Tribal Health - A Case Study
- Jagannath Chatterjee
Today Tribal's are in the centre of attention, and for the wrong reasons. They are being despised because they are the natural owners of two of our precious and coveted posessions, forests and their produce, and the huge store of minerals that lie under their feet. As a result they are having to fight a grim battle for survival.
They also face another battle of another sort that is more peculiar in nature. It comes in the garb of an extnded hand of help. Our civillisation wants to "mainstream" the tribals without realising that they are naturally sheltered from many of the pitfalls that plague our society. Effors to "mainstream" them in the Andaman's have led to tragic consequences as entire races of the rehabilitated tribals have been decimated and the reason remains a mystery till date. Only those have survived who have stuck to their natural habitats and resisted and ferociously fought civillisation.
What I am particularly concerned about is the "medical care" that is being targeted at the tribals. When it is generally recognised that they may be genetically different from the rest of the population and being dissociated from society may be more vulnerable to its ills, but the injudicious medical interventions do not take this into account. Neither does the medical establishment realise that what they suffer from today is primarily malnutrition, a fact very clearly proved and talked about by one the legendary physicians of our times, Dr Binayak Sen, who has spent his entire life working with them and so ought to know more on the subject than us.
The reasons for malnutrition among tribals are not difficult to trace. They were dependent upon non timber forest produce and bush meat for their food, medicinal and other needs. They also cultivated millets in forest slopes. Now with receding forests and fast disappearing wild life they have become highly vulnerable. Add to this the exploitation by the other castes who not only loot them but also sell them diseased cattle for meat which is telling on their health.
I and my colleagues, have in a remote location of Orissa tried to study this, and intervene, with the help and opinion of the tribals themselves on how their problems can be solved. When we started our intervention it took us just a few weeks, with the aid of PRA tools, to trace all the problems they faced. We found that the government too was to blame as they introduced commercial crops in the land they used for millets cultivation and introduced rice into their food chain, a practically useless food as far as nutrition is concerned.
While planning our intervention we had to face opposition from both the local population, who did not want us to empower them, and also the government, who thought we were harming them, making our job very tough.
Taking into consideration aspects like climate change, we went in for afforestation keeping in mind the nature and composition of the forest as it existed earlier, and their NTFP needs, reintroduced millets cultivation, forbade cattle meat, taught them sustainable harvesting of forest produce, introduced concepts of community forest protection, made them apply for forest ownership land under the FRA Act 2006, linked them to local cooperatives and SHG groups for marketing the produce they harvested and also by talking to tribal elders and shamans, we retrieved their traditional knowledge of medicinal plants, roots, leaves, tubers and barks.
The scientists of the CTCRI chipped in by pointing out that certain tubers they ate must be consumed in moderation as they had anti-fertility properties.
We did not feel the need to open PHCs or to recommend drugs and vaccines. There is in fact a fairly big PHC building in their area which has never seen any other activity except completing the building and decorating the walls with NRHM wall paintings. The electricity to their villages has been cut off long ago as the poor tribals could not pay their bills.
Instead of making them dependent on government charities we made them self reliant and allowed them to revert to their traditional way of life which had sustained them for centuries. We pointed out to them negative aspects of marrying within their clans. We also taught them how to deal with exploitation by uniting the various sub sects of the tribes and by arranging for collective community funds we helped release and reown their trees and land that had been usurped by the locals.
All this we did not by doing it ourselves but by only facilitating the whole process so that the tribals themselves did everything and so they also trained themselves in the process and had no problems after our exit. They had become so attached to us that they were unwilling to leave us. They invited us to live with them saying they would build huts for us and give us land to cultivate. While we were on our way out of the forests and hills they followed us for a great distance, their woman folk wailing and crying.
This, we believe, is how human beings should treat and help other humans. The enire process was full of challenges but not very difficult because the team was sincere to learn from the tribals and was not interested in imposing their will or preconcieved notions on them. This is how we tackled their health problem in a holistic fashion and with their help and opinion. We are non medical people and we do not understand the current and prevailinhg one size fit all medical approaches or interventions.