Malavika VyawahareShakuntala Kirkire, at her aunt’s home in Koshimshet village in Thane district of Maharashtra, on Aug. 17.
BANDRICHIWADI, India — On the morning of July 23, Shakuntala Kirkire, a housewife in Bandrachiwadi village in the western state of Maharashtra, carried her 10-month-old daughter in her arms and walked in rain down the slope of a hill on which her village stands. Her husband, Ajay Kirkire, walked close to her, holding up an umbrella to protect their sick child as they tried to reach the government-run clinic in a neighboring village.
A few minutes later, Mr. and Mrs. Kirkire stopped midway. Priya, their child, had died. She had been born healthy but had lost weight rapidly over the months. At the time of her death, Priya weighed 4.5 kilograms (10 pounds), four kilograms less than what is considered normal for her age. Doctors listed pneumonia as the cause of her death in government records.
Bandrichiwadi is a picturesque and poor village in the mountainous Jawhar area in the district of Thane. Jawhar, about 150 kilometers (93 miles) east of the megacity of Mumbai, is home to various tribes, who are among the most marginalized sections of Indian society. About 8.7 percent of Maharashtra’s 112.4 million people are tribals, according to the 2011 central government census. Intense public attention was focused on the area in the early 1990s, when hundreds of children died of malnutrition in 1992-93 in Jawhar and the adjoining Mokhada and Vikramgarh subdistricts.
Little has changed in the past 20 years. In July this year, 12 children under the age of 6, apart from Priya, died there. In June, it was 11 children. In May, another nine. Between July 2012 and July 2013, 80 children died in the Jawhar subdistrict. The official causes of death, listed in the medical records of the children who died in June, include pneumonia, aphasia and febrile convulsions, which are usually not fatal. But the government records also show that the deceased children were malnourished, and more than half were severely malnourished, like Priya.
“Malnutrition is a precipitating cause, so we speak of deaths that are attributable to malnutrition,” Victor Aguayo, chief of child nutrition and development at Unicef India, explained in a recent interview in New Delhi.
In 2011, the infant mortality rate, expressed as the number of children younger than 1 who died per 1,000 live births, was 44 in India, which translates into 1.19 million infant deaths, according to data collected by the Registrar General of India. In 2010 the under-5 mortality rate stood at 59, one of the highest in the world.
A study published by the British charity Save the Children in 2012 estimated that 1.83 million Indian children die every year before the age of 5. “Most of the deaths occur from treatable diseases like pneumonia, diarrhea, malaria and complications at birth,” the study noted.
“The child may eventually die of a disease, but that disease was lethal because the child was unable to fight back because of malnutrition,” Mr. Aguayo said.
The Indian government has not updated its national statistics on nutrition, known as the National Family Health Survey, since 2005-2006. Even its smaller and poorer neighbor, Bangladesh, has conducted three such surveys in the past decade. India’s data from 2005-2006 showed that 42.5 percentage of children under the age of 5 were underweight, a measure of acute and chronic malnutrition.
Half a decade after the last National Family Health Survey, the levels of malnutrition remained startlingly high. A 2011 Hungama survey, carried out through a collaboration between several independent organizations, showed that among the children under 5 in 100 districts of the country that have historically fared poorly on child nutrition indicators, 42 percent are underweight. Prime Minister Manmohan Singh responded to the findings of the Hungama survey by describing malnutrition as a “national shame.”
According to the official records at the Bandrichiwadi village council office, 25 out of the 42 children under 6 in the village are malnourished. A wave of malnutrition-related deaths in the village is also exacerbated by the lack of pediatricians in rural hospitals.
“We are not pediatricians,” said Vijay Sangle, a doctor at the public hospital where the Kirkires had once sought treatment for their child. “We are not even equipped to diagnose a respiratory infection as pneumonia.” Dr. Sangle and his colleagues refer most patients to a bigger hospital at Jawhar, about 5 kilometers away.
Malavika VyawahareA farmer working in a field in Jawhar sub-district in Thane district of Maharashtra, on Aug. 17.
