; oncologist trained at AIIMS.</div><div class="MsoFootnoteText"><br />
</div></div><div id="ftn8" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref8" name="_ftn8" style="mso-footnote-id: ftn8;" title=""><span class="MsoFootnoteReference">[8]</span></a> Novartis publication “Fact vs. Fiction”</div><div class="MsoFootnoteText"><br />
</div></div><div id="ftn9" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref9" name="_ftn9" style="mso-footnote-id: ftn9;" title=""><span class="MsoFootnoteReference">[9]</span></a> Battling Patent Laws: The Glivec Case, S. Srinivasan, Economic and Political Weekly, September 15, 2007, p. 3686.</div></div></div>Jonathan E Finehttp://www.blogger.com/profile/07031814720598988581noreply@blogger.com1tag:blogger.com,1999:blog-3597997732596309562.post-13098427359518490802010-08-20T09:19:00.000-07:002010-08-22T08:53:12.764-07:00The Story of Jethuram - Death by a Rabid Dog<div class="MsoNormal" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;"><b><br />
</b></span></div><div class="MsoNormal" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;"><b>As told by his widow, Sham Bai, in her own words.</b></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;">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.</span></div><div class="MsoNormal" style="text-align: center;"><br />
</div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2tWmdU2dtrpck9_MU2dR9_ojoU2bJmGwxX6ZGXLhEgfztEi7d6pKKdlbdexRSdwX0kbx4tVq7ro7-nEz2sNwub8ylm-nocyZhDJ5AspgvN-vOKuy-9ANqaoVEQyfwjmnOLQCORCaSzho/s1600/Sham+Bai.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2tWmdU2dtrpck9_MU2dR9_ojoU2bJmGwxX6ZGXLhEgfztEi7d6pKKdlbdexRSdwX0kbx4tVq7ro7-nEz2sNwub8ylm-nocyZhDJ5AspgvN-vOKuy-9ANqaoVEQyfwjmnOLQCORCaSzho/s320/Sham+Bai.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;">Sham Bai</span></td></tr>
</tbody></table><div class="MsoNormal"><div style="text-align: left;"><span class="Apple-style-span" style="color: #0b5394;">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. </span></div></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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. </span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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 </span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn1" name="_ftnref1" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[1]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> and they sent a Marshal </span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn2" name="_ftnref2" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[2]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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.</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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.</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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 </span><i><span class="Apple-style-span" style="color: #0b5394;">mahua </span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn3" name="_ftnref3" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[3]</span></span></a></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"> and when she does other forest work.” He said: “I have five children. </span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn4" name="_ftnref4" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[4]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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.”</span></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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.<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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 </span><i><span class="Apple-style-span" style="color: #0b5394;">Society</span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"> </span></span><i><span class="Apple-style-span" style="color: #0b5394;">store </span></i><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn5" name="_ftnref5" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[5]</span></span></a><span class="Apple-style-span" style="color: #0b5394;">, 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.</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><b><span class="Apple-style-span" style="color: #0b5394;">Anything else?<o:p></o:p></span></b></div><div class="MsoNormal"><i><span class="Apple-style-span" style="color: #0b5394;">Mola koi Posaiya Nikko</span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">. </span></span><i><span class="Apple-style-span" style="color: #0b5394;">There is no one to take care of me.</span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"> These are the exact words. I went to my </span></span><i><span class="Apple-style-span" style="color: #0b5394;">panchayat</span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"> </span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn6" name="_ftnref6" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[6]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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 </span></span><i><span class="Apple-style-span" style="color: #0b5394;">Parichaya Patra </span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(ID card</span></span><i><span class="Apple-style-span" style="color: #0b5394;">)</span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"> and other papers. They checked if I had registered his death at the police station in Lormi </span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn7" name="_ftnref7" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[7]</span></span></a><span class="Apple-style-span" style="color: #0b5394;">. 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.</span></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">I returned to my panchayat. The </span><i><span class="Apple-style-span" style="color: #0b5394;">sarpanch </span></i><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn8" name="_ftnref8" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[8]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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 </span><i><span class="Apple-style-span" style="color: #0b5394;">nirashrit </span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">pension </span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn9" name="_ftnref9" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[9]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> but this too proved empty. I haven’t gotten anything from anywhere. It’s been over a year now. </span></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">We eat about 1.5 kgs. of rice in our home daily. When the rice I buy from the </span><i><span class="Apple-style-span" style="color: #0b5394;">Society</span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"> is used up, I have to buy </span></span><i><span class="Apple-style-span" style="color: #0b5394;">khanda</span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"> (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.</span></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div align="center" class="MsoNormal" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;">*************</span></div><div align="center" class="MsoNormal" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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 – </span><i><span class="Apple-style-span" style="color: #0b5394;">all alone</span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">. Her patience and her courage are remarkable. If you might like to help her, let me know.</span></span></div><div class="MsoNormal"><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> </span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7mw7GxxRLgpWYNM6c5_k4NKE6qsH4DRWUjZOgy9u8iB_iGJSMAxHhFtSMOCVKqkFIJxKMhYyUPyDkwUmP4STdQJlZzB0E_bxvqtqniyAvQNLWeRSkTQzs7F9qDCJUiiYm25YvzQ6_4DU/s1600/Sham+Bai+w+baby+2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7mw7GxxRLgpWYNM6c5_k4NKE6qsH4DRWUjZOgy9u8iB_iGJSMAxHhFtSMOCVKqkFIJxKMhYyUPyDkwUmP4STdQJlZzB0E_bxvqtqniyAvQNLWeRSkTQzs7F9qDCJUiiYm25YvzQ6_4DU/s320/Sham+Bai+w+baby+2.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;">Sham Bai with Manakram, 2, the youngest of her four children</span></td></tr>
</tbody></table><div class="MsoNormal"><span class="Apple-style-span" style="font-family: 'Times New Roman'; font-size: 16px;"><span class="Apple-style-span" style="color: #0b5394;">Once the monsoon rains abate sufficiently and the roads permit a home visit, there will be a note added to this account.</span></span></div><div style="mso-element: footnote-list;"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span><br />
