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As Shivraj Singh Chouhan calls for making health fundamental right, Panna's creaky health infrastructure awaits facelift

In 2014, at an inauguration ceremony of the Bhopal Care Hospital, chief minister of Madhya Pradesh Shivraj Singh Chouhan demanded that health should be made a fundamental right. Today the public health structure in Panna, a region famous for its tiger reserve, is rusting. As per Census 2011, Panna had a population of 1,016,520. How many hospitals does it have? One! “We have one single hospital with less than 200 beds, but we have about 250 patients at one time. You can’t even imagine how they lodge themselves in here. We have requested the government for a larger space for 300 beds,” said Dr KL Tiwari, civil surgeon at the District Hospital. He also voiced the demand for more staff, especially two pathologists (one pathologist is retiring in five months’ time) two radiologists, two gynecologists and more internal medicine specialists. He said many patients come from villages like Kunjwan, Barachh, Tilguwan and Brijpur and if the hospital wasn’t short-staffed and low on space, it could have tended to nearly 400 patients.

An announcement demanding a medical college in Panna streams out of a loudspeaker. There is only one hospital in Panna and as per Census 2011, the district has a population of 1,016,520. Pallavi Rebbapragada/Firstpost

An announcement demanding a medical college in Panna streams out of a loudspeaker. There is only one hospital in Panna and as per Census 2011, the district has a population of 1,016,520. Pallavi Rebbapragada/Firstpost

Along with those transferred from the hospital was a silicosis specialist. Silicosis is an incurable lung disease caused by inhalation of dust containing free crystalline silica and is quite common among those who work in stone quarries in Panna. Owing to the presence of tigers in the region, Panna doesn’t attract industrial investment and working in quarries is commonplace. Dr Sudhakar Pandey was a TB officer in the Government of Madhya Pradesh, two years ago. He was sent to Penang, Malaysia for a workshop on diagnosing silicosis by The Asian Network for the Rights Of Occupational and Environmental Victims (ANROEV). But six months after he returned, he too was transferred to another district. “Long-term exposure to silica dust damages lung tissues and results in respiratory diseases. But the problem is that tuberculosis develops as a co-infection, thereby making it difficult to tell the two apart. Silicosis cannot be traced to a single bacteria or virus and is harder to diagnose. The general practice doctors adopt in places like Panna is that if symptoms persist once the treatment for TB is over, only then the possibility of silicosis emerges. Unfortunately, by then, tissues are irreparably damaged,” Dr Pandey stressed on the unavailability of facilities like ILO’s system of classifying chest radiographs and CT scans. He added that such equipment is missing in Panna and the district had only one medicine specialist back then. Another medicine specialist had been transferred to Bhopal and yet another had taken voluntary retirement.

In 2011, Dr V Murlidhar of the Occupational Health and Safety Centre (OHSC, Mumbai) along with his team agreed to visit Panna for a medical camp. “In the camp, 43 workers were diagnosed and their medical reports, including x-rays, lung function tests and other diagnostics were carried out. He certified that 39 workers were suffering from silicosis out of the 43,” said Yousuf Beg, social activist who runs the Pathar Khadan Majdoor Sangh and is attached to the Environics Trust, a non-profit organization that conducts participatory research on environmental and human behaviour and develops solutions.

In 2016, an Indore-based NGO Nai Shuruwat (now Shilpi Kendra) had conducted a survey between 2011-2012, which covered 102 villages in the three districts of Madhya Pradesh and identified 1,701 patients and 503 deaths due to silicosis. “The suffering of these people is real. For timely screening, the government should transport those who exhibit symptoms to big hospitals in Bhopal in batches from affected districts like Panna and Jhabua,” Dr Pandey said. He elaborated that due to the lack of human resources and infrastructure, good schemes like the Deendayal Antyodaya Upchar Yojana that grant free medical aid to those below the poverty line, end up becoming redundant. The scheme was launched in 2004 by the Madhya Pradesh government. Under the scheme, medical checkup and treatment up to Rs 20,000 is given to a family in one financial year.

As per the government of Madhya Pradesh, all silicosis patients are to have a priority stamp of ‘Silicosis Priority’ on their Deen Dayal card that marks them for special attention. But, the survey revealed that few patients have the Deen Dayal card. Among the patients who did, nearly nobody had a silicosis priority stamp on it. Janka Bai, from a village named Umravganj approached Yousuf Beg and Dr Pandey some years ago when doctors fail to treat his prolonged respiratory illness. “Despite a silicosis certification from a private practitioner, the government doctors failed to diagnose her husband with the disease, thereby denying him access to free treatment,” said Yousuf, who called the situation disgraceful. One of the problems in Panna is the lack of awareness about silicosis, which is a notifiable disease under the Factories Act and is included in the list of diseases for which compensation can be claimed in the Employees’ State Insurance Act (ESI) Act, 1948 and the Workmen’s Compensation Act, 1923.

The story doesn’t end at silicosis. As per the 2012 Sample Registration Survey, Government of India, Panna had the highest infant mortality rate in the country, which stood at 140 per 1,00,000 live births. Panna has 2,500 anganwadi workers as part of its primary healthcare network.

In 2012, Panna had the highest Infant Mortality Rate in the country, which stood at 140 per 1,00,000 live births. Its force of 2,500 Anganwadi workers complain they are overburdened with administrative work and aren’t able to focus on primary healthcare. Pallavi Rebbapragada/Firstpost

In 2012, Panna had the highest Infant Mortality Rate in the country, which stood at 140 per 1,00,000 live births. Its force of 2,500 Anganwadi workers complain they are overburdened with administrative work and aren’t able to focus on primary healthcare. Pallavi Rebbapragada/Firstpost

Recently, anganwadi workers in districts like Sajhapur, Rajgarh, Ujjain, Panna and Aagar were protesting on the streets. They were demanding regularisation of jobs and higher pay slabs. Priya Dwivedi, president of the Anganwadi Association in Panna, said that it is women who voted Shivraj Singh Chouhan to power and his government's rejection of their needs has left them distraught. She alleged that for a mere Rs 5,000 a month, anganwadi workers are made to do tedious data collection exercises for various government departments on diseases like filaria and polio. Dwivedi added that the departments of health, education and the nagar palikas come together to burden them with work. There’s little incentive or time or energy for these women to focus on malnutrition for women and children, especially when they feel they are being exploited from all ends.

In the recent Assembly by-polls in Mungaoli and Kolaras, the Congress emerged victorious. But that doesn’t impact the lives of people in Panna. What does affect them is the fact that Shivraj Singh Chouhan held 63 road shows in Kolaras and another 58 road shows in Mungaoli. Panna wonders whether it will have to wait for election season to draw the attention and affection of its leaders.

Demands of the anganwadi workers, who feel working on the ground should be incentivized with regularization of jobs and salaries higher than the current slab of Rs 5,000 a month. Pallavi Rebbapragada/Firstpost

Demands of the anganwadi workers, who feel working on the ground should be incentivized with regularization of jobs and salaries higher than the current slab of Rs 5,000 a month. Pallavi Rebbapragada/Firstpost


Updated Date: Mar 04, 2018 16:16 PM

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