By: Paritosh Chakma
The death of 19 persons due to malaria in one month (June-July 2008) in the Chakma dominated village of Marpara in western Mizoram is shockingly disturbing. More shocking is the fact that 15 of them were children. This is only the official figure of the deaths; the unofficial toll is higher. I have been informed that in neighboring Silsury, also a Chakma village under Mamit district, as many as 30-40 persons, if not more, died in June and July 2008 but there has been no official documentation of the deaths. Importantly again, the majority of the deaths were children.
These deaths are only the tip of the iceberg. The larger problem is that the entire western belt of Mizoram inhabited by the minority ethnic Chakmas does not have any semblance of healthcare system.
Yet, the state government does not seem to be at all concerned.
a. Deaths in election year
It seems lives in this part of the planet are considered so less valuable that even high number of unnatural deaths are not officially recorded or reported.
This is not the first time that such a high number of deaths have taken place in a Chakma village in a given year. But this is certainly the first time in the recent memory that the figure has been officially reported and accepted. Every year dozens of Chakmas die of malaria and other “unknown” diseases but get no attention from the government, let alone medical aid.
But 19 deaths in a village within a month in an election year have knocked the sleep off the Mizo National Front government which immediately dispatched a medical team to Marpara and Silsury to take the situation under control. The team reportedly tested blood samples and distributed medicines and mosquito nets. Although I hugely appreciate the wisdom of the Zoramthanga government to send a medical team, I ask - why do politicians act only in times of elections? The mosquito nets and malaria pills were very much necessary throughout the whole year, in particular during the monsoon, but the authorities distributed them to the poor people only after some deaths have been reported. Is it merely a face saving formula and not a genuine effort to contain malaria, the most dreaded disease in the state?
b. Absence of healthcare facilities in Chakma areas
Any genuine effort to combat malaria, or for that matter any other disease, must be holistic. Ad hoc and temporary medical teams are not sufficient to meet the challenges created due to absolute vacuum of healthcare services in the entire western belt of the state. For decades, the healthcare system in the Chakma areas in the western belt has been neglected.
Although Mizoram is one of the 18 “high focus states” in the National Rural Health Mission (2005-2012), the basic healthcare facility is yet to reach the Chakma areas of Mizoram. The goal of the NRHM “to improve the availability of and access to quality healthcare by people, especially for those residing in rural areas, the poor, women and children” is still an unrealistic dream for the entire Chakma population. Forget about the “availability of and access to quality healthcare”, the Chakma villagers are not fortunate even to know the name of the disease which took away the lives of their beloved. While malaria is a household name, other deaths are often attributed to “unknown” diseases. In this age of advanced medical sciences, Chakmas of Mizoram still live in Dark Ages.
The apathy of the state government towards the welfare of the Chakmas has been the single most important factor responsible for this pathetic state of affairs.
188 km away from Aizawl, Marpara villages (I and II) have a combined population of about 2,500. Yet, there is only one Primary Health Centre – that too very ill equipped – to cater to the medical needs of the people of Marpara North and South villages and other neighboring villages like Tarabonye, Hruiduk, and Hnahva. In the PHC, there is no MBBS doctor and the wellbeing of the villagers is being looked after by a Chakma health worker who the villagers know as the “doctor”. Similarly, the Sub Centre in Silsury village (having a population of over 1,000) is being manned by a Chakma health worker. The Sub Centre is in shambles and the Mizo staffs posted in the Sub Centre have taken transfer to elsewhere.
Yet, Marpara and Silsury which are considerably large in size and populations are rated among the best of the Chakma villages in the western belt in terms of access to medical facilities and medicines. If such are the conditions of these two “best” villages, one can imagine the conditions of the other Chakma villages.
In the 21st century the lives of the Chakmas of Mizoram continue to fragilely lie at the mercy of the self trained medics and traditional herbal “doctors” (“Boddyo” in Chakma tongue) who apply their great intuition rather than medical expertise while attending a patient. Despite their lack of sufficient medical skills, these self trained medics have played critical roles in saving a number of precious lives.
In the doomed land of the Chakmas – the western belt of Mizoram – the villagers wait for Death in the absence of medical facilities and doctors. The visuals are still vivid in my mind when one day I visited a seriously sick child (aged about 4 years) in a Chakma village where there is not a single doctor. Many Boddyos (Chakma herbal doctors) were called to save the child but nothing helped. I never felt so helpless in my life as we all waited for the child to die. How we wished there were roads and cars in the village so that we immediately shifted the child to a hospital in Aizawl. In the towns and cities even a minute is crucial to save a life. But in the Chakma hinterland in Mizoram, people just wait for Death, helplessly.