<hr align="left" size="1" width="33%" /><div id="ftn1"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref1" name="_ftn1" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[1]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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.</span></div></div><div id="ftn2"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref2" name="_ftn2" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[2]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> A four-wheel-drive vehicle maintained by JSS for ambulance and patient transport over the rough terrain of the forest region.</span></div></div><div id="ftn3"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref3" name="_ftn3" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[3]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> An edible flower</span></div></div><div id="ftn4"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref4" name="_ftn4" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[4]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> The elder daughter has since married, leaving four dependent children at home with Sham Bai.</span></div></div><div id="ftn5"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref5" name="_ftn5" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[5]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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. </span></div></div><div id="ftn6"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref6" name="_ftn6" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[6]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> The village council</span></div></div><div id="ftn7"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref7" name="_ftn7" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[7]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> The block headquarters. The block is an administrative unit of local government with 100 or more villages.</span></div></div><div id="ftn8"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref8" name="_ftn8" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[8]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> The </span><i><span class="Apple-style-span" style="color: #0b5394;">sarpanch</span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"> is the elected head of the panchayat or village council.</span></span></div></div><div id="ftn9" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref9" name="_ftn9" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[9]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> Literally </span><i><span class="Apple-style-span" style="color: #0b5394;">nirashirt</span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"> means “without help” – hence, a pension for a destitute person.</span></span></div></div></div>Jonathan E Finehttp://www.blogger.com/profile/07031814720598988581noreply@blogger.com0tag:blogger.com,1999:blog-3597997732596309562.post-35026778476851292752010-08-20T06:39:00.000-07:002010-08-21T23:18:04.198-07:00The Story of Kala Bai - Tuberculosis of the Spine<div class="MsoNormal" style="text-align: center;"><i><b><span class="Apple-style-span" style="color: #0b5394;">A medical cure…and then what?</span></b></i></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><br />
</b></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixjMq0DrChRFuFL-cys6I_jANCorqWC3zcJ3ldnZHWlGw2MLMT2lYwquRpMYus4EB18ORhVf7KxCqxqM_bA166QGp595B7_Ie47apWppGgx0peNCEu2eb00KysH0n2dcGaNAGrwLYYVpg/s1600/Kala+Bai+at+Interview+July+10.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixjMq0DrChRFuFL-cys6I_jANCorqWC3zcJ3ldnZHWlGw2MLMT2lYwquRpMYus4EB18ORhVf7KxCqxqM_bA166QGp595B7_Ie47apWppGgx0peNCEu2eb00KysH0n2dcGaNAGrwLYYVpg/s320/Kala+Bai+at+Interview+July+10.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;">Kala Bai, 22</span></td></tr>
</tbody></table><div class="MsoNormal"><b><span class="Apple-style-span" style="color: #0b5394;">The illness</span></b></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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.</span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn1" name="_ftnref1" title=""><sup><span class="Apple-style-span" style="color: #0b5394;">[1]</span></sup></a><span class="Apple-style-span" style="color: #0b5394;"> Given the severity of her illness, this journey must have been of epic proportions.<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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</span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn2" name="_ftnref2" title=""><sup><span class="Apple-style-span" style="color: #0b5394;">[2]</span></sup></a><span class="Apple-style-span" style="color: #0b5394;"> 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.<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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.</span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn3" name="_ftnref3" title=""><sup><span class="Apple-style-span" style="color: #0b5394;">[3]</span></sup></a><span class="Apple-style-span" style="color: #0b5394;"> Pott’s Disease has all but vanished in the West but is often diagnosed in rural India. A confirmatory MRI is planned.</span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn4" name="_ftnref4" title=""><sup><span class="Apple-style-span" style="color: #0b5394;">[4]</span></sup></a><span class="Apple-style-span" style="color: #0b5394;"> On this first hospitalization, Dr. Jain initiated three-drug, anti-tubercular therapy.</span><sup><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn5" name="_ftnref5" title=""><span class="Apple-style-span" style="color: #0b5394;">[5]</span></a></sup></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLQ5iQ83R7IgsZUStUXSoteq51xoluXUlQuHy9eluRqykc5eWJ6ZeceJ4zglTXQQhzdho5ufXjZ1A8Bc9VfesQDUD515PnpilXB1yPPF690EAFnaaqBegJJ_hF3jexjRdQNm_MJuLlG7s/s1600/Kala+Bai+JSS+hospital+July+10.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLQ5iQ83R7IgsZUStUXSoteq51xoluXUlQuHy9eluRqykc5eWJ6ZeceJ4zglTXQQhzdho5ufXjZ1A8Bc9VfesQDUD515PnpilXB1yPPF690EAFnaaqBegJJ_hF3jexjRdQNm_MJuLlG7s/s320/Kala+Bai+JSS+hospital+July+10.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;">Kala Bai on her hospital bed with her four month old daughter, Ritu</span></td></tr>
</tbody></table><div class="MsoNormal"><o:p></o:p></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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.</span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn6" name="_ftnref6" title=""><sup><span class="Apple-style-span" style="color: #0b5394;">[6]</span></sup></a></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><b><span class="Apple-style-span" style="color: #0b5394;">The long haul<o:p></o:p></span></b></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">There will be no sudden cure, no sudden relief. Nine months of drug therapy lie ahead.</span><b><span class="Apple-style-span" style="color: #0b5394;"> </span></b><span style="font-weight: normal;"><span class="Apple-style-span" style="color: #0b5394;">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.</span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn7" name="_ftnref7" title=""><sup><span class="Apple-style-span" style="color: #0b5394;">[7]</span></sup></a><span class="Apple-style-span" style="color: #0b5394;"> 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.<o:p></o:p></span></span></div><div class="MsoNormal"><span style="font-weight: normal;"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> </span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><span style="font-weight: normal;"></span></span></div><div class="MsoNormal" style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><b><span class="Apple-style-span" style="color: #0b5394;">A full-blown tragedy<o:p></o:p></span></b></div><div class="MsoNormal" style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #0b5394;">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</span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn8" name="_ftnref8" title=""><sup><span class="Apple-style-span" style="color: #0b5394;">[8]</span></sup></a><span class="Apple-style-span" style="color: #0b5394;">, 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.</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjG_F0tixHOLRI-TPqZeJSNE1DEY9O4BxTW9e41TjfUPWfsbo7-mkhfqJ3z3eO5OqtMu5NKpAi0ASvtz6dLJCiWlOK63weZWSaK6BjUUP7dDY_WiQRigJaMh6_k3WyOT_Og4K0oCJw19IU/s1600/Kala+B+Fa.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjG_F0tixHOLRI-TPqZeJSNE1DEY9O4BxTW9e41TjfUPWfsbo7-mkhfqJ3z3eO5OqtMu5NKpAi0ASvtz6dLJCiWlOK63weZWSaK6BjUUP7dDY_WiQRigJaMh6_k3WyOT_Og4K0oCJw19IU/s320/Kala+B+Fa.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;">Kala Bai with her father and her daughters at the entryway to her parents' home</span></td></tr>
