A woman with her two-month-old daughter waiting outside the child malnutrition treatment centre at Chaibasa in West Singhbhum district. (Photos: Priyanka Parashar/Mint)
A woman with her two-month-old daughter waiting outside the child malnutrition treatment centre at Chaibasa in West Singhbhum district. (Photos: Priyanka Parashar/Mint)

Inside Jharkhand's Singhbhum, the worst constituency in India

  • 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.
Nutritious food for children is a luxury in a household which finds it hard to make ends meet. (Priyanka Parashar/Mint)

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.

(Mint)

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. (Priyanka Parashar/Mint)

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.
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. (Priyanka Parashar/Mint)

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.
Singhbhum is found wanting in basic facilities, such as potable drinking water. (Priyanka Parashar/Mint)

Like elsewhere, there are of course systemic issues that hinder the eradication of malnutrition—pilferage in the public distribution system, non-functioning anganwadis, 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…"

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