It seems as if we live somewhere in the dense jungles of Africa and not in a rising nation like India. It’s an utter shame!
Yet I am surprised to see a government data of March 2007 which stated that Mizoram had 366 Sub Centres against the required 146; 57 Primary Health Centres against required 22; and 9 Community Health Centres against required 5 in the state! The same data points out that there were 39 doctors at PHCs against required 57 (that is shortfall of 18), there were 303 Heath Workers against required 366 (that is shortfall of 63); but surprisingly no shortfall of Health Assistants (both male and female).
If there is no shortfall, then why there is no medical staffs (health assistants) in Chakma villages, say in Silsury village which has only a health worker at the Sub Centre looking after for over 1,000 villagers?
If there are more than required Sub Centres, as the government has claimed, why is that there is no Sub Centre in Chakma villages including Tarabonye, Hnahva and Hruiduk under Mamit district?
c. Chakmas - victims of state apathy
That the Chakmas have been victims of state apathy is beyond doubt. But whenever the Chakmas level charges of discrimination, denial and apathy against the state government, Aizawl tends to dismiss those charges by giving the impression that they are enjoying self rule under the Chakma Autonomous District Council (CADC) in Lawngtlai district and hence the state government is not to be blamed for their miserable socio-economic and health conditions. But Aizawl will never stress the fact that out of total of about 100,000 Chakmas, about 50% live in areas (particularly under Lunglei and Mamit districts) falling outside the jurisdiction of CADC and they are the most discriminated lot. They are the poorest and most illiterate. Majority of the Chakmas living outside the CADC live in tattered bamboo houses. Their living conditions are shabby and unhygienic which make them most vulnerable to diseases.
In absence of health centres/medical staff in the rural areas, the poor who cannot go to Aizawl for treatment are most likely to die if the self trained medics and Chakma “Boddyos” raise their hands in surrender. It is nothing sort of miracle that some still survive.
The situation is more aggravated due to lack of proper transport system connecting the villages to hospitals.
Yet still, the Chakmas continue to be at the mercy of a section of the hardliners in the society who scrupulously try to block roads to meet their political ends. In the first week of April 2008, there was a blockade against the Chakmas of Marpara, Silsury, Hnahva, Hruiduk and Tarabonye at Mizo village Pukzing by the Pukzing villagers who were protesting against some old demarcation of village boundaries. While the fight ought to have been against the government which is responsible for official demarcation of village council boundaries, the Mizos of Pukzing chose to vent their ire on the most vulnerable – the Chakmas. The blockade called “the Chakma blockade” was intended to be “indefinite” but the protestors were forced by the district officials to withdraw after the second day as it was illegal and immoral. The socalled blockade was informed only through the press but since newspapers do not reach the Chakma villages, the Chakmas were caught unawares. On the first day of the blockade, no Chakma was allowed to pass through Pukzing, the only point of transit for the Chakma villagers to the outside world. The Chakmas traveling on the Mizoram State Transport bus from Marpara to Aizawl were forced to get off and threatened with violence if they did not return home. Despite repeated pleas, even the ailing Chakmas, old men, and pregnant women were not allowed to go with the bus but had to walk on foot back to Marpara which is more than 20 kms away from Pukzing.
The Chakmas faced all the problems for no fault of theirs but authorities failed to take any action against those responsible for imposing a blockade against a minority community which is “racial, communal, illegal and unconstitutional”. The incident was unprecedented and will remain a blot in the social history of Mizoram.
d. Final words
The government of Mizoram cannot remain a blind or silent spectator to the problems facing the minority Chakmas. The Chakmas’ right to enjoy “the highest attainable standards of physical and mental health”, among others, must be ensured as best as possible.
Aizawl must not act only in times of elections but every time and all the time to ensure that not a single precious live is lost due to curable diseases or during child birth. Apart from sending regular medical teams to the rural areas, the state government must put in place permanent structures – health centres, doctors and adequate and regular supply of essential quality drugs must be ensured in every village.
As a short term and effective measure, the government of Mizoram can identify the self trained medics (who otherwise do not have academic qualification to practice medicine) and provide them necessary training and facilities at the expense of the public exchequer to enhance their medical knowledge and expertise to deal with the most common diseases in the rural areas such as malaria, typhoid, jaundice etc. This is the best immediate step the state government can take in the absence of doctors, health centres and medical staff in the rural areas.
However, the long term approaches should be to facilitate Chakma students from Mizoram who aspire to pursue medical courses by providing them financial assistance including scholarships.
Making all government doctors compulsorily serve in rural areas, including Chakma areas for at least five years each is also not a bad idea. This could help overcome the lack of doctors in remote rural areas.