</tbody></table><div class="MsoNormal"><o:p></o:p></div><div class="MsoNormal"><b><span class="Apple-style-span" style="color: #0b5394;">Closing comment</span></b></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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: </span><i><span class="Apple-style-span" style="color: #0b5394;">A poor person like me never has a chance to read a book.</span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"> No income, no savings, total disability, no one to help, plenty of fear, no hope.<o:p></o:p></span></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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.<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;">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</span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn9" name="_ftnref9" title=""><sup><span class="Apple-style-span" style="color: #0b5394;">[9]</span></sup></a><span class="Apple-style-span" style="color: #0b5394;">, 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.<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div class="MsoNormal"><i><span class="Apple-style-span" style="color: #0b5394;">Kala Bai will be helped</span></i><span style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">. 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.</span><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftn10" name="_ftnref10" title=""><sup><span class="Apple-style-span" style="color: #0b5394;">[10]</span></sup></a><span class="Apple-style-span" style="color: #0b5394;"> We can contribute to support her through the crisis of her illness. There could be a happy ending to this story.</span><o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipXAVZhXCxcmp3_8Z2PFKdmIYF6ABEFtt_aNQ_bv8l5rMODbxrlSBmKjR-34Bf78Kf4p26qBuleC4tmbONRni4HAVz02DCUaMp6Ndp7dtLLFB_jBCKEMIwdiaj8DKEi8vA2a6zMooKhrU/s1600/Kala+Bai+Smiling+JSS+Hospital+July+10.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipXAVZhXCxcmp3_8Z2PFKdmIYF6ABEFtt_aNQ_bv8l5rMODbxrlSBmKjR-34Bf78Kf4p26qBuleC4tmbONRni4HAVz02DCUaMp6Ndp7dtLLFB_jBCKEMIwdiaj8DKEi8vA2a6zMooKhrU/s320/Kala+Bai+Smiling+JSS+Hospital+July+10.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;">Kala Bai smiling</span></td></tr>
</tbody></table><div class="MsoNormal"><o:p></o:p></div><div class="MsoNormal"><div style="text-align: center;"><i><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><span class="Apple-style-span" style="color: #0b5394;"><span class="Apple-style-span" style="background-color: white;">What use is it to spare her life through timely medical intervention and fail to help make her life worth living?</span></span></span></i><br />
<i><span class="Apple-style-span" style="font-family: Verdana, sans-serif;"><span class="Apple-style-span" style="color: #0b5394;"><span class="Apple-style-span" style="background-color: white;"><br />
</span></span></span></i><br />
<div style="text-align: left;"><span class="Apple-style-span" style="color: #0b5394;"><span class="Apple-style-span" style="background-color: white;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">Postscript</span></span></span></div><div style="text-align: left;"><span class="Apple-style-span" style="color: #0b5394;"><span class="Apple-style-span" style="background-color: white;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">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.</span></span></span></div></div></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></div><div style="mso-element: footnote-list;"><b><i><span class="Apple-style-span" style="color: #0b5394;">Footnotes</span></i></b><br />
<hr align="left" size="1" width="33%" /><div id="ftn1" style="mso-element: footnote;"><div class="MsoNormal"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref1" name="_ftn1" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[1]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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.</span></div></div><div id="ftn2"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref2" name="_ftn2" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[2]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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.</span></div></div><div id="ftn3"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref3" name="_ftn3" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[3]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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.</span></div></div><div id="ftn4"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref4" name="_ftn4" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[4]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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.</span></div><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref5" name="_ftn5" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[5]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> Compliance issues loom large in India’s villages. But Kala Bai is an intelligent woman, 8</span><sup><span class="Apple-style-span" style="color: #0b5394;">th</span></sup><span class="Apple-style-span" style="color: #0b5394;"> standard graduate and literate. Compliance is not likely a problem.</span></div></div><div id="ftn6"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref6" name="_ftn6" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[6]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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.</span></div></div><div id="ftn7"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref7" name="_ftn7" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[7]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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.</span></div></div><div id="ftn8"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref8" name="_ftn8" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[8]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> Alcoholism among village men in India is rampant. It is often accompanied by verbal and physical abuse of wives and impoverishes many a family.</span></div></div><div id="ftn9"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref9" name="_ftn9" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[9]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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.</span><b><span class="Apple-style-span" style="color: #0b5394;"><o:p></o:p></span></b></div></div><div id="ftn10" style="mso-element: footnote;"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=3597997732596309562#_ftnref10" name="_ftn10" title=""><span class="MsoFootnoteReference"><span class="Apple-style-span" style="color: #0b5394;">[10]</span></span></a><span class="Apple-style-span" style="color: #0b5394;"> 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.</span></div></div></div>Jonathan E Finehttp://www.blogger.com/profile/07031814720598988581noreply@blogger.com1tag:blogger.com,1999:blog-3597997732596309562.post-51645917226771432062010-08-20T05:28:00.000-07:002010-08-21T22:15:19.091-07:00The Story of Dalsingh – A fatal snake bite<div style="text-align: center;"><b><span class="Apple-style-span" style="background-color: white;"><span class="Apple-style-span" style="color: #0b5394;">As told by Aghni Bai, his mother</span></span></b></div><div style="text-align: center;"><span class="Apple-style-span" style="background-color: white;"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></span></div><div style="text-align: center;"><i><b><span class="Apple-style-span" style="background-color: white;"><span class="Apple-style-span" style="color: #0b5394;">In the face of death, he said: Ram Johar – Goodbye to All</span></span></b></i></div><span class="Apple-style-span" style="background-color: white;"><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></span><br />
<div style="text-align: center;"><span class="Apple-style-span" style="background-color: white;"><span class="Apple-style-span" style="color: #0b5394;">The locale : A forest village of the Baiga tribe in the Achanakmar Tiger Sanctuary, 70 kms. north of Bilaspur in central Chhattisgarh, India.</span></span></div><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqp3r8FRhlANFfmnpZoRO4LwHiC1nLLxQgrDgaM6C7EIwHfA6TGe3aamR46p2q3WN8pvSdQ4hMSUXuTHXbBbrgKmyMDY8iCe3YyWDzpcm-nueR0MVjqXVEFfD5b2TtLj7CdxzImhFhm98/s1600/Aghni+Bai.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqp3r8FRhlANFfmnpZoRO4LwHiC1nLLxQgrDgaM6C7EIwHfA6TGe3aamR46p2q3WN8pvSdQ4hMSUXuTHXbBbrgKmyMDY8iCe3YyWDzpcm-nueR0MVjqXVEFfD5b2TtLj7CdxzImhFhm98/s320/Aghni+Bai.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;">Aghni Bai</span></td></tr>
</tbody></table><br />
<div class="" style="clear: both; text-align: center;"><b><span class="Apple-style-span" style="color: #0b5394;">Her story in her own words</span></b></div><b><span class="Apple-style-span" style="color: #0b5394;">The night he was bitten</span></b><br />
<span class="Apple-style-span" style="color: #0b5394;">It was the month of </span><i><span class="Apple-style-span" style="color: #0b5394;">Sawan <span class="Apple-style-span" style="font-size: x-small;">(1)</span></span></i><span class="Apple-style-span" style="color: #0b5394;">, three years ago, the day of the festival, </span><i><span class="Apple-style-span" style="color: #0b5394;">Hareli <span class="Apple-style-span" style="font-size: x-small;">(2)</span></span></i><span class="Apple-style-span" style="color: #0b5394;">. 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.<span class="Apple-style-span" style="font-size: x-small;"> (3)</span> 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 <i>What is this?</i> He picked it up and it bit him on the wrist.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMJ89yRYUmfRo600Z2h1Ji5F8tWLktHBm1o4jyj-0wjHqtEBb5EFaZyswe3pj05-96Uh-AKXHn0cnjvKlZEAaGIyFz5l5O490cW4MyLrJ65hc-X7GcD2InCxslA3ZAF1dlYAyPdkYRToA/s1600/Amrit+Bai+1A.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMJ89yRYUmfRo600Z2h1Ji5F8tWLktHBm1o4jyj-0wjHqtEBb5EFaZyswe3pj05-96Uh-AKXHn0cnjvKlZEAaGIyFz5l5O490cW4MyLrJ65hc-X7GcD2InCxslA3ZAF1dlYAyPdkYRToA/s320/Amrit+Bai+1A.jpg" width="178" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;">Aghni Bai pointing to the site of the bite</span></td></tr>
