A Melghat obituarynbsp;

When we visited Dilip in April last year, he was out of Grade IV malnutrition, thanks to the government8217;s prompt action. But then, he had developed another problem 8212; he had become paralysed waist below and could hardly move. The doctors said he either had cerebral palsy or was mentally retarded. We had ended his last story on the note that we would probably get a smiling photograph of his next year when we would check on him.

This time, when we visited the Kasdekars at their shanty in Chikhli village, there was no picture to take. Dilip, his mother Yashoda told us, had died in September last year, barely four months after we had seen him. Then we showed her the paper with her son8217;s photograph. 8220;Yes, he is my Dilip,8221; she said, almost in a trance.

8220;We had taken care of Dilip. We had taken him to Amravati8217;s Irwin Hospital where noted paediatricians had said he needed brain surgery at Nagpur. But the parents weren8217;t ready for that,8221; says Dharni Tahsil health officer Amol Nalat. Yashoda, however, disagrees. 8220;Doctor bole uska bajan kam hai, isliye operation nahin kar sakte they said he is underweight, so can8217;t be operated upon,8221; she says. Nalat agrees to that too. 8220;He was just 7.8 kg whereas the minimum weight should have been 10 kg.8221; But of course, no questions were asked and no answers given. The Kasdekars8217; tragedy had lived out, yet again, the routine Melghat story.

While the government claims it is doing everything possible to check the health crisis, there are few tangible results on the ground. In the Semadoh Primary Health Centre, where Dilip was treated, there were 21 cases of Grade III and three cases of Grade IV malnutrition. Last year, the corresponding figures were 32 and 1. These, of course, are official figures, always contested by NGOs.

Says Ashish Satav of Tribal Health Research Programme: 8220;We are working in 37 villages and intervening in 19. Last year, our survey revealed that the infant mortality rate IMR in these 37 villages was 84, the child mortality rate CMR was 140 and Grade III and Grade IV malnutrition was 10 per cent. And malnutrition of all four grades taken together was 82 per cent. The government figures were one-third of our figures.8221;

Abhay Bang8217;s SEARCH in Gadchiroli and 13 other NGOs had said in a 2002 that the government health machinery didn8217;t register up to 80 per cent of child deaths in the state. Satav8217;s NGO is linked to SEARCH and is following the SEARCH model of home-based health treatment in their 19 intervention villages.

At Hirabambai village, which hit national headlines in 1993 with 14 children dying in a month, forcing a visit by then Chief Minister Sharad Pawar, the spectre returned after two years. Three children died in October-November this year in the village.

Mahendrasingh Ahirya8217;s wife Rukmibai had given birth to her fifth child this year despite undergoing family planning operation last year at the Sadrabadi PHC. 8220;But Munna died in three months. Doctors said they can8217;t do anything as I don8217;t lactate. Last time also, when I gave birth to Akash, I didn8217;t lactate. How then he is so chubby?8221; she says, pointing to her fourth child.

Hirabambai had its first bus transport and a PHC sub-centre after Pawar8217;s visit. There is one nurse-midwife NM for four villages, separated by about 10-12 kilometres of rocky terrain. 8220;So, she can come only once to a village in a week,8221; says Shamim Sheikh Bashir, Satav8217;s health worker in Hirabambai. The Sadrabadi PHC is 18 km from the village. Even if there is intervention at some stage or the other, there is hardly regular monitoring to stem the deaths.

At Semadoh, 12 of this years 23 cases are new. And that again, NGOs claim, is a much reduced figure. 8220;Last year, when we had claimed that the government figures in our intervention villages were much lower than we had assessed, the government sent in a team of officials which, after its own study, concurred with us,8221; says Satav.

Dr Naresh Geete, director Monitoring, Rajmata Jijau Mission for Mother and Child Nutrition, the government body appointed to monitor health reporting and coordinate among the various agencies working for child and mother care, admits to under-reporting: 8220;Satav is 100 per cent correct. We have asked our officers to improve reporting. Unless we report correctly, we won8217;t be able to solve the problem.8221;

Government reporting has since improved in Satav8217;s 19 intervention villages, with IMR going up from 31 to over 50, but figures of the remaining 18 control villages are still questionable.

But, of course, it8217;s not monsoon yet.