Inside Singhbhum - India's worst constiuency

Published by MAC on 2019-03-27
Source: Livemint (India)

Inside Jharkhand's Singhbhum, the worst constituency in India

Ashwaq Masoodi

Livemint

26 March 2019

Nearly 67% children in Singhbhum are underweight, the highest in India.
More than half are stunted and a third suffer from wasting

In Jharkhand, malnutrition is still an alien concept, and the lack of
drinking water, ration or electricity supercedes need for healthcare

Singhbhum: In the waiting room of a hospital ward in Jharkhand’s West
Singhbhum district, Mukul Kalandiya is carefully holding something that
from a distance looks like a featherless pale-skinned newborn bird. In her
arms, wrapped in an old bed sheet, is her two-month-old daughter, Rohivari
Kalandiya. Rohivari is frail and skeletal, her arms and legs
broomstick-thin, and her eyes wide open. She is barely moving her limbs
and if not for the heavy breathing, it is difficult to tell whether she is
alive or not.

For a ward filled with over 20 children, the malnutrition treatment centre
(MTC) is unusually quiet. The mothers are whispering among themselves or
staring into the distance, and the children—from newborns to over five
years of age—are so weak that they cannot even cry in pain.
Nutritious food for children is a luxury in a household which finds it
hard to make ends meet.

There is six-year-old Sarita Jamuda, from Dharamsai village in the
district, who looks not more than three. She has a hunched back, bowed
legs, and deformed forearms. On the opposite bed is two-month-old Subni
Sirka from Kolaisai village. The outlines of her ribs are visible, the
forehead skin is cracked, and her head circumference is much larger than
children her age.

These children with severe acute malnutrition are at nine times higher
risk of dying of common childhood diseases than well-nourished children.
And Jharkhand’s Singhbhum parliamentary constituency, which votes on 12
May 2019, is full of such children, barely surviving or on the verge of
dying. Singhbhum, a predominantly tribal constituency, is perhaps India’s
worst performer on child nutrition indicators.

Demographic nightmare

This dismal ranking is revealed in a report by a team of public health
experts from Harvard University and Tata Trusts, who have begun to map
India’s development indicators on to parliamentary constituencies for the
first time. Nearly two-thirds of Singhbhum’s children (under the age of
five) are underweight, the highest in the country. More than half are
stunted (low height for age) and a third suffer from wasting (low weight
for height).

The scientific consensus on the consequences has held steady for several
decades now: a huge chunk of Singhbhum’s children are more likely to die
younger (common cold is life threatening), and even if they somehow manage
to survive, as adults, they will suffer disability, have impaired physical
and cognitive development, and reduced performance levels at school and
work.

Bharatiya Janata Party’s (BJP’s) Laxman Giluwa represents Singhbhum since
2014. A glimpse through his participation in parliamentary debates shows
he is concerned about issues of development—from providing clean drinking
water to electrification of villages to farmer incomes.

In a Special Mention on 11 August 2016, Giluwa spoke about a maternal
death in his constituency. On 25 July 2014, a little over two months after
taking over, in the Lok Sabha, he sought statistics on malnutrition deaths
and asked the ministry of women and child development whether funds
allocated by the government were sufficient.

But the real question as India starts its festival of democracy is this:
why has the country’s electoral system so miserably failed its children,
especially when even poorer countries like Bangladesh have shown that
swift progress is possible?

At an age where she should have been playing around with the rest of the
kids her age, the six-and-a-half-year-old can barely sit without help.
At an age where she should have been playing around with the rest of the
kids her age, the six-and-a-half-year-old can barely sit without help.

In Jharkhand at least, the question of how to save children like Rohivari
hasn’t quite entered the everyday vocabulary despite a series of child
deaths in 2017 and 2018. Child nutrition is not an election issue, either
for common people or for their leaders.

Over the five-year term of the present Lok Sabha, Jharkhand’s members of
Parliament (MPs) sanctioned work costing over ₹80 crore from
constituency-specific funds ( ₹5 crore is given to each MP per year),
according to data on the Members of Parliament Local Area Development
Scheme (MPLADS) portal. Most of that money went toward minor roads and
bridges, with less than 1% getting spent on health. It is unclear how
Giluwa himself spent funds meant for Singhbhum since those details have
not been uploaded despite being mandatorily required.

Despite repeated attempts, Mint could not reach out to Giluwa.

Repressive state

Jharkhand was carved out of Bihar in 2000, and among the foremost reasons
behind the statehood demand was to focus on the development of the
adivasis.

Among other issues, the issue of child malnutrition is something that the
state has been grappling with since its formation.

As development economist Jean Dreze says, the sheer number of
developmental challenges is one reason why the public hasn’t mobilized
behind an issue like child health. “In Jharkhand, there are a lot of
sectional demands: demands for reservation, against other people’s
reservation, fight for land… when society is fragmented, it becomes much
harder to fight for common issues. If you take away something that people
have, then, people will easily react to it. But if there is something that
is lacking and has been so for a long time, it is much harder to get
people to react to such a state of affairs," he says.

If the two-month-old survives, she will be one of the only few lucky ones
in the Singhbhum constituency, filled with such malnourished children. The
rest are barely surviving or on the verge of dying.