</tbody></table><span class="Apple-style-span" style="color: #0b5394;">Dalsingh saw the snake and the snakebite in the dim light of the lantern. He shouted from his house: <i>Mother, Come! I have been bitten by a snake!</i> He took a stick and moved it out of the house. He said: <i>Let us not kill the snake. Let’s just get it out of the house.</i> 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 </span><i><span class="Apple-style-span" style="color: #0b5394;">Karaith</span></i><span class="Apple-style-span" style="color: #0b5394;"> (The Common Krait). <span class="Apple-style-span" style="font-size: x-small;">(4)</span> I recognized that snake.</span><br />
<span class="Apple-style-span" style="color: #0b5394;"><br />
</span><br />
<span class="Apple-style-span" style="color: #0b5394;">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 </span><span class="Apple-style-span" style="color: #0b5394;"><i>jholachap</i></span><span class="Apple-style-span" style="color: #0b5394;"> (a village doctor) from the nearby village of Danganiya. </span><span class="Apple-style-span" style="color: #0b5394;"><span class="Apple-style-span" style="font-size: x-small;">(5)</span></span><span class="Apple-style-span" style="color: #0b5394;"> He came and gave Dalsingh two injections, one in the left arm and one in the upper right arm.</span><br />
<br />
<span class="Apple-style-span" style="color: #0b5394;">Once all the remedies proved futile, Dalsingh spoke: <i>My mother and my brother : I know you will not be able to save me now.</i> He put his hands up, </span><i><span class="Apple-style-span" style="color: #0b5394;">Ram Johar</span></i><span class="Apple-style-span" style="color: #0b5394;"> (Saying goodbye and paying respect to all present). <span class="Apple-style-span" style="font-size: x-small;">(6)</span></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyv8oa9urguHZZoyMHahpbkOQ6g9rwOgZPdh9613ezNblu910YuB2rTIc_YtP1xgvKW5Gi5LSBTPIbeN9h-R6wPcq8agnsYWM7otdKA9oNbthd9mXIOWnihC6B35fdVKhq4-7daARNkTU/s1600/Amrit+Bai+4.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyv8oa9urguHZZoyMHahpbkOQ6g9rwOgZPdh9613ezNblu910YuB2rTIc_YtP1xgvKW5Gi5LSBTPIbeN9h-R6wPcq8agnsYWM7otdKA9oNbthd9mXIOWnihC6B35fdVKhq4-7daARNkTU/s320/Amrit+Bai+4.jpg" width="178" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;">Aghni Bai showing how her son said </span><i><span class="Apple-style-span" style="color: #0b5394;">Ram Johar (Goodbye)</span></i><span class="Apple-style-span" style="color: #0b5394;"> on dying</span></td></tr>
</tbody></table><div class="separator" style="clear: both; text-align: left;"><span class="Apple-style-span" style="color: #0b5394;">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.</span></div><div class="separator" style="clear: both; text-align: center;"><span class="Apple-style-span" style="color: #0b5394;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOV6BEYnUw-3p-AjSck8xhlPkLlbJsNWD4U6F163Dgda3NacSGnug8_G5mlzyxayay7B14wCVqJcNBUhHNgaju2r3AtBHCGUIZOeryyaqBNOWfiBqeMa3nrwCeDP8-rh2LjHPTAmVVJKk/s1600/Amrit+Bai+2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"></a></span></div><span class="Apple-style-span" style="color: #0b5394;"><br />
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<b><span class="Apple-style-span" style="color: #0b5394;">Following Dalsingh’s death</span></b><br />
<span class="Apple-style-span" style="color: #0b5394;">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 </span><i><span class="Apple-style-span" style="color: #0b5394;">ghoda karaita</span></i><span class="Apple-style-span" style="color: #0b5394;">. <span class="Apple-style-span" style="font-size: x-small;">(7)</span></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGFjS660gRSg1ugrBfF9EMV4rrJkbDO81hPQxuiYER7sllhNVqyxAiyPr3mzEbgpOCQg5jWGXKF_f_wyehZqHBb_cHb1kwr-eg55ghkoJ3p6ZHrCptvhmrMg47szZd9WHfj96zsZwRkQw/s1600/Aghni+B+3.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGFjS660gRSg1ugrBfF9EMV4rrJkbDO81hPQxuiYER7sllhNVqyxAiyPr3mzEbgpOCQg5jWGXKF_f_wyehZqHBb_cHb1kwr-eg55ghkoJ3p6ZHrCptvhmrMg47szZd9WHfj96zsZwRkQw/s320/Aghni+B+3.JPG" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="color: #0b5394;">Aghni Bai showing the length of the snake</span></td></tr>
</tbody></table><span class="Apple-style-span" style="color: #0b5394;">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 </span><i><span class="Apple-style-span" style="color: #0b5394;">jaadu tona</span></i><span class="Apple-style-span" style="color: #0b5394;"> (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 <span class="Apple-style-span" style="font-size: x-small;">(8)</span>, so that when forest officers or the <i>sarpanch</i> (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.</span><br />
<span class="Apple-style-span" style="color: #0b5394;"><br />
</span><br />
<b><span class="Apple-style-span" style="color: #0b5394;">The funeral</span></b><br />
<span class="Apple-style-span" style="color: #0b5394;">My sons and I had a funeral and we fed everyone. After eating, we all went and washed our hands in the lake. <span class="Apple-style-span" style="font-size: x-small;">(9) </span> 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. <span class="Apple-style-span" style="font-size: x-small;">(10)</span> 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. <span class="Apple-style-span" style="font-size: x-small;">(11)</span></span><br />
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</span><br />
<b><span class="Apple-style-span" style="color: #0b5394;">Persistent fears</span></b><br />
<span class="Apple-style-span" style="color: #0b5394;">The children remember little as they were very young but they do ask what happened to that uncle <span class="Apple-style-span" style="font-size: x-small;">(12)</span> 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.</span><br />
<span class="Apple-style-span" style="color: #0b5394;"><br />
</span><br />
<span class="Apple-style-span" style="color: #0b5394;"><i>Ever since, I live with that night.</i> I keep a stick under the </span><i><span class="Apple-style-span" style="color: #0b5394;">khatiya</span></i><span class="Apple-style-span" style="color: #0b5394;"> (a cot). <span class="Apple-style-span" style="font-size: x-small;">(13)</span> Any noise at night wakes me with a start. <i>Is it a snake? Or a mouse on the roof rustling about?</i> 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. </span><br />
<span class="Apple-style-span" style="color: #0b5394;"><br />
</span><br />
<b><span class="Apple-style-span" style="color: #0b5394;">Her struggle since</span></b><br />
<span class="Apple-style-span" style="color: #0b5394;">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.</span><br />
<span class="Apple-style-span" style="color: #0b5394;"><br />
</span><br />
<span class="Apple-style-span" style="color: #0b5394;">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. <span class="Apple-style-span" style="font-size: x-small;">(14) </span> And for the past three years, I’ve served with three other elderly women in my village as a <i>dai</i>. <span class="Apple-style-span" style="font-size: x-small;">(15)</span> 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. <span class="Apple-style-span" style="font-size: x-small;">(16)</span> 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. <span class="Apple-style-span" style="font-size: x-small;">(17)</span></span><br />
<span class="Apple-style-span" style="color: #0b5394;"><br />
</span><br />
<span class="Apple-style-span" style="color: #0b5394;">No elderly widow in the village like me has ever received a pension. But if I do get one, </span><br />
<span class="Apple-style-span" style="color: #0b5394;">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. <span class="Apple-style-span" style="font-size: x-small;">(18)</span></span><br />
<span class="Apple-style-span" style="color: #0b5394;"><br />
</span><br />
<b><span class="Apple-style-span" style="color: #0b5394;">Emotional aftermath of Dalsingh’s death</span></b><br />
<span class="Apple-style-span" style="color: #0b5394;">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.<i> It feels like I have lost my soul.</i></span><br />
<b><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> </b><br />
<i><b><span class="Apple-style-span" style="color: #0b5394;">Footnotes</span></b></i><br />
<span class="Apple-style-span" style="color: #0b5394;"><i></i></span><br />
