Project SaveMom, as part of its process of delivering quality maternal and fetal care during the First 1000 days, tries to understand the health conditions of the people of the region and the quality of pregnancy journey vis-a-vis the WHO standards. The blog is an interview with a local doctor, Dr. Ajithakumari, to understand the pregnancy journey of a Paniya Tribal community at Vellaramkunnu.
WHO reports that an estimated 303, 000 women died from pregnancy related causes, 2.7 million babies died during the first 28 days of life and 2.6 million babies were stillborn. What is the rate of maternal mortality, maternal morbidity, and infant mortality among tribal community of this region?
Vellaramkunnu is home to Paniya Adivasis. The community had a nutritious lifestyle with an efficient healthcare system, midwives, and medicinal herbs. Sadly, with the industrialization, deforestation and uphill migration the community has lost its rich heritage and has been pushed to the margins. They are poor lacking awareness, skills and resources for a healthy and decent lifestyle. As far as pregnancy is concerned, there are only a few midwives who administer home delivery. Most of them, therefore visit government primary health care centres (henceforth PHCs) for delivery. Maternal mortality, morbidity and infant mortality is still an issue that needs to addressed in this region, I won’t be able to give you an exact number. We can gather it from the Sub-Primary Health Care Centre at Mananthavaady.
WHO recommends that the pregnant mothers receive a minimum of 8 antenatal visits with a first contact before 12 weeks’ of gestation. Do these women go to hospitals during pregnancy? Do they meet WHO Standards?
“WHO standards”, I don’t think they meet. They go to government hospitals or visit AmritaKripa hospital if there are any health complications during pregnancy. Since local government health care centres do not attend to complications during delivery, if there was no record of visit earlier, they make it a point to visit government primary health care centres. A few of them, visit AmritaKripa Hospital, we recommend them also to visit government healthcare centres or a handful I get to meet them during my visit to these regions. But, according to my knowledge, there are no systematic ‘antenatal care programme’ offered to pregnant women of this region as per WHO standards. I believe therefore 90% of the pregnant women would visit government PHCs at least once before their delivery.
WHO recommends that the pregnant mothers receive Iron-Folic acid tablets and Nutritious diet which enriches their energy, protein, and calcium levels. What is their health condition? Do they take Iron and Folic acid supplements?
About their health condition, I should be frank that they have lost their healthy robust physical condition which their ancestors possessed, due to a change in their life-style and access to food resources. They used to eat what they cultivate at home and were surrounded by healthy herbs and fruits. Now, things have changed. Neither do they possess land, hence no cultivation, nor are they surrounded by edible flora. So there is a drastic downward spiral in their health condition. A good number of them suffer from Anemia and other health complications. The entire fold is malnourished. The most vulnerable are the women and the children especially the newborn.
About Iron and Folic Acid supplements, they have an access to these tablets. I give them if they contact me during my visits to this place. They would also get them from government PHCs but they know very little about its importance. Hence even if they get it, it is as good as not having it at home. They are not to be blamed because for generations they have lived healthy and had normal delivery without any of these. So, even if they are badly in need of these supplements, the traditional mindset prevents any such intakes. We might have to build inculcate the culture of a regular intake these supplements.
WHO recommends that we assess the pregnant women’s health complications, unhealthy habits (alcohol/tobacco use etc.), and external conditions that could cause adverse effects during pregnancy. Do these women smoke or drink? What about intimate partner violence in this region?
The women of Paniya tribe do not generally smoke or drink but are heavily addicted to chewing tobacco. Chewing tobacco is a major problem with almost 95% of the pregnant women in this community. There is a also heavy caffeine intake. Generally, the Paniya community is matriarchal and there were supposed to have lead a peaceful family life. Now, with the spread of alcoholism and the influence of media, intimate partner violence is emerging as a concern among them.
During the First 1000 days, every child is entitled for a FairStart. Do children in these regions meet their developmental potential? Can you give us an idea about the state of global challenges like stunting, breastfeeding, obesity, acute malnutrition, low-birthweight, and anaemia in this region?
Generally, the community is undernourished. They suffer from malnutrition. Obesity is not a problem here. Breastfeeding is a common-practice but the problem is the low nutrition levels of the mother’s milk. In these regions, generally children’s birthweight is normal but as they grow there is a record of wasting. Stunting, therefore, is prevalent in this region.
About Dr. Ajithakumari
Dr. Ajithakumari a devotee of Mata Amritanandamayi Devi and a qualified physician, has been serving more than 12 years in Amrita’s mission to provide quality health care for the poor. In the past decade, she along with her husband Dr. Sanjeev Vasudevan has been serving as medical officers at AmritaKripa Hospital which is located at Kainatty, Kalpetta in the national highways of Bangalore-Calicut, Kerala. In the hospital, the couple along with a handful of nurses cater to nearly 200 patients a day and visit remote villages on a regular interval setting up make-shift clinics for the poor and tribal communities of the region. During our visit to Vellaramkunnu, the SaveMom team was inspired by the dedication and devotion of the couple to ‘Amrita’s Health Mission’.
We interviewed Dr. Ajithakumari to better understand the health eco-system of Vellaramkunnu and the tribal community that lives in its surroundings. While she responded to most of the questions from her experience, she quickly consulted local people around, for a few of them, to verify if her opinions and views were correct.