Moreover, there are serious perception problems about the idea of the
state as a body accountable for the welfare of its people. Siraj Dutta,
who works on social policy in Jharkhand, says: “State here is always
viewed as a repressive entity. Its role as a welfare giver is not well
established. In fact, it is for the first time that I am seeing
significant anger against the BJP. It is the first time people directly
blame a party for issues like Aadhaar, Digital India, etc. Generally, the
attitude was kya karen nahi mila to nahi mila (what can we do) because
that’s how people view the state."

Like the rest of the Hindi heartland, Jharkhand too voted en masse for the
BJP in the 2014 Lok Sabha elections, handing the party 12 out of the
state’s 14 seats (the Jharkhand Mukti Morcha (JMM) managed to win two
seats in its stronghold of Santhal Pargana). The BJP, which came to power
in the state months after the Lok Sabha elections, has in fact provided
the only stable government the state has seen since its formation in 2000.
This time around, opposition parties have been targeting the state
government on issues such as changes in tribal land laws and the domicile
policy—both related to identity politics and, hence, easy props to make or
break public opinion.

Letter versus Spirit

While changes to tribal laws will play out in Singhbhum constituency as
well, there are more “pressing issues" other than malnutrition that the
people are concerned about. “For the people here, even today, clean
drinking water is not available. For them, even today, roads are like a
far-fetched dream. Asking for anything else, they think, is a luxury. As
legislators, even we realize that we have to first provide them with roads
and water as these are basic needs. So, my focus has been just that," says
Geeta Koda, who is a member of legislative assembly (MLA) from
Jagannathpur (which falls in the constituency), and who joined the
Congress in October 2018.

“I think it is because of politicians and political parties that the issue
of malnutrition is still so rampant. Not just malnutrition, I don’t think
governments take health seriously," says Koda.

Singhbhum is found wanting in basic facilities, such as potable drinking
water.

Like elsewhere, there are of course systemic issues that hinder the
eradication of malnutrition—pilferage in the public distribution system,
non-functioning anganwadis [mother-child health centres], state-centre
blame games, lack of manpower and doctors, and defunct sub-health centres.

To add to it all, though, is the complete disconnect between policymaking
and social realities on the ground. For example, the ANMOL-ANM online app
for auxiliary nurse midwives (ANM) developed by the ministry of health and
family welfare is aimed at enabling real-time access to information about
the health of women and children in malnutrition-hit districts. But in
most parts of Singhbhum, there is no phone connectivity, forget internet.

Unlike those visiting the MTC for the first time, the doctors or the
nurses aren’t asking Mukul and other mothers about why they didn’t come
earlier. Like many others in this ward, Rohivari too has several black and
white threads wrapped around her neck, wrist and ankle—a sign that all of
them have visited local quacks before their first visit to any hospital.

“Earlier, people here were convinced that malnutrition was an incurable
illness. The parents couldn’t imagine that the kid would recover only by
eating right. Even now, they keep saying ‘the kid is fine, he just looks
weak’, or devi ka prokoap hai (evil eye)," says Dr Jagannath Hembrom, who
runs the MTC at Chaibasa.

In the villages, malnutrition is not a concern because people don’t really
know why the kids are growing weak. To add to it, the word Kuposhan
(malnutrition in Hindi) is still an alien concept among villagers, who
only know of it as a word outsiders use when talking to them.

Superstition aside, as Chhandosree Thakur, a consultant with
non-governmental organization Manthan, in Ranchi says, “If you don’t let
people know or even say that the death was because of malnutrition, how
will they speak up?" So, in a way, this ignorance of why children are
dying or whether it was really malnutrition that killed their children is
helping political parties brush aside the need to tackle this silent
emergency in the state.

But Kunal Sarangi, JMM MLA from Baharagora, says it is like any other
demand supply chain model. “It is very unusual for local people to even
ask why a health centre is defunct, let alone issue of malnutrition. It is
only in case of a death that some questions are asked for a few days. It
is demand-driven policymaking. Only if I am interested on my own as a
leader will it become an issue. If I am just going by people’s
preferences, it doesn’t figure in the list of priorities."

Ground reality

Jharkhand was in the news when 18 people died due to starvation since
September 2017 and late 2018. After a brief outrage and sporadic coverage
in the media, the conversation died its natural death. Sadly, malnutrition
hasn’t really become a parameter when it comes to influencing or
convincing voters to vote.

BJP’s food minister and senior party leader in the state Saryu Roy
explains, “We (politicians) use issues like malnutrition for our vested
interests. For issues such as these, politicians need to rise above party
lines, and work together."

Petapeti village in Khuntpani block of West Singhbhum is lush green with
Palash blossoms almost everywhere around this time of the year. To reach
the village, it is a steep walk up several hillocks. There is a small pond
which is where the locals get their drinking water from. It is more like a
swamp where dogs, pigs and human beings, all drink water from. There is
one electricity pole here which was installed years ago but the villagers
claim they have never seen electricity.

In one of these hamlets lives Suru Bhiggi, an 8-year-old boy, with his
four siblings and his parents. Suru is severely malnourished, and even
though he is old enough to roam around and play on his own, he mostly
spends time at home because he is too weak to play, and his parents worry
that he will break his bones.

For his mother, her vote will go to anyone who ensures she gets a ration
card which she and her husband applied for a decade ago. Her husband says
anyone who gets electricity to the village will get his vote. What about
malnutrition? They both laugh. “It is an issue with my child, or a few
individuals, not the entire village…"