Poor health & nutrition service delivery in villages cause of higher morbidity & mortality rate

Poor health & nutrition service delivery in villages cause of higher morbidity & mortality rate

                        

Mathura Raut, a 30 year old woman of Mahulpadar village died in the government Health Centre (CHC) of Boden in Nuapada district on 2^nd of August. She was admitted to the hospital by her parents with complaint of diarrhea. The doctor acted immediately but could not save her life as other complicacies also developed.

“She recovered from diarrhea but developed breathing problem and died due to cardiac arrest” said Dr. Soren who treated her in the hospital. “The cause of cardiac arrest might have been severe anemia. She was referred to the CHC of Khariar but she did not go” he added.

Mathura’s husband Bhakta is a migrant worker. He had left home a week ago for Hyderabad in search of work leaving Mathura with her parents. “Bhakta has taken advance from the labour broker, he would not be able to come for the funerals” says Mathura’s father.

Mathura gave birth to a child two months back. She was very week much before the delivery and her health got worst after the child birth. The hemoglobin level was 9 just a few days before the delivery. It is astonishing that, the field staffs of health and ICDS department could not notice her weakness in their regular check up in Village health & Nurtition Day (VHND).

“It is mandatory to organize VHND every month in every village to conduct tests during pregnancy and post natal stage. The ANMs have all the required equipments like hemoglobin metre and BP checking instrument to conduct the required tests, but they hardly do that” says Anandini Sadangi  – a social activist working in Boden.

Considering her low Hemoglobin level, Mathura should have been given 200 tablets of Iron and folic acid by the health staffs. But only 50 tablets were given to her. There was no home visit by the service providers during her pregnancy to monitor whether she gained required level of hemoglobin or not.

“Untimely death of Mathura reveals that, the health service delivery system in the block is not functioning properly” adds Anandini.

Padma Dal of Khaira village in Boden block also suffered the same problem one month ago. She was severely anemic and was bedridden after a few days of giving birth to her child at home. Neither the ASHA,  Anganwadi Worker nor the ANM took step to admit her in the hospital when she was dying. Luckily she was noticed by some volunteers of a civil society organization called Ayuskam, who admitted her in to the CHC, Boden. As she needed blood, she was immediately referred to Khariar CHC for blood transfusion. But unfortunately, the doctor in charge of Blood storage unit in Khariar CHC has been transferred and the post is lying vacant. Padma was thus referred to the district headquarter hospital for treatment. Blood was not available even in the District Headquarter Hospital. The volunteers had to arrange the blood from donors. She got well after transfusion of 2 units of blood.

Bina Nial wife of Rupsing of Amhera village under Boden PHC died in the district headquarter hospital last month due to same problem during the pregnancy and post natal period. Her hemoglobin level was below 3.5 when she was admitted to the district headquarter hospital at Nuapada. She was provided blood after she was admitted but could not survive. The child also died after the death of the mother.

There are several other cases of such nature in the block. In Margaon village of this block there are three cases of still born babies. In Patdarha village of Bhainsadani Panchayat, 2 women have died due to post delivery bleeding. The maternity mortality rate (MMR) of this block is 385 which is much higher than the state figure of 250. About 50 percent of the total pregnant women are underweight and anemic in this block. Under these circumstances, it is quite distressing that existing health service system is not functioning properly. Slackness of the government in appointment of doctors is adding to the woe. Out of 4 posts of doctors in Boden CHC, two are laying vacant. The Medical Officer in Charge of this CHC Mr. A.Rout was transferred to another hospital a month back, but he has not handed over the charge to anyone.

“Dr. Rout was appointed the MO I/C of Boden two years ago. But he never did his duty properly. He was always staying out of station and the hospital was being managed by his junior” says Faruk Bhai a congress leader of Boden.

More than 30 thousand people of 10 Panchayats of Boden block depend on Boden CHC for their health needs but health administration of the district has not taken adequate step for the proper management of the CHC. No action was taken against the negligence of the MO I/C Mr. Rout. 

The situation in other CHCs of the district is no good either. The CHC at Khariar, which is the largest outlet of the district with daily turnout of 500 outdoor patients and average 10 institutional deliveries per day, is being managed by only two doctors. Posts of specialist in gynecology, medicine and surgery are laying vacant.

Out of the 46 posts of doctors in Nuapada district 26 are laying vacant. There is also dearth of health workers and staff nurses. There are only 9 Janani Express to provide service of transportation for institutional delivery to the pregnant women. “When more than 45 deliveries take place daily in an average in the district, the availability of 9 vehicles in service is certainly not sufficient. Out of the 9 vehicles 5 are in the district headquarter hospital” says Dr. Ajit Panda of Ayuskam. “There is also a dearth of ambulance; population served by one ambulance is more than 30 thousand in the district. This is quite low” he adds. 

According to district health department sources, out of 653 villages in the district 446 villages are considered to be malaria prone. Likewise, about 25 thousand people of 214 villages in the district are dependent on unsafe source of drinking water as the tube wells of their villages have marked red due to excessive fluoride contents. Considering all these factors, it is necessary that, the government should take extra caution during the monsoon. But the efforts seem to be inadequate. Diarrheal and malaria deaths have already occurred in all the blocks of the district.

                                                                                                                        Ajit Panda, Nuapada