<i><span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(1) Sawan is the 5th month of the Hindu calendar and runs from July 16 until August 16, the height of the monsoon season.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(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.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(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.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(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.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(5) An untrained village medical practitioner. Typically, they give saline injections regardless of the nature of the illness.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(6) A common term for farewell or goodbye among the forest people. </span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(7) There are different kinds of poisonous kraits in the villages of this region, a banded krait and the common krait, a <i>ghoda karaita</i>, as in this instance. </span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(8) Eight years of formal schooling, the completion of primary school, is considered quite an achievement in village India, though short of high school.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(9) A ritual cleansing that follows the cremation of the body and the ritual meal.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(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. </span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(11) The funeral ritual goes on for 10 days. The berieved family give the guests <i>daru</i> (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.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(12) Besides its literal meaning, </span><i><span class="Apple-style-span" style="color: #0b5394;">Uncle</span></i><span class="Apple-style-span" style="color: #0b5394;"> is also an honorific term for an older person to be afforded respect.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(13) A <i>khatiya</i> is a cot made of a type of wood from the forest called balli across which strips of canvas are stretched.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(14) The two sacks of <i>paddy</i> (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.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(15) A </span></span><span class="Apple-style-span" style="color: #0b5394;">dai</span><span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"> is a village midwife. </span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(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.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(17) As astounding and improbable as this sounds, it is confirmed by Prafull, the JSS head village specialist. He explains that the </span></span><span class="Apple-style-span" style="color: #0b5394;">sarpanch</span><span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;"> 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.</span></span><span class="Apple-style-span" style="color: #0b5394;"><br />
</span> <span class="Apple-style-span" style="font-style: normal;"><span class="Apple-style-span" style="color: #0b5394;">(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.</span></span></i><br />
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<b><span class="Apple-style-span" style="font-weight: normal;"><b><span class="Apple-style-span" style="color: #0b5394;">PART II – A Visit To Aghni Bai’s home will follow.</span></b></span></b>Jonathan E Finehttp://www.blogger.com/profile/07031814720598988581noreply@blogger.com0tag:blogger.com,1999:blog-3597997732596309562.post-37103188174851464992010-02-15T11:59:00.000-08:002010-08-20T16:01:07.865-07:00Dasrath’s Story, Part III: Jhum Bai’s Dream<a href="http://www.blogger.com/"></a><span id="goog_1266541256550"></span><span id="goog_1266541256551"></span><br />
<div class="MsoNormal"><span class="Apple-style-span" style="color: #634320; font-family: Helvetica, Arial, Verdana, 'Trebuchet MS', sans-serif;"><span class="Apple-style-span" style="font-size: x-large;">For background, see previous posts</span><span class="Apple-style-span" style="font-size: x-large;">, </span><a href="http://povertyandhealth.blogspot.com/2010/01/story-of-dasrath-burn-patient.html" style="color: #bf4e27; font-weight: bold;"><span class="Apple-style-span"><span class="Apple-style-span" style="font-size: x-large;">Part I: Initial Presentation and Surgery</span></span></a><span class="Apple-style-span"><span class="Apple-style-span" style="font-size: x-large;"> and </span></span><span class="Apple-style-span" style="font-size: x-large;"><a href="http://povertyandhealth.blogspot.com/2010/02/dasraths-story-part-ii-harshness-of.html">Part II: The Harshness of Village Life</a></span></span><br />
<div style="text-align: center;"><span class="Apple-style-span" style="color: #634320; font-family: Helvetica, Arial, Verdana, 'Trebuchet MS', sans-serif;"><span class="Apple-style-span" style="font-size: x-large;"><a href="http://povertyandhealth.blogspot.com/2010/02/dasraths-story-part-ii-harshness-of.html"></a><span class="Apple-style-span" style="font-size: 13px;">******************</span></span></span></div><span class="Apple-style-span" style="color: #634320; font-family: Helvetica, Arial, Verdana, 'Trebuchet MS', sans-serif; font-size: small;"><span class="Apple-style-span" style="font-size: 13px;"><br />
</span></span><br />
Jhum Bai returned to Ganiyari with Dasrath to discuss her life, even her destiny, defined by abject poverty, her husband’s will and childlessness. Expecting despair, I found instead hopefulness and resiliency. Dr. Ramani Atkuri joined me for this interview.</div><div class="MsoNormal"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq1gV3Pc-ovcM1DzmkAqnGxOkq9fuZCsz9EDRypSOoQLOxEkx0ZRdJeHKMb54Ii7WhxdLBymK5zqVeD1Byu7kTV7EGe3Gosvd_v9Y1fkql1g6BBic4tee07qVjkKnh0VWwCG8x8zOIC68/s1600-h/IMG_3937.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="356" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq1gV3Pc-ovcM1DzmkAqnGxOkq9fuZCsz9EDRypSOoQLOxEkx0ZRdJeHKMb54Ii7WhxdLBymK5zqVeD1Byu7kTV7EGe3Gosvd_v9Y1fkql1g6BBic4tee07qVjkKnh0VWwCG8x8zOIC68/s640/IMG_3937.JPG" width="640" /></a></div><div class="MsoNormal" style="text-align: center;">Jhum Bai with Ramani at the JSS medical compound in Ganiyari Village </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Jhum Bai explained: “There are no children at home – except Dasrath (age 10), my brother-in-law. My husband’s older brother is single and has made clear he doesn’t want to marry. So the burden is on me. I have one or two years”, she relates, “to have a child. If I don't, my husband, Kunwar, will take another woman…and I will leave; go back to my parents’ home. There is further pressure from my parents. They remind me disapprovingly that my brother married about the same time I did. He has two children while I have none.”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We brought up adoption as a remote possibility. In rural India, the custom is to adopt within the family. For example it could be a relative’s girl child where there are too many mouths to feed. Not Jhumbai’s situation.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“Would you marry again?”</div><div class="MsoNormal">“No, no one will marry a woman who can’t have children.”</div><div class="MsoNormal">Nor, she added, would she consider living with another man not her husband.</div><div class="MsoNormal">But this fate, feared by all childless women, is not sealed. Jhum Bai is yet hopeful.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“Why haven’t you sought medical help after six years of trying to have a child?”</div><div class="MsoNormal">“Over the past two years, every time, I bring Dasrath for a visit to Ganiyari (the site of JSS’s clinics and hospital), my husband says: ‘Why don’t you have yourself checked up?’ He has been urging me to get examined almost from the beginning.” </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">She hasn’t, she admits, because the thought of a gynecological exam has overwhelmed her with embarrassment, even if the doctor be a woman. But now that she is more familiar with JSS, she says, she hopes to overcome her shyness.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Ramani adds that among village women, there is a shroud of secrecy about vaginal bleeding, discharges or pelvic pain. Further, itching, irritation or a white discharge from the vagina is so common as to be considered normal. Help is seldom sought and practically never discussed with others. Only when pain, as in the late stages of cervical cancer, becomes overwhelming do village women seek medical help. Mothers even avoid discussion of menstruation with their daughters. Jhum Bai has never talked with other young women in the village about her concerns.</div><div class="MsoNormal"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNR98F5weHRPbrefJmJ01p92qk-BviI7XW-h3F4uhCE4A2ixdOJqkyQOiPzr4ENCx5avbMEU-pdVgCckieDV5QVcoSHMi6xJvftQ2GWOS4SxB8NPSCvh88are3AFiFJ0jOzdtuCJcY5P8/s1600-h/IMG_3929.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNR98F5weHRPbrefJmJ01p92qk-BviI7XW-h3F4uhCE4A2ixdOJqkyQOiPzr4ENCx5avbMEU-pdVgCckieDV5QVcoSHMi6xJvftQ2GWOS4SxB8NPSCvh88are3AFiFJ0jOzdtuCJcY5P8/s400/IMG_3929.JPG" width="400" /></a></div><div class="MsoNormal" style="text-align: center;"><o:p> Jhum Bai with a hint of embarrassment</o:p></div><div class="MsoNormal" style="text-align: center;"><br />
