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Journalism of Courage
One of the few Gond community members from Chhindwara to pursue an MBBS degree, 21-year-old Akash says a lot has changed in the Madhya Pradesh district. “Earlier, we were forced to go to Nagpur for medical treatment. Now, even knee replacement surgeries are performed here. A medical college helps sustain an ecosystem of clinics and other related businesses. Hence, it is important in the tribal belt,” says the 21-year-old.
It is a common sight across Chhindwara to see not just voters but also party workers discuss healthcare, with many people raising concerns about the state of health infrastructure. While Congress workers speak about former Chief Minister Kamal Nath footing the medical bills of people, BJP workers promote the Narendra Modi government’s Ayushman Bharat Yojana and its efforts to ramp up testing for sickle cell anaemia.
Chhindwara, which is Nath’s turf, is one of the five tribal-dominant districts of eastern Madhya Pradesh along with Mandla, Shahdol, Sidhi, and Balaghat that will vote in the first phase of the Lok Sabha elections on April 19. Here, healthcare is a major concern for voters and parties too seem to have taken note. Sickle cell anaemia is known to be prevalent among tribals in Madhya Pradesh with at least 27 of the state’s 33 districts in the sickle cell zone.
With the BJP presenting the government’s welfare schemes and improved health infrastructure as evidence of the tribal belt’s transformation, The Indian Express travels across the five districts.
In Chhindwara, which is Kamal Nath’s turf, tribals make up 36.8% of the district’s population. BJP candidate Vivek Bunty Sahu, who will take on Nath’s son Nakul in the Lok Sabha battle, claims to have helped more than 7,000 people with medical problems. He also claims 318 patients availed of free cataract surgeries started in honour of a tribal boy who died of sickle cell anaemia. Nath’s camp claims to have helped even BJP workers with treatments and has accused the BJP-led state government of slashing the budget of the medical college.
The district, which achieved a 100% literacy rate in 2022, is a part of MP’s Mahakaushal region and is home to the Gond and Baiga Adivasi communities along with other Particularly Vulnerable Tribal Groups (PVTGs). Tribals make up around 57% of the district’s population.
At the Nutritional Rehabilitation Centre here, a concerned Kavya Parte complains to the child specialist Dr Kamlesh Thakur that her two-year-old daughter has stopped drinking milk. “Your daughter is suffering from sickle cell anaemia. Everyone in your family needs to be treated now,” the doctor says, breaking the bad news to the 29-year-old who fails to understand what it means for her daughter’s future.
“I do not know what the disease is and do not have an Ayushman card. Many people from my village have the card and are being tested by the government,” she later tells The Indian Express. Kavya is referring to the Central government’s National Sickle Cell Anaemia Elimination Mission, which Prime Minister Narendra Modi launched in July 2023 ahead of the Assembly elections in the state, setting a target to “eliminate the disease by 2047”.
The sickle cell disease is a chronic single-gene disorder that causes a debilitating systemic syndrome characterised by chronic anaemia, acute pain, and organ damage. Under the mission, the Centre has begun screening across 278 districts and aims to test seven crore people in the next three years. In Madhya Pradesh, people diagnosed with sickle cell anaemia are provided with a disability certificate so they can access welfare benefits.
Even Congress leaders do not discount the significance of Modi’s announcement. “While we gave tribals their rights, the Congress is unable to counter the BJP on two key issues – opposing Droupadi Murmu’s presidential candidature and the sickle cell elimination mission that affects every second tribal. We feel we have a tough road ahead,” says a senior member of the state Congress’s Scheduled Tribes (ST) cell.
Anju Ajite (34), a Gond from Bambhani village, attributes the infection to the partial implementation of the Centre’s Har Ghar Nal Yojana. “We have electricity and homes but no water supply under the Har Ghar Nal Yojana. Tribals contract viral infections as we are forced to drink water from the local pond during monsoon. Once we get tap water, we will not fall sick,” she says.
Around 315 km away on the state’s border with Uttar Pradesh lies Sidhi, the birthplace of Mughal emperor Akbar’s advisor Birbal. Abundant in natural resources such as limestone, various types of ores and composite minerals, and surrounded by hills, the district has a significant chunk of tribals (27% of the population).
At the Government Women’s Degree College here, 19-year-old Pooja rushes to submit her assignment. “I wanted to join the government nursing college, which never became operational. I cannot afford private education hence I am pursuing a BA course,” she says, disappointment writ large on her face.
The Sidhi Nursing College that Pooja aspired to enrol in is one of the colleges that has been on the CBI’s radar after the Madhya Pradesh High Court in 2022 directed the agency to probe alleged irregularities in nursing colleges of the state. The CBI in its probe found at least 65 nursing colleges across the state ineligible to operate due to lack of infrastructure. In some cases, the colleges had rented out their premises.
Then CM Shivraj Singh Chouhan announced a medical college in Sidhi last September when the state had only five. The number since then has grown to 31.
At the Sidhi district hospital, chief hospital superintendent Dr S B Khare says that till about five years ago there was a shortage of ambulances and hearse vans “Earlier, tribals would die waiting for an ambulance but now it is a question of whether they come to the hospital at the right time,” he says.
Health department officials acknowledge that the Ayushman Bharat scheme, which covers treatment costs up to Rs 5 lakh, has been a game-changer. “Around 300-400 patients avail of the scheme daily. Most of the expensive treatments have now become free of cost,” Khare says.
A 125-km road connecting Sidhi and neighbouring Shahdol, used by a handful of vehicles, is mostly broken. Tribals make up around 44% of the population of the district, which houses coal mines and marble quarries.
Outside the Shahdol Medical College, Gulabia Bai (68) of the Gond community, who has travelled around 70 km from Umaria, nurses an eye wound. She laments about the absence of a decent hospital back home. “The local politician has worked hard but a hospital with good doctors is still a dream,” she says.
Deepak (20), a paramedical student at the Shahdol Medical College, says though the medical infrastructure has improved, the threat of privatisation looms large. “Earlier, people drew a monthly salary of Rs 30,000 for jobs like lab assistants, who are now paid only Rs 15,000 as they are contract-based and outsourced by private players. A secure job is important. Also, the scholarships and exam results are delayed. I am in the second year even as the first-year biochemistry result is yet to be out,” he adds.
Local health officials say discrimination has deterred tribals from visiting government hospitals. They say spreading awareness is all the more important given that four infants in Shahdol have died since January after being branded with hot iron to “treat basic illnesses”.
Around 700 km from Shahdol is Balaghat district, which over the years has shed its tag of being where Maoists operate and now boasts of automobile and finance companies, and houses hotels. However, the most oft-heard complaint here is the lack of high-paying jobs.
Nisha Bansore (19) is busy packing her belongings at the government-run Scheduled Caste (SC) hostel, which will serve as a polling station. She rues the fact that students are forced to work at the post office, medical stores or as receptionists in hotels despite performing well in academics. “Announcements regarding setting up of medical colleges are made in election season but are often forgotten. We need to move beyond these jobs which pay Rs 10,000 per month,” she says.
