Village markets are changing in Bihar — as they are in the other states #ETTG reported from. This piece looks at some of those changes — and advances hypotheses to explain these changes.
In Bhagalpur, the historic Bihar city on the southern banks of the river Ganga, doctors disagree about the threat of dengue in the area. Vijay Kumar, the civil surgeon for Bhagalpur, says dengue is under control. His statement has been flatly contradicted by doctors at Bhagalpur’s Jawaharlal Nehru Medical College and Hospital. The hospital identified its first dengue case about four or five years ago. Since then, said an administrator, the number of cases has grown. “We had 441 confirmed cases last year – almost double from the previous year.”
Bihar’s exposure to dengue is relatively recent but the state needs to start fighting the disease. Fighting dengue can be easy because there are clear measures that need to be taken. Since there is no cure and no vaccines for the disease, doctors can only treat symptoms – pain, chills, fever, nausea and vomiting, rashes and bleeding. In most cases the disease subsides but a few cases may be so severe that without hospitalisation and treatment it can lead to death. If a patient has excessive bleeding or a very low platelet count he might be given a platelet infusion.
But fighting dengue is also difficult because it requires meticulous and consistent control of the Aedes aegypti mosquitoes – the main species of mosquitoes that carry and spread the dengue virus. This can be done using anti-mosquito sprays to kill the mosquitoes that are normally active during the day. Dengue control also involves thwarting the mosquitoes from breeding, which can be done by reducing places – any stagnant water – where they can lay eggs. To ensure this, regular water supply is essential so that people stock less water. Also important is good garbage disposal.
Given the meticulous work needed to combat diseases like Dengue, how is Bihar doing? And what does its response tell us about the state?
In 2016, dengue hammered Krah. As many as 100 people living in this densely-packed, predominantly Muslim ghetto of about 1,000 families near Biharsharif contracted the disease, say residents. The scale of the outbreak was unprecedented. As Mohammad Ilyas, a young tailor who works and lives in Krah, said: “We never had such an outbreak earlier.”
The disease itself is a newcomer to the region. Krah and surrounding areas have been battered by many diseases. But many of the old diseases are in decline now, according to Dr Lakshmi Chaudhary who runs a clinic in adjacent Silao. “There were only two-three cases of jaundice last year,” he said. “Hepatitis B is even lower. We now almost never see cases of diarrhoea.”
This is the story across Bihar. Doctors, epidemiologists and people living across the state say that in the last ten years the state’s disease burden has seen three large changes. First, some infectious diseases like kala azar, measles, diphtheria, pertussis and polio that used to wreak havoc earlier are far less common now. Second, people are falling to new diseases like drug-resistant tuberculosis, dengue, chikungunya, Japanese encephalitis and arsenic poisoning. Third, some of the old infectious diseases – hepatitis A and E, malaria, pneumococcal meningitis and typhoid – are claiming more patients than before.
This, as the article says, is very different from the epidemiological transitions in other states. And gets into the reasons why. Part two, out tomorrow, will look at the state’s response to these causal factors.
The driveway is lined with people who have travelled a long way to get to this charitable hospital in Patna. Families sit huddled, holding their bags close. The lobby is even more crowded, rather like the ticket buying hall of a train station. The hospital gets between 60 and 100 patients every day – a substantial number for a 400-bed hospital. Ashok Ghosh, who heads research at the hospital, said that the load is such that “surgery has a two-month waiting list even though the disease might become inoperable by then”.
One reason this hospital is receiving so many patients is the dismal state of public healthcare in Bihar. Government hospitals are understaffed and poorly equipped. While the state has seen a jump in the number of private hospitals, most of them are too expensive for middle income and poor families in the state. Most of them, Ghosh said, end up coming to Mahavir Cancer Sansthan.
But lack of affordable care is not the only reason. Tata Memorial Hospital in Mumbai, one of the best cancer treatment facilities in India, gets about 25,000 patients every year from around the country. In contrast, Mahavir Cancer Sansthan gets nearly as many at about 22,000 patients last year despite drawing patients from just Bihar, Uttar Pradesh and Nepal. Many of these patients suffer from cancers of the gall bladder or liver, both which are associated with arsenic toxicity.
This year’s EOTY (end of the year) bike ride started at Guwahati, Assam, and ended at Miao, Arunachal Pradesh. The route (Guwahati, Mangaldoi, Dekhiajuli, Pabhoi, Majuli, Sibasagar, the coaltown of Margarita, Miao, followed by a visit to Namdapha Tiger Reserve) stretched along the north bank of the Brahmaputra till the river island of Majuli and then crossed over to the south bank before entering Arunachal. Moving from west to east, Assam seemed to change from day to day. The profile of the local population gradually changed (from Bengali influences to Muslim dominated to Axomiya hindus to a greater tribal composition as one neared the Arunachal border). As did the houses, diets and local markets.