</div><div class="MsoNormal">Dr. Ramani explained that in any case, the initial approach would be to determine if her husband is fertile, a sperm count. Her husband would only have to go to Shivterai, a JSS sub-center close to their village. The idea of male infertility was a realm beyond. Jhum Bai promised to speak with her husband. To Jhum Bai and Kunwar, the idea of male infertility is novel. His response is in no way assured to be positive. Generally in village India, a rumor, any hint, of a man’s lack of “virility” would by itself bring shame and ridicule. So why then be tested?</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Other than an explanation, at menarche, from her mother that menstrual flow would come monthly, and awareness that sexual relations may result in pregnancy, Jhum Bai has no knowledge of reproduction or the relevant female anatomy. That the uterus exists was news to her today.</div><div class="MsoNormal"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAeDz1YZXjK5LaceU3abq_A-dNKaef9ucgUH-AGNTrpB8-6cdvVeDA2wcu_IjA6t1ziTjYOzzW1GcdJtU38HcAlseKrw8sCoPwZp5Q9GN1aa4NFPoDbNWnMKMneEhewa0-Ix7b6ksa6Gs/s1600-h/IMG_3933.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAeDz1YZXjK5LaceU3abq_A-dNKaef9ucgUH-AGNTrpB8-6cdvVeDA2wcu_IjA6t1ziTjYOzzW1GcdJtU38HcAlseKrw8sCoPwZp5Q9GN1aa4NFPoDbNWnMKMneEhewa0-Ix7b6ksa6Gs/s400/IMG_3933.JPG" width="223" /></a></div><div class="MsoNormal" style="text-align: center;">Jhum Bai absorbing the revelations on causes of infertility.<o:p></o:p></div><div class="MsoNormal" style="text-align: center;"><br />
</div><div class="MsoNormal">Jhum Bai’s education ended during the preschool years as her father had fallen ill and the family needed her to do the household chores and to take care of the infants in the family. Even had she continued through the primary grades, sex education has not come to the village schools of Chhattisgarh nor to most schools in India, even in larger towns.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We asked about her happiness. “My husband treats me well”, she replied. "He doesn’t get drunk or beat me. I know he loves me as I do him. And I have friends my own age in the village. We go together to the forest to get wood. Sometimes I go with Kunwar to Kota, the nearest village with a market. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“What do you think about all day?” I asked.</div><div class="MsoNormal">“If I were better off, I wouldn’t have to do all these chores. If I were rich, I would buy jewelry and some farm land.” Jhum Bai has a few, commonplace bangles and hardly any other jewelry, marking her as the poorest of the poor. Today, she arrived dressed in a sari in tatters.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“How will life be different if you have a child?”, I asked.</div><div class="MsoNormal">“A child will give me inspiration to live. Someone to live for and build a future. It doesn't matter whether it will be a girl or boy. I will devote my life to that child and do everything possible to see that my child receives a good education. Without an education, a child can’t get anywhere.”<br />
<br />
Jhum Bai added that the Mangalpu village school goes through the 5<sup>th</sup> grade. Then, in the nearby village of Karka up to the 8<sup>th</sup> grade, only two kilometers away. In Kota, 5 kilometers distance, there is a high school. Currently, three children from the village go there, two boys and a girl. All have bicycles.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“You are young”, we said. “Would you like to go back to school?” Jhum Bai replied: “Yes, I would if my husband would agree. I could go to school from eight in the morning until one and then go home and work until eight in the evening.” I mentioned that we could help her financially make this possible. Jhum Bai said she would seek her husband's consent. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“If not, and I don’t have a child and am rejected, once back with my parents, I’ll find work and, then, I’ll try to go back to school. I would not be interested in marrying again nor living with another man.” All of this as if we were discussing the weather, her mood betrayed only by the self-control borne of a lifetime of the lowest of expectations.</div><div class="MsoNormal"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgrm1BK6lqqwWZSwngrtZTDUr8F4a8mAYAtFlLjOALlA2KABe1MHUhtGGipfO2illo1HmwjYj0SSIglTgLTTqNPZVFXYE-jyRdbvKhJHpHf3JX-rzRRLi3E1XhSsqo86ktCBNSsj9VlrE/s1600-h/IMG_3934.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="358" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgrm1BK6lqqwWZSwngrtZTDUr8F4a8mAYAtFlLjOALlA2KABe1MHUhtGGipfO2illo1HmwjYj0SSIglTgLTTqNPZVFXYE-jyRdbvKhJHpHf3JX-rzRRLi3E1XhSsqo86ktCBNSsj9VlrE/s640/IMG_3934.JPG" width="640" /></a></div><div class="MsoNormal" style="text-align: center;">A moment of reflection<o:p></o:p></div><div class="MsoNormal" style="text-align: center;"><br />
</div><div class="MsoNormal">We asked how she came to marry, here in Mangalpur village, one the poorest of the region. Jhum Bai replied, “Before I married, my family was better off. We had more to eat. When my parents decided that the time had come for me to marry, they considered three suitors. Two came from families with greater wealth. The third, Kunwar, came from a poorer family. My mother said: “This will be a better marriage. The richer suitors will treat you with little respect. The poorer suitor is more likely to treat you well.” So it came to pass.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Jhum Bai is driven with a determination to improve her lot in life. After she married Kunwar, she nevertheless managed to save over the years, so that they now have pots and pans. Think of it: pots and pans – but not enough food to avoid hunger! She told us that the other girls in the village used to make fun of her for marrying into such a poor family but her tireless basket weaving brings in two dollars weekly. Not even her husband knows, but she is keeping these savings in secret for hard times ahead.<br />
<br />
</div><div align="center" class="MsoNormal" style="text-align: center;">**********</div><div class="MsoNormal">Update on Dasrath: On the way to JSS today, Dasrath suffered a seizure and, while with us, still another while playing outside on the grounds. Yogesh Jain is once again adjusting his anti-seizure medications. </div>Jonathan E Finehttp://www.blogger.com/profile/07031814720598988581noreply@blogger.com1tag:blogger.com,1999:blog-3597997732596309562.post-75790320248759815632010-02-01T07:33:00.000-08:002010-08-20T16:01:07.865-07:00Dasrath's Story, Part II: The Harshness of Village Life<div class="separator" style="clear: both; text-align: center;"></div><span class="Apple-style-span" style="font-size: x-large;">For background, see Dasrath's Story, </span><a href="http://povertyandhealth.blogspot.com/2010/01/story-of-dasrath-burn-patient.html"><span class="Apple-style-span" style="font-size: x-large;">Part I: Initial Presentation and Surgery</span></a><br />
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<div style="text-align: center;">*************</div><br />
Since writing <i>Dasrath’s Story, Part I</i><span style="font-style: normal;"><b>, </b></span>I have visited<b> </b><span style="font-weight: normal;">Dasrath and Jhum Bai in Mangalpur, their forest village, and have interviewed Jhum Bai once again in Ganiyari at the JSS health center and hospital complex. Their story, like the road itself into the village, twists and turns, down narrow, rutted paths. But one conclusion is clear. In the end, their greatest suffering is the sense of helplessness to find a brighter future, free of the deprivations of poverty. Dasrath, perhaps, lives from day to day, seizure to seizure. Jhum Bai, married close to the onset of puberty, six years later remains childless and faces the most bleak of all possible outcomes: abandonment. This is the fate of perhaps the majority of childless, village women. Let’s hope that I’ve got it all wrong.</span><br />
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</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsDGhS5hWpFortxuBXCD0qRcIUztvzjo5x74Pfp76ON7dd7BgzKKIOCnkflAxB80SzLKd2TecDII7TmayfkYOi9aK1sOMTvKjoLSom1I6WHdJU5Z3V8BEkAmHzvRAz1drL06uiXdyTRAE/s1600-h/IMG_3516.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsDGhS5hWpFortxuBXCD0qRcIUztvzjo5x74Pfp76ON7dd7BgzKKIOCnkflAxB80SzLKd2TecDII7TmayfkYOi9aK1sOMTvKjoLSom1I6WHdJU5Z3V8BEkAmHzvRAz1drL06uiXdyTRAE/s320/IMG_3516.JPG" width="320" /></a></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><div style="text-align: center;">The winding, dirt road to the Village of Mangalpu<o:p></o:p></div></div><div class="MsoNormal" style="tab-stops: .25in;"><br />
</div><div class="MsoNormal"><b>Visit to Dasrath and Jhum Bai in Mangalpur Village</b></div><div class="MsoNormal">Mangalpur is a remote village of 28 families and 150 individuals. Most single family dwellings have but one room; few have tile roofs; all are constructed of mud and have dirt floors. None have latrines nor running water. The primary school is housed in a tiny one-room building adjacent to a newer facility that has never been finished. </div><div class="MsoNormal"><b><span class="Apple-style-span" style="font-weight: normal;"><br />
</span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA0PNg-BjHw_YaXQpoZvORFn_3ZFG389ej3892mmdNP6JusH2TOckabFHrCQzoiVJPJT9dwRUTXMd4DSyB8rdXlsDXBuN5jvCUHTIvD0eTenHKPtap6yCnHJmTUQ4ySjtdRvY1lYPGtUA/s1600-h/IMG_3542.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA0PNg-BjHw_YaXQpoZvORFn_3ZFG389ej3892mmdNP6JusH2TOckabFHrCQzoiVJPJT9dwRUTXMd4DSyB8rdXlsDXBuN5jvCUHTIvD0eTenHKPtap6yCnHJmTUQ4ySjtdRvY1lYPGtUA/s320/IMG_3542.JPG" width="320" /></a></div><div class="MsoNormal"><div style="text-align: center;">The unfinished village school house, center, and the temporary, inadequate school building at the far left.</div></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Arriving at the village, active electioneering for the first panchayat (local governing body) election in sixty years was underway.</div><div class="MsoNormal"><b><br />
