Just four years back, when Tuni Krishani, a Bonda tribal woman, at her later stage of pregnancy with critical condition came with her husband from Bonda hill top village Krishanipada to Khairaput Community Health Centre (CHC), I was worried how to save both mother and child,” said Dr Debabrat Barik, the medical officer of CHC, Khairaput.
He continued, “Her condition was very critical and she needed immediate operation. I consulted and convinced our only O and G surgeon to do the surgery immediately. The problem was that here there was no proper facility for caesarean section but I convinced him to go for that only, because of her critical condition.” Besides this, Dr Barik also prepared a risky bond paper, convinced her husband and other family members and also sought the permission of Block chairperson to carry out the surgery at the CHC.
It was really a challenging task for all of them, but after an hour long hard toil, the Bonda woman Tuni delivered a healthy baby boy. It was an overwhelming moment for all the family members of Tuni. That was the first and last C-section held at the Khairput CHC, though institutional delivery among Bonda primitive tribal group has been increased than earlier.
Now people are more aware of their health issues and consult about various schematic issues run by the State Government. But there are some villages in Andrahal Panchayat on Bonda hill top area where maternal health issue is still a far cry because of its inaccessibility and geographical condition, expressed Dr Barik, who is better known as Bonda doctor among the primitive tribe Bondas, living on Bonda hill top in Malkangiri district around 618 km from Bhubaneswar.
Primtive tribe Bondas are living on the hill top around 4,000 feet above sea level. They still need a lot of intervention and improvement in the sectors like education, health, environment and socio-economic development.
Bonda Development Agency (BDA) project leader Santosh Rath said BDA has been working in this area since 1977 on the improvement of health, education and their socio-economic development. “Just a decade ago very few women were opting for institutional delivery but in recent years due to various schemes launched by Government and the effort by ASHAs and ANWs, Bonda women are taking the advantage of institutional delivery, though the percentage is very low. Besides, through training and health camps their awareness towards pre-natal and post-natal care has been improving than earlier. But sometimes due to various reasons we are unable to provide them proper service and facilities related to health,” he said.
Adibari Krishani, a 20- year-old Bonda woman recently delivered twins at home as the ambulance couldn’t reach her village Krishanipada on time. Her husband Budai Krishani said, “We have contacted CHC through our ASHA to send the ambulance for institutional delivery, but my wife delivered twins before it reached our village. Then immediately we moved to Mudulipada PHC for necessary treatment and also enrolled in Government’s Mamata scheme. Now both our children are in good health.”
Mani Krishani, a 19-year-old, delivered a baby boy at home as the ambulance couldn’t reach her village Sindhiguda on time. Th local ASHA who has been working in this village for a long time, said, “Though these primitive tribal women are aware of institutional delivery but due to its geographical condition we are unable to take them to Khairaput CHC or district hospital. We have a PHC at Mudulipada but for critical condition we need to take them to Khairaput CHC or district hospital and there the problem arises. The 102 Janani Surakshya Yojana ambulances are very small to drive on stiff hilly road while 108 ambulances are too big to enter into these tiny villages. Earlier, there was one ambulance at Mudulipada PHC and was accessible to most of the villages and easy to drive on stiff hilly roads. It was given on PPP mode to provide health service to these tribal groups. But recently the Government has withdrawn its provision, so the villagers are facing a lot of problems regarding institutional delivery.”
Rashmi Rekha Barik, who is now doing her PhD on Bonda tribes said, “Earlier the tribe members were unaware of Government-run schemes and about institutional delivery. All of them were dependant on home delivery and for any health related complications they used to take the advice of “Dishari” or better known as medicine man. Tribal women are more labourious than their counterparts; even if they are pregnant they do all the household works and also go to forest to collect wood and other forest foods. Sometimes I have seen women delivering inside forest area and come back to home.”
Sharing one her experience Barik said, “Once a Bonda woman delivered a baby here at Khairaput CHC and just after delivering she walked to 13 km hilly area to reach to her village on hill top. I was scared and shocked seeing this. It is true that now Bonda women prefer to go for institutional delivery but the percentage is very low between 10-15 because of lack of proper communication and awareness. Another problem is in Andrahal panchayat most of the villages are inaccessible and sometimes during advance stage of delivery villagers carry the pregnant woman in a cot and bring her to Mudulipada PHC, which is nearly 15-20 kilometer away from their village.”
Dr Barik says, “Through health camps and Mobile Health Units (MHU) these tribal women are getting health related messages and also being aware about health issues. But the recent provision of CUGs given to ASHAs in inaccessible villages in Bonda hill top area has bought a lot of changes in maternal health issues. Now for any complications ASHAs immediately contact us (doctors) at CHC or PHC and get necessary advice”.
National Health Mission Director Roopa Mishra on being asked about provision of ambulance at Mudulipada PHC, which has been withdrawn for funds crunch, said, “As in this year’s budget plan Rs50 crore has been sanctioned on special intervention for IMR and MMR to meet a gap fill approach, we are thinking to introduce small vehicle service in the inaccessible areas like Bonda hill top where these vehicles will reach out the villages and provide service to the need. Besides, we are also planning to provide two units of stretures each with safety straps. With the help of villagers or respective units of the village these will be provided in inaccessible areas where pregnant women will get better health service.”
Apart from providing health service to them, if primitive tribes will get better education and awareness, it will solve most of the health related problems of them, sums up Dr Barik.
(The article is a part of Child Survival Media Award-2014 fellowship by NFI in collaboration with Save the Children)