Bandrichiwadi sits atop one of the many hills that rise up on the lush green landscape of Jawhar, dotted by small seasonal streams and muddy pathways seeping through. The frequent rainfall lends a perpetual mistiness to the upper reaches of hills. Along the only road that runs from Jawhar to the villages, a sturdy surfaced road gives way to a mushy rocky track leading up to Bandrichiwadi, on which hardly any motorized vehicles ply. Passing through are laborers on their way to work and women, some with water-filled pots on their heads, others with children clinging to them.
There is no public transport after dusk. The night before Priya died, the doctors at the village hospital had told the Kirkires to take her to the Jawhar hospital. “It was evening, there was no way for us to get there,” Mrs. Kirkire recalled. “No one told us that we could get an ambulance to go there.”
The Kirkires are from the Varli tribe, which is listed in the Indian Constitution as a scheduled tribe, groups recognized as historically disadvantaged, isolated from the Indian mainstream, which qualifies them for affirmative action policies. Scheduled tribes make up 8.6 percent of India’s population of 1.2 billion, according to the 2011 census.
Among tribal populations spread across 10 states in the country, 52 percent of preschool children (between 1-5 years) were underweight, a National Nutrition Monitoring Bureau survey noted. In the tribal districts of Maharashtra, 64 percent of preschool children were found to be underweight, with 28.8 percent considered severely underweight.
The Varlis, who are known for their folk art, wall paintings made from rice paste, are mostly either daily wage agricultural laborers or subsistence farmers. “The root cause of malnutrition is the loss of control over food production and food security,” said Milind Bokil, a sociologist and writer.
Although the Kirkires grow rice, millet and finger millet on their 2.5 hectares of land, the produce is not enough to sustain them throughout the year. Mr. Kirkire, like most men in his village, supplements their meager income by working as laborer in the sand-mining industry in neighboring districts for most of the year. Mrs. Kirkire, like most village women, has to walk three kilometers to get drinking water from a well.
Malavika VyawahareThe house of Ajay and Shakuntala Kirkire in Bandrichiwadi village of Maharashtra, on Aug. 17.
A photograph of Mr. and Mrs. Kirkire hung from a wooden pole supporting the roof of their single-room mud house. A broken clock hung by a bamboo pole next to the photograph. Since their child’s death, Mr. Kirkire has been spending his days by roaming aimlessly in the village fields. Mrs. Kirkire moved out and has been living in her parents’ home, about an hour away.
“I cannot bear to be in that house,” said Mrs. Kirkire. “I can still hear the cries of my child.”
Mrs. Kirkire’s pain is compounded by the awareness that breast milk was crucial for the health of her child, but she suffered from a condition known as inverted nipples, in which a mother’s nipples retract inwards and make it difficult for the baby to suckle. Mrs. Kirkire had to feed powdered milk to her child, which cost 300 rupees ($5) for two tins. But because they couldn’t afford any more tins, the Kirkires switched to rice starch. “Our family hardly makes enough to sustain ourselves,” said Yashwanti Kirkire, Mr. Kirkire’s mother.
Workers with the government-sponsored Integrated Child Development Scheme place part of the blame on parents in these impoverished tribal areas being inattentive to the needs of their children, but crushing poverty forces most women to leave their young children at home and work in the fields during the agricultural seasons. “None of the women here sit at home and feed their children for the first six months,” said Surekha Patekar, the program caseworker at Bandrichiwadi.
The common practice is for 5- to 6-year-old children to start working with the parents in the fields or stay home to take care of the younger children. “Parents have to go to the fields leaving their child behind — there is no other way,” Ms. Patekar said “They will have nothing to eat otherwise.”
A few meters from the Kirkire house, a path led to a grove of trees. A small metallic bowl, empty bottles of medicine, and a plastic bag full of baby clothes lie beside Priya’s unmarked grave. The frequency of malnutrition-related deaths has given birth to a new superstition. “Every monsoon five people die in this village,” said Mrs. Kirkire. “It is a curse.”
This story has been facilitated under the OneWorld-POSHAN Fellowship grant.
After service in the British SAS Regiment the author became a physician and then an orthopaedic surgeon.
He has held professorial positions in Canada, Vietnam and the United States, practiced and taught orthopaedic surgery in three continents and in several wars.
He has extensive experience as an expert witness in court. Somewhere along the way, time was found to operate a four hundred acre mixed farm, a one hundred seat restaurant and to obtain a licence as a flying instructor.
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