</b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwtJbqKduBFJl-Vtg3xs3Q__OA9M8ZY4p088a8jLMUA8UKmR7wgraN3tx3f0haRL9MlFRtcuJCNSyLn8X7gBIlG53mr9ceuwF6ELYyrsUThoBMB1C5c_Tp3LNDqETnFeFduK9tPTDc25Y/s1600-h/IMG_3521.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwtJbqKduBFJl-Vtg3xs3Q__OA9M8ZY4p088a8jLMUA8UKmR7wgraN3tx3f0haRL9MlFRtcuJCNSyLn8X7gBIlG53mr9ceuwF6ELYyrsUThoBMB1C5c_Tp3LNDqETnFeFduK9tPTDc25Y/s400/IMG_3521.JPG" width="400" /></a></div><div class="MsoNormal"><div style="text-align: center;">Entering the village, the panchayat election poster is prominently displayed.</div></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Several hundred meters on, we came to another cluster of huts including Jhum Bai’s and Dasrath’s.</div><div class="MsoNormal"><b><br />
</b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjalFluojsv4zmd7BqmaBDF0SleHsfDZrkwf5PRNhYF5V-huNodO8LRp9HzXdw2TY6XzXWGP3ectLbx8TgpcjZhH75DNYIxOpOXnWwjllK62cdA-GsjhaUiqhMam9YhDwxaZ-FA9caEMUg/s1600-h/IMG_3584.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="358" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjalFluojsv4zmd7BqmaBDF0SleHsfDZrkwf5PRNhYF5V-huNodO8LRp9HzXdw2TY6XzXWGP3ectLbx8TgpcjZhH75DNYIxOpOXnWwjllK62cdA-GsjhaUiqhMam9YhDwxaZ-FA9caEMUg/s640/IMG_3584.JPG" width="640" /></a></div><div class="MsoNormal"><div style="text-align: center;">Jhum Bai stand in front of her home shared with her husband, Kunwar Singh, Dasrath and others. </div></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Our visit to Dasrath and Jhum Bai’s one-room hut was brief. Her husband, Kunwar Singh, and JSS’s volunteer Senior Village Health Worker, Aghaniya Bai, were present.</div><div class="MsoNormal"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZHTdEWG2ZwWJ98UYqgiLhkT2_fVgUor6l3wjc2x4xJj3AV4G1DK7BE1OJWzOcy6GIzld7F-QW-f_6J9vaeynQRqgnj0BBWtQvQaP2p3VCKFMz4DlCNIkbp9tBo5jLQdkq7DvAlANowZc/s1600-h/IMG_3576.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZHTdEWG2ZwWJ98UYqgiLhkT2_fVgUor6l3wjc2x4xJj3AV4G1DK7BE1OJWzOcy6GIzld7F-QW-f_6J9vaeynQRqgnj0BBWtQvQaP2p3VCKFMz4DlCNIkbp9tBo5jLQdkq7DvAlANowZc/s400/IMG_3576.JPG" width="400" /></a></div><div class="MsoNormal"><div style="text-align: center;">Left to right: Jhum Bai, Aghaniya Bai, Kunwar Singh, and JSS Village staff specialist, Prafull</div><div style="text-align: center;"><br />
</div></div><div class="MsoNormal">I presented Jhum Bai, with Aghaniya Bai as witness, Rs. 3,000, the balance required to pay off the moneylender and reclaim the family’s small plot of land on which a single crop of paddy is harvested each September. Earlier, I had gained clearance from Yogesh Jain and other physicians of JSS to provide such assistance. Thus, with a total donation of Rs. 5,000, or about $100, the family was able to regain their land on which they grow rice. Jhum Bai told us that Kunwar cried when he heard the news. (See Dasrath’s Story, Part I.)</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The electrical connection, to provide illumination from a single bulb inside the home, had been out of order for several months. Jhum Bai related that the leader of the panchayat demanded Rs.100 to get the responsible government official based in Kota, the block headquarters, to fix it. She could not pay. Hence it remains a useless relic. </div><div class="MsoNormal"><b><span class="Apple-style-span" style="font-weight: normal;"><br />
</span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKnyG0noH4jeSLuhfjXTX3X9WOgudbh-4bfKFEnCUDku2OwpP1BkaPdIlWJyc7MwS0J6Q7ppDHqnKPJQOn1G7jTIdUKskyJscqb1S6ysC9TZwliLqFvBMYAOZdJ6Kcs2VVGev_dFQtXn4/s1600-h/IMG_3549.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKnyG0noH4jeSLuhfjXTX3X9WOgudbh-4bfKFEnCUDku2OwpP1BkaPdIlWJyc7MwS0J6Q7ppDHqnKPJQOn1G7jTIdUKskyJscqb1S6ysC9TZwliLqFvBMYAOZdJ6Kcs2VVGev_dFQtXn4/s320/IMG_3549.JPG" /></a></div><div class="MsoNormal"><div style="text-align: center;">The broken electrical connection, many months out-of-order</div></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><div style="text-align: center;">At night, the family depends on the dim light from a single bulb attached to the exterior of the hovel. At times, a kerosine lantern is available. The battery of a torch, which sits on top of on of three bags of paddy, has long ago expired.</div></div><div class="MsoNormal"><b><span class="Apple-style-span" style="font-weight: normal;"><br />
</span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWe5COZXrJIU_HCqW9veNGJsgX-3iKl9r5s7T4RBfDMltvvpFySwyoo-o8ePBEwHudSMpuOCO9EUvUsFGu0fBcB84gR-6ZvEHQMktlXRFS2hfQmFMoOH5SZLl2wHPlPVMTuTv4gKeV9H0/s1600-h/IMG_3572.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWe5COZXrJIU_HCqW9veNGJsgX-3iKl9r5s7T4RBfDMltvvpFySwyoo-o8ePBEwHudSMpuOCO9EUvUsFGu0fBcB84gR-6ZvEHQMktlXRFS2hfQmFMoOH5SZLl2wHPlPVMTuTv4gKeV9H0/s320/IMG_3572.JPG" /></a></div><div class="MsoNormal"><div style="text-align: center;">Bags of paddy from the September harvest, stored in the family's hut with the useless torch</div></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"> Three large sacks of paddy from the September harvest are stored in the room, only about one-third the normal yield due to the failure of monsoon rains in 2009. The family <span style="font-weight: normal;">plans to extract the seed for planting of their plot of land at the onset of the monsoon season in July. Hence, there will be no rice from their own crop. The family itself depends on the government-subsidized rice purchased with ration cards but this only lasts for a portion of each month.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">On the back wall of the hut hang everyone’s garments, mosquito nets, dried corn brought by Jhum Bai’s parents, who live 40 kms. away and, heaped on the floor, assorted light, threadbare blankets and ground coverings. Jhum Bai owns three saris. There are no beds.</div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHVsdXkNjSNvsHMwkMCp6CieEaA-xizIXVXV9p2uvbdApTsVpC67_LEzOO0WDvKspZLiout9GX1Df5RxW0_y8tTl6hsxUtU3xs8ZWeV9HFE9T6EnVjOeNY2L94vo1h9Y0A_5uO4V-T8iI/s1600-h/IMG_3554.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHVsdXkNjSNvsHMwkMCp6CieEaA-xizIXVXV9p2uvbdApTsVpC67_LEzOO0WDvKspZLiout9GX1Df5RxW0_y8tTl6hsxUtU3xs8ZWeV9HFE9T6EnVjOeNY2L94vo1h9Y0A_5uO4V-T8iI/s320/IMG_3554.JPG" /></a></div><div style="text-align: center;">The back wall of the hut with clothing. Jhum Bai holding mosquito netting. Piled on the floor, flimsy blankets. Dried corn on upper right.</div><br />
</div><div class="MsoNormal">Soon, the family hopes to finish construction of a second room, adjacent. When completed, Jhum Bai, her husband and Dasrath will live there. The current hut will be converted into an animal keep for the family’s two remaining oxen and for storage.</div><div class="MsoNormal"><b><span class="Apple-style-span" style="font-weight: normal;"><br />
</span></b></div><div class="MsoNormal"><span id="goog_1265013797404"></span><span id="goog_1265013797405"></span></div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlynSHo-0ymHxR70eOi4BNiqxAkdaV04b7pMakIESHxqe3q_QQAhQgNn5_KmwmQzrYjxFjMkQ1Yn_r5WBmVrQGHsnhRFvV-oFzHEoyvynnnjz3q64aKSB3Ech8z-k1C3hSMwJ07bb9stg/s1600-h/IMG_3573.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlynSHo-0ymHxR70eOi4BNiqxAkdaV04b7pMakIESHxqe3q_QQAhQgNn5_KmwmQzrYjxFjMkQ1Yn_r5WBmVrQGHsnhRFvV-oFzHEoyvynnnjz3q64aKSB3Ech8z-k1C3hSMwJ07bb9stg/s320/IMG_3573.JPG" /></a></div><div style="text-align: center;">The partial wall of the adjacent, new one-room home under construction. The current home will accommodate two oxen in the future.</div><div style="text-align: center;"><br />
</div></div><div class="MsoNormal"><b>Daily life</b><span style="font-weight: normal;"> </span></div><div class="MsoNormal">We asked Jhum Bai to return to Ganiyari a day after the elections for further discussion. This is the story that emerged.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Life is unimaginably hard. During these winter months, November – February, despite keeping a fire burning inside their hut at night, they shiver from the cold. All garments available are not sufficient for protection. Sleep is fitful. Often, Jhum Bai, her husband and Dasrath awaken by 2 AM and sit around the fire to warm up before lying down once more, trying to sleep. They have no woolen clothes and only the thinnest of blankets. I felt compelled to provide wool sweaters and blankets but colleagues advised the cold would penetrate even those. I also brought Jhum Bai a food basket of sorts, including a few oranges. Only once previously in her whole life had she ever eaten an orange. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">When in need, neighbors can’t be counted on. Nor can the government. The bore well, the source of drinking water near their home, has been out-of-order for a month. Two weeks ago, each villager paid Rs. 10 to the Panchayat but, since, there’s been no repair.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The government has failed to install any latrines in this or other villages in the forest preserve.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The government is now beginning to force villagers out of their homes to resettlement areas outside of the forest on the order of New Delhi. Four villages already have been moved and, as yet, the government has failed to provide amenities or compensation. A weak protest is growing against overwhelming odds. These villagers are mostly of the Baiga tribe, officially protected, but in fact scorned by officialdom as illiterate and too few in numbers to be taken seriously.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The roof leaks badly; the best solution, tile, is beyond their grasp. Even a new sheet of heavy plastic, to be covered with leaves from the forest is unaffordable. Broken and old tiles hauled from another village may be used on the adjacent roof but the quantity and quality is grossly insufficient. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">For personal hygiene, washing up takes place at the bore well pump – when functioning. But poverty dictates that soap be used only every other day. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">No one in the family owns a bicycle. Those seen in the photo belong to two of Kumar Singh’s cousins that live elsewhere.</div><div class="MsoNormal"><br />