Some pictures. That snap you see on top left is the endangered Pygmy Hog. The beneficiary of what is described by my biologist friends as India’s only successful wildlife reintroduction programme. The two snaps below it were taken as we (three friends and me) pedalled towards Majuli. The snap of haystacks in the middle was taken on the second day — en route to Orang National Park. The snap on the top right? That is the sort of house we saw in the initial days — houses with attached fishponds.
The snap of a bridge, mustard fields and the setting sun? That was taken en route to the ferry for Majuli (which stars in the next snap). The two misty snaps were taken the next morning in Majuli as we cycled to catch a ferry from Majuli’s eastern bank. That was a morning to remember — us cycling on the fine sand of the Brahmaputra’s riverbed, with the mist swallowing up everything beyond 20 or so metres. The next snap, of my sand encrusted cycle, was taken after this ride.
That shack you see was a place where we breakfasted shortly after getting off the ferry. The gent wearing the adidas sweatshirt was running that eatery along with his wife. The two people below him? We met them, at another tea-stall, on the way out of Sibasagar. Ditto for the young man from Bihar selling cakes, puffs and pastries from his cart. Around here, the houses had changed. We saw fewer houses with ponds. Most houses had a canal running out in front with these cane bridges over them.
Then came Margarita. And that is where the next set of snaps — like that of the vegetable sellers, including the one with the coal mine in the background — were taken. Around here, the houses (and the profile of the local population) had changed yet again. And then, we entered Miao. The vertical snap you see was taken inside Namdapha Tiger Reserve. The rest were taken in local markets in this part of Arunachal — the first set of women are selling, among other things, local turmeric. Rs 10 for each page’s worth. In the snap to the right, you will see what looks like white cookies in plastic bags. That is yeast, using for making local rice beer called Loh-Paani.
In the final snap, the woman holding up that newspaper belongs to the Apatani tribe — look at the facial tattoos. She was eating jalebis when I took that snap. This, of course, is little more than a random sampling of snaps. That week of cycling left us with more impressions than what a quickly-written blogpost can handle.
PS: It was a good break. No email. The phone on DND. The brain caught a break from its usual ADD, spending hours at a stretch cycling or reading. Two notable books from this trip: Jon Prochnau on the adversarial reportage by David Halberstam, Neil Sheehan, Mal Browne and others during the early days of the American quagmire in Vietnam. And another on Aristotle’s staggeringly accurate (and sweeping) effort to make sense of life’s diversity on Earth.
PS: You will have to forgive me the multiple snaps of my cycle — my Surly Cross-Check is tough and beautiful. And I keep photographing it.
PS: And here is a blogpost on the trip by my fellow cyclist Vidya Athreya.
On November 9, life suddenly came to a standstill in Chikka Tirupathi, Bagalur and Hosur. As in the rest of India, the first day of demonetisation in these towns abutting the Karnataka-Tamil Nadu border was marked by problems in conducting day-to-day trading for small businesses and a frenzied hunt for Rs 100 notes for families.
The response to the government action was mixed on that first day. As the cash crunch sank in, small traders figured out that their businesses would take a hit until they replaced their Rs 500 and Rs 1,000 notes. Slightly larger enterprises, such as Jivita who runs a tailoring shop in Bagalur in Karnataka, were more optimistic. “We have enough money for rotation [working capital] for a week,” she said.
On the whole, it was a day of uncertainty. Notebandi was a sweeping decision. People weren’t sure how long it would take to exchange their old cash and for the situation to return to normal. At a branch of the Indian Bank in Bagalur, a bank official was calm. “We will open tomorrow morning,” he said. “People can come with their passbooks and exchange their notes.”
That is it. The last story of 2016. It has been a good year. Intense and packed with learning. Now to see what 2017 is like.
Happy new year, too. 🙂
This series has flagged a puzzling trend. State governments are struggling to use Aadhaar-based fingerprint authentication in ration shops. At the same time, a rising number of companies are integrating Aadhaar into their databases.
The answers vary depending on whom you ask. Former officials of the Unique Identification Authority of India, the government agency which issues Aadhaar numbers and manages the database, blame state governments and banks for poor execution of Aadhaar-based welfare delivery. State governments in turn blame banks and poor internet connectivity and the failures of biometrics-based technology.