My final question this day to Jhum Bai: "If you were granted three wishes, what would they be?" Without hesitation, she replied: "I would not have three wishes, only one, to have children." Her survival may depend on this wish coming true.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>Final interview to follow: Jhum Bai's Dream<o:p></o:p></b></div><div class="MsoNormal"><br />
</div>Jonathan E Finehttp://www.blogger.com/profile/07031814720598988581noreply@blogger.com1tag:blogger.com,1999:blog-3597997732596309562.post-4358300905611353912010-01-25T22:11:00.000-08:002010-08-20T16:01:07.865-07:00The Story of Dasrath - A Burn Patient<div class="MsoNormal"><div style="text-align: center;">JSS, Ganiyari Village, Bilaspur District, Chhattisgarh, India</div></div><div class="MsoNormal"><div style="text-align: center;"><i>A preliminary report</i></div></div><div class="MsoNormal"><div style="text-align: center;">Ref. purposes: 46 Indian rupees = About one dollar, U.S</div></div><div class="MsoNormal"><div style="text-align: center;">Informant: Jhum Bai, sister-in-law of Dasrath, the injured boy</div></div><div align="center" class="MsoNormal" style="text-align: center;"><o:p></o:p></div><div class="MsoNormal"><b><br />
</b></div><div class="MsoNormal"><div style="text-align: center;"><div style="text-align: left;"><b><span class="Apple-style-span">Part I – Initial Presentation and Surgery</span></b></div></div></div><div class="MsoNormal"><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKHo68k03Scv9OMgYC0VkMSgQ-LRj5ScCwKUy_dtV3GEJn_RoZOXnbQvXbF_AOzWUb1JaycribFn7dRDVuCccNfoWTLLm47eryZhjz4ooh6ItUZSzjOWcpv_CvCYKJ_WUeEXilxKIog-E/s1600/IMG_3404.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" height="161" id="BLOGGER_PHOTO_ID_5430920148070139714" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKHo68k03Scv9OMgYC0VkMSgQ-LRj5ScCwKUy_dtV3GEJn_RoZOXnbQvXbF_AOzWUb1JaycribFn7dRDVuCccNfoWTLLm47eryZhjz4ooh6ItUZSzjOWcpv_CvCYKJ_WUeEXilxKIog-E/s200/IMG_3404.JPG" style="height: 258px; margin-top: 0px; width: 320px;" width="200" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;">Dasrath, age 10<o:p></o:p></div><br />
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</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhY7H6QjoFqbba5viGnUNoeSJxcNcq6MKTJkttNrg6TE3prDqW_pbnARODfhRpFBvFjPqnlSkFanF0FbNzX8Qx58uaMJ2xe3rtpxX4YxEEG09Kuaxoh9xk3nhgzQUnyc401lahgSk7WZ5E/s1600/IMG_3438.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" height="171" id="BLOGGER_PHOTO_ID_5430920160394360306" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhY7H6QjoFqbba5viGnUNoeSJxcNcq6MKTJkttNrg6TE3prDqW_pbnARODfhRpFBvFjPqnlSkFanF0FbNzX8Qx58uaMJ2xe3rtpxX4YxEEG09Kuaxoh9xk3nhgzQUnyc401lahgSk7WZ5E/s200/IMG_3438.JPG" style="height: 274px; margin-top: 0px; width: 320px;" width="200" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;">Jhum Bai, Dasrath’s sister-in-law, age unknown<o:p></o:p></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
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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. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><o:p></o:p></div><div class="MsoNormal">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.<br />
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</div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgICaa7idgtNF1TtjVDWhz7WzR9-1d7tyYCZW9OFnIJxmioIRWWhX2uM4NeXjzJAnLW1bINUA3PZsH2QcSShasK1Lwv3JjrgGl5HQdu4xlvXWGHcMfm55Ysp3jVWYDI4_J3jBUrwk4e7OI/s1600-h/IMG_3401.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgICaa7idgtNF1TtjVDWhz7WzR9-1d7tyYCZW9OFnIJxmioIRWWhX2uM4NeXjzJAnLW1bINUA3PZsH2QcSShasK1Lwv3JjrgGl5HQdu4xlvXWGHcMfm55Ysp3jVWYDI4_J3jBUrwk4e7OI/s320/IMG_3401.JPG" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;">Dasrath and Jhum Bai in the JSS clinic at Ganiyari</div><br />
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</div><div class="MsoNormal">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. <br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-Y0TTV5IxGEyx2OFTtp3e45WRqCiLBwlyopajeOvGNNnBp8cMxKCMuGLb01DvxPy89qcGnhZwILbto8kFq5gSf-BLxQYTUysa_a0ubmQ0VKagcqlGWivP6DjnujGOdLg8wvhwruU_Zns/s1600/IMG_3402.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" height="135" id="BLOGGER_PHOTO_ID_5430920175041718866" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-Y0TTV5IxGEyx2OFTtp3e45WRqCiLBwlyopajeOvGNNnBp8cMxKCMuGLb01DvxPy89qcGnhZwILbto8kFq5gSf-BLxQYTUysa_a0ubmQ0VKagcqlGWivP6DjnujGOdLg8wvhwruU_Zns/s200/IMG_3402.JPG" style="height: 217px; margin-top: 0px; width: 320px;" width="200" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;">Dasrath’s burned, infected legs. Burns are <i>common</i><span style="font-style: normal;"> complications of epilepsy in rural India.</span></div></div><div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><o:p></o:p></div><div class="MsoNormal">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.<br />
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</div><div class="MsoNormal">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.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRMWNc81DSMzCNH1ZmUszkfLbrk3IXlTOUfiEiq7FpGpeouYXHubIZcl3JJguaNTRa7fJYBH2b9YUBV8X8dcotWyRebF24vJOoDuqPOgsj74Mf9aYMGNK_TS4eXP3IPtzRKy63WJHTwPE/s1600-h/IMG_3420.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRMWNc81DSMzCNH1ZmUszkfLbrk3IXlTOUfiEiq7FpGpeouYXHubIZcl3JJguaNTRa7fJYBH2b9YUBV8X8dcotWyRebF24vJOoDuqPOgsj74Mf9aYMGNK_TS4eXP3IPtzRKy63WJHTwPE/s320/IMG_3420.jpg" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;">Dasrath, chronically semi-starved and famished.<b><o:p></o:p></b></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
</div>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.<br />
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</div><div class="MsoNormal">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.<br />
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</div><div class="MsoNormal">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.<br />
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</div><div align="center" class="MsoNormal" style="text-align: center;">Dasrath at the moment of a seizure during interview</div><div class="separator" style="clear: both; text-align: center;"><br />
</div>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.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">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.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">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<sup>th</sup> and 6<sup>th</sup> 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.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">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 <i>above</i><span style="font-style: normal;"> 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.)</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The family has no radio or other electrical device. Drinking water is available from a bore well that serves the entire village.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>Nutrition<o:p></o:p></b></div><div class="MsoNormal"><b><br />
</b></div><div class="MsoNormal">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. (<i>600 Rs from where?)</i><span style="font-style: normal;"> A similar story with dal. They are able to afford a </span><i>cup’s worth</i><span style="font-style: normal;"> 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.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">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.<br />
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</div><div class="MsoNormal"><div align="center" class="MsoNormal" style="text-align: center;">Dasrath and Jhum Bai returning to their village in the JSS ambulance/bus<br />
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<b><div class="MsoNormal"></div><div class="MsoNormal"></div></b></div><div class="MsoNormal"><o:p></o:p></div><div class="MsoNormal"><o:p></o:p></div>Jonathan E Finehttp://www.blogger.com/profile/07031814720598988581noreply